All Things Private Practice Podcast for Therapists

Episode 72: Is There a "Right Way" to Do Private Practice? [featuring Tara Holmquist]

Show Notes

Therapists starting private practice often get hit with a lot of self-doubt and end up second-guessing many of the decisions they make.

Grad school doesn't prepare us to build a business, so when we decide to go into private practice, everyone seems to give different advice and have different values around what's ethical, how you should handle money, what is and isn't okay when providing client care, etc.

It can feel really overwhelming when there are so many voices saying how private practice should be done.

In this episode, I talk with Tara Holmquist, psychologist and moderator of the All Things Private Practice Facebook Group.

Top 3 reasons to listen to the entire episode:

  1. Understand the many ways you can do therapy and run a private practice.
  2. Get answers to some of the most common questions about private practice startup that show up on the All Things Private Practice Facebook Group.
  3. Learn how to align your private practice with your values to thrive and help clients as your authentic self.

There are so many ways to structure your private practice. Different clients have different needs, so don't be afraid to step outside the box and make your private practice your own. If you operate from a place of authenticity and align your private practice with your values, you, your business, and your clients will be more likely to thrive.

More about Tara:

Tara is a clinical psychologist licensed in CA and WI. She has been in private practice for about 5 years working with adults with relational/attachment trauma, as well as addiction/substance use. Her practice is exclusively telehealth, and her practice values include a heavy examination and challenge of implicit biases, internalized capitalism, and patriarchal leanings. Her practice is trauma and social justice informed. And she's a pretty cool regular human too.

Tara's Website:

DM Tara on Facebook: Send messages to Tara Michelle.


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PATRICK CASALE: Hey everyone, you are listening to another episode of the All Things Private Practice Podcast. I'm your host, Patrick Casale, joined today by my good friend and colleague, Tara Holmquist. And she is in Wisconsin, a practicing psychologist out of California. And today we are going to talk a little bit about doing things differently in private practice and private practice startup, because we both moderate the All Things Private Practice Facebook group, we get a lot of questions, and we just kind of want to talk about some of the things that often come up. 

So, Tara, thanks again for being on, again, and happy to see your face. And I know it's freezing up there. It's freezing down here. So, let's get it started.

TARA HOLMQUIST: Nice and warm. Thanks for having me, again. Always happy to be here.

PATRICK CASALE: Yes, of course. So, Tara and I moderate All Things Private Practice. It's a therapy Facebook group for people who are in private practice or thinking about going into private practice. And the group has grown exponentially over the last year and a half. We're almost at 7000 members now. And it's growing all the time. And we see a lot of consistent themes and questions. 

And one thing that we, you know, talk about while moderating is some of the conversations that are going on, just to make sure things are running smoothly, and people are treating each other respectfully. There is a lot of second-guessing and self-doubt in practice startup, there's a lot of second-guessing and self-doubt in our profession. And I think the two go hand in hand. And I know you really wanted to talk about doing things differently. And I think this is the perfect place to do that. So, take it away.

TARA HOLMQUIST: Yeah, I mean, you introduced it, exactly what I was thinking is that you know, you and I talk to a lot of sort of people wanting to do things the right way. And their right way is sort of maybe what they've been taught in grad school or maybe what they've seen, you know, other practitioners doing. 

And I noticed that a lot of people, you know, message me and be like, "I was thinking about doing this. But I really like the idea that you're doing this over here and it's so different. How did you manage that? How did you figure out, you know, that this is okay to do?" And I don't know, it leads to a lot of conversations, I think, around like, really digging in, and questioning, and challenging where you learn to do your right thing. 

And I don't know, I think, you know, I have to remember that when you're starting off as a brand new clinician, you're starting off in private practice, none of us know how to do this, none of us have learned how to do this at all, we just know that we don't want to be in community mental health, you don't want to be in, you know, these oppressive systems that are not helping us. And so, we kind of go into, like, let me just go and be on my own. And let me just, like, be my own boss, and have my own hours, and be flexible, and have this freedom, and you know, the ability to make our own money. And I think we just stop there sometimes. And then go, "Okay, that sounds wonderful. But how do we do that?" 

And that's when I noticed, I think, a lot of the messages start coming in to me of like, "Well, this is what I want, and how the hell do I get there, because what they're teaching us in grad school, or you know, what I'm seeing ahead of me just isn't matching up. And it doesn't align with this, like freedom that I'm looking for, or this, like flexibility that I'm looking for." Or just kind of aligning with your own personal values around, you know, how you want to run your practice or how you want to view the world or engage in it. That gets a little tough there.

PATRICK CASALE: Yeah, well said. There's a lot of nuance, there's a lot of complexity to this. And I think what Tara is saying too, I want to really go deeper is, she's talking about deeper level meaning within business ownership, not simply the overthinking analysis paralysis of which electronic medical record system should I use, and I've done a trial run of 63. And I've narrowed it down to 60. And I know some of you out there have done that because I get those messages. She's talking about how do we create a business structure that works for me? And that is very complicated, because, like you alluded to, you don't know what you don't know, grad school is not teaching you how to be a business owner. We are constantly concerned about, you know, the word unethical being thrown around in terms of our own practicing and our own policies. And I think as therapists a lot of us are… there's a different level of insecurity, it seems like and there's also a different level of, you know, concern and introspection. So, there's all this complication.

And it leads to this overthinking when it comes to simply how do I want my business to look, and run, and operate? And how do I create something that is in alignment with who I am as a human, because just like we talk about your niche needing to be in alignment, and your content creation, and your policies, your business model needs to be in alignment with you. Otherwise, things feel fragmented, and disjointed, and gross at times if you're enforcing things you don't want to be enforcing or vice versa. 

And then, where do we turn when we're feeling this way? To the all-powerful social media, where you're throwing things out there, but you're not realizing like, you're about to get 100 responses and every single person is going to tell you to do something differently, which leads to more paralysis, and more second-guessing, and more fearfulness, and more insecurity.

And then, how do you determine what does make sense for me? And how do I move into a space where maybe I am doing things differently? And I think you're alluding to when people are messaging about how are you doing things about your pay-what-you-can model comparatively to like flat fee for service model, and cancellation policies, and stuff that you've talked about on the podcast before. So, what's the answer to this when we are thinking about all the nuance?

TARA HOLMQUIST: It's exactly right. That's a great question, you know? And I think, you know, we're reaching out to our colleagues in social media to try to sort of assuage the anxiety around not knowing. And I mean, what do we do when we don't know? Is we try to seek and we don't even know where to look. 

And I think, for me, personally, I will say that over the years I've done the exact same thing, you know, and I'm like, "All right, you know, this is what my friends and colleagues who are successful have done. Like, let me try this too. How come it doesn't feel good. Like, what's going on here around this?" Like, "Actually, it's not making my anxiety, you know, decrease at all, or anything, you know, what's happening here?"

So, I've found that personally, for me, it's really kind of doing a deep dive into, like, who I am as a person and what my values are, because the biggest thing that has helped me feel successful and feel proud of the model, and the business that I've created is how closely it is aligned with my values, and how I want to engage in this world, right? 

And of course, you're still keeping an alignment with your actual ethics code and actual legalities around this. And I think it's also important to know, let your ethics actually state, you know, what does it actually mean by do no harm? What does it actually mean, you know, when it says, you know, no client abandonment if they're not paying for their fees or whatever that is, you know? And to really understand what that means and how that can align with how you want to practice. 

So, yeah, you brought up pay-what-you-can, you know, and I've talked about this before in episodes, so I'll just briefly say it, but for me, you know, I work with a lot of marginalized people. I'm a trauma therapist, so I work with a lot of trauma. And I work with a lot of ranges, and different folks from different socio-economic statuses, different, you know, parts of the country, you know, and different parts like this. 

And so, when I came up with how I want to charge people for their services, I really worked hard to take money out of the forefront of the conversation. It does not center our conversation, because I do feel like in our society, right, we're in capitalism, we are participants in capitalism. And that is how we're trained, right? Is at the forefront of running a successful business is, you know, making as much money as possible, or, you know, making enough money to, you know, do whatever you want with it, which is great. And I agree with that. I absolutely do. And how do we then access our clients? And how do we then help them also feel successful in the world. You know, how can we contribute to, you know, them feeling like they're gaining the same things that we're gaining in this world and we're doing well together? 

So, I guess to kind of like, sum up in a nutshell, which is not my forte, and I don't do well, it is, I looked at how I want to serve my clients and how I would like to show up in this world. And for me, showing up in this world is taking care of my community, you know, providing as much access as possible, and finding ways in which power in the room, that inherent power imbalance in the room is just completely taken away, because I don't believe in having power over other people. So, then how can I create a practice where we're all making this sort of collaborative decisions that the client is in charge of their therapy, the client is in charge of, you know, how they want it to go, how much they want to pay, how long they want to stay in therapy, so that they're empowered too. 

So, I'm not taking away my power, but I'm empowering them so that we're kind of practicing all together, which is very different from what we're taught about starting a practice and a business if we want to be successful. It's just been the opposite for me. Doing it my way has actually made me a lot more successful in all ways than doing it in a way that I feel like I'm supposed to be doing it, because everyone else is doing it. 

PATRICK CASALE: That's well said. And I think that probably feels really energizing and there's more passion behind the work. And, you know, to play devil's advocate here, for those who are listening, Tara's model is not my model. But Tara's values and my values are very similar, but she is, you know, very strongly centered in that philosophy. And it really makes sense for her business. 

I don't give a shit if you charge cancellations or don't. But the fact of the matter is regardless of what you decide to do with your business, why does it matter what somebody else is doing with their business? And we so often get wrapped up in that, we let that influence our decision-making. And then when it starts to feel out of alignment or misaligned, we start to question ourselves as business owners and in reality, it's like, well, maybe you're just not running the business in a way that suits you. And why are you relying upon information from a source where if they differ from what your values are, or your opinions are, you all of a sudden now second guess every decision you've ever made, because they're doing things differently. 

And I think there's so much room in this to say, like, however you want to run your business, you can run your business. Like, I run my group practice very differently than a lot of group practice owners, where I prioritize people over profit, and I have group practice owners DM me all the time asking me, "How do you pay your client or your therapist X amount? How do you offer X amount of things." And I'm like, "I don't really need to make that much money out of this group practice. That's not the priority here. That's not why I started it. It was because I knew we needed to serve more people. I've always been a good leader, I just felt like it was something that was on the next step for me to do. And I thoroughly enjoy having the staff that I have. 

However, if you're operating from a different model, where you are paying your employees less, it's not my place to judge you for your business model. But you have to be okay with your decisions that you're making, which also leads to repercussions from the decisions that you're making, too. You might have more turnover, you might have a harder time finding applicants, et cetera, et cetera, et cetera." And those things just sometimes go hand in hand.

Now, we get these DMS often, because I think we are so concerned about perception and getting it right. And I want to know, like, how to define what getting it right is in a private practice. In my opinion, and this may feel really simplistic, is getting it right is showing up, seeing your clients in a way that does no harm. And just making sure that you're taking care of yourself too, because if you're not and you're burnt out all the time, you're not doing good clinical work. And that for me is getting it right. 

Now, we can go down the ethical guidelines, and you know, we're not going to do that today. There are obviously things that are pretty black and white. But there's a lot of gray area too, because we're working with human beings, we're working with their mental health, we're working in relationship, we're working with their attachment systems. I mean, it's really important to start asking yourself the whys, the driving questions, the values behind your business, because otherwise, you're kind of letting someone else dictate that for you. And that's never going to feel good. It's never going to feel good when you say, "I set my policies up this way, because this person said this on a podcast, or a Facebook group, or whatever, but it doesn't really align with my values. And it feels gross every time I have to do A, B, and C." 

And then that causes rupture in relationship A, B, and C. And it's just really challenging to move through the day when you're feeling like these things just really aren't my ideas, or my values, or kind of my ethics, or my morals.

TARA HOLMQUIST: You said it perfectly, that's exactly it. And I will say that the vast majority of DMs that I get asking questions about whatever, my answer is 90% of the time, "What do you want do? What feels good for you, you know? You are allowed to choose all of this. How do you want to find flexibility and financial freedom? How do you want to show up in your practice, you know?" 

And to be honest, I don't usually answer the question right off the bat, you know, "Hey, how do you set up a pay-what-you-can model." My consults are not about how to set up the pay-what-you-can model until we've had a discussion about what they imagine it to be, what a person imagines it to be, and why they think this will be beneficial for them, you know?

And so, you said it perfectly, it's not about serving and appeasing somebody else, or looking good for somebody else, or whatever that is. It's about what feels good for you. And what lights you up and energizes you to keep wanting to do this in a way that, you know, feels successful in all ways for you. 

You know, every time I make a different decision in my practice, because it literally evolves every single month, even, every time I make a different decision and try something out, and see that it works or it doesn't work, like, I get so energized and so excited, because it's aligning exactly with what I imagined it could be even outside of what I thought it should be and what it was five years ago, six years ago, when I started

PATRICK CASALE: There you go. And it's going to evolve from here, too.

TARA HOLMQUIST: Absolutely. 

PATRICK CASALE: You know, just scratching the surface on what this can look like for you. I know, just knowing you over the last year, there's been a lot of transformation and a lot more clarity around, what does my business mean to me? What do I want it to look like? How do I want it to operate? 

And I imagine, over the next couple of years that will continue to happen. And you'll continue to parse that out. And all of you will. This is not a finish line type process of like, okay, I started my practice, now, that's it. Like, nothing ever changes, nothing evolves. I mean, it should be a live document, it should be a live template, and it should be malleable. And you should be able to make decisions, and then come back to them and say, "You know what, that's not really working for me anymore." Or, "This is working, let me do more of X, Y, and Z."

And I don't give a shit if you're listening, and you want to have an entire caseload of sliding scale, or you only want to have four, or you don't want to have any. Like, I don't care, it's not my place to tell you what to do. And you'll get this information in Facebook groups. And as a moderator of one, I watch the comments, and I watch the interactions, and it's just that we're operating a lot of this mindset of like, if you do this, you will taint the profession, or you will lessen the profession's value, or you will do A, B, and C. And in reality, no the fuck you won't, because there are so many people out there looking for therapy, that doing your own thing is not going to change how that is done. 

When you have these big tech firms, and I'm not going to name them, because I don't feel like getting sued, who are doing things purely unethically, and who do not have client or mental health therapist's best interest at mind, that is what is going to impact the profession. It's not Tara who's doing pay-what-you-can, or so and so who only has sliding scale or someone who only has private pay clients. Like, none of these have impact on the profession except your own community and your own client base. And that is it. 

It's important to ask for feedback, it's important to ask for suggestions, because like without them, a lot of us are floundering, a lot of us don't have the training in business, a lot of us don't know how to start a practice. You get these checklists off these groups and you get these worksheets and you go from there. But you also have to think for yourself. And you have to constantly come back to your why. Your why is really important in all of this, it is so, so important, because that's what is going to be empowering for you when you get to go to your office or your telehealth office, and turn your lights on, and decorate it the way you want, and say your schedule the way you want, the reason we all do these things. 

But if it doesn't feel like it's congruent with your values and in alignment, it is not going to feel good for you and you are going to have recreated your agency job environment that you left for a reason in the first place. 

TARA HOLMQUIST: Yes, yes, that's exactly right. And you nailed it when you said you have to go back to your why. And I think even further than that, you have to be clear on what your why is, you know? I mean, I think many of us, I did, you know when I first started, I didn't even want to start a private practice when I did start my private practice. And I was up against these awful options. And so, I was like, "Okay, I'll just give it a shot." You know?

And then I built a practice based on being afraid of the other option or really not wanting the other option, which was a gnarly group practice that was going to work me to the bone. And it was like, one or the other, you know? And so, I started that practice, my practice now, based on what I didn't want to experience over there, but had no idea of how to start it. So, I did. It was very much on, like, this scarcity mindset, very much on, I just want to go on my own a little bit, but I had no concept of what my why was, what I wanted it to look like, what felt good for me until I started to… 

You know, I was actually very financially successful, I had employees, you know, I had made more money than I've ever made in my life, the first two years of the private practice, but I was very burnt out, and I was very anxious, and grumpy all the time, and just like, "This is really hard." The admin staff felt hard, managing people felt hard, and it shouldn't have, because that's a natural ability for me, is to be with people and build relationship with people. And yet, you know, constantly wondering why this was so hard.

Once I started reflecting on that, it is, oh, because I'm running this business the way that my mentor runs her business. And her and my values do not align at all. She was great at teaching me how to build this business, and how to do it, and how to make a lot of money. And it was completely opposite from what felt good for me internally. 

And so, when I started to shift that and go, you know what? Just stop and like, spend some time really trying to understand who I want to be in this world and how I want to run the practice. And that was the most empowering thing for me.

So, Patrick, you're absolutely right where, when I start to find that I'm like, anxious or stressed out, or I feeling like I'm making their decisions, or like, I don't have a handle on the business, I go right back to the why and go, "Am I doing what I intended to do from the get-go here?" And how can I do this better moving forward? How can I align with this even more? How can I bring this, you know, into fruition even more so than I did last month, last year, you know, and so on?

So, it's absolutely right. I think that always needs to be at your forefront. And you always need to be going back to it and having a relationship with your why, and going, you know, is the serving anymore? And being okay when that why changes, because it is going to and it should. You know it should evolve, and it should encompass, you know, so much more as you gain experience in running a business. 

PATRICK CASALE: Yeah, that's really well said. And, you know, I think so many of us are in reactionary mode of like, "I've just got to get out." And you don't really take the time to reflect or have that introspective process of why am I doing what I'm doing other than I know I don't want to be doing this other thing. And that's fine, because that's kind of like survival 101. But that doesn't suit you long term. That's very much a short-term reaction. 

"I can't work in this environment anymore, I need to get out and start my own thing for all these reasons." And then you start to figure out, okay, now what? It would be great if as you're moving out of this space of like, you know, a shitty agency job or shitty group practice, or whatever. And you're also simultaneously asking yourself, why am I doing this? Because if the solution and the answer is, I just don't want to do this anymore, I don't think that lends itself to long-term sustained success in this career. And we can define success in all sorts of ways. But really, what I mean by success is the opposite of burnout. And if we're questioning, and we're reflecting, and we're listing, and we're kind of having that introspection, and that internal process of, what do I want this to look like this year? In three years? In five? How do I want this to evolve? What's working for me? What's not? What policies do I enjoy? What do I not? 

And that's the same thing with revisiting your niche, that's the same thing with revisiting your website, your content. Like, all of this stuff should be revisited and reflected on pretty consistently. It doesn't mean you have to do it as a daily practice. But I would challenge all of you listening to create that list. Your why, why am I in business for myself? Why do I want to go into business for myself? What do I want this to look like? Who do I want to serve? Who do I want to support and why? It's really important because then you can always go back to it and find your footing and find your grounding in that decision. And you can say to yourself when that imposter syndrome comes up and you're questioning, "Ooh, I want to try this new thing, but nobody else is doing it." 

If it feels like it's in alignment, you will be able to tell that imposter syndrome to shut the fuck up and move to the side, because you will be fully grounded and rooted in that decision based on your own values, which is really, really powerful, really empowering and really, really important.

TARA HOLMQUIST: Very, very much so. And I think, Patrick, you and I have been around enough therapists and interfaced with enough therapists to know just the survival of like, "I got to get out." Has never been successful. Like, if that's the only thing, it's never been successful with everybody that we've talked to, and anybody that we've just watched on social media, or any of those things. 

And, you know, it's funny, I was listening to you talk and like the trauma, therapists came in me of like, "Oh, yeah, if we're operating in a survival mode, we're reactionary, right? We're either going to be fight, flight, or freeze, right? Or fun, right?" So, we're either going to be fighting against what, you know, your group practice, or your CMH, your agency, whatever, did. We're going to be fighting against that, so we're just going to haphazardly, we're just doing the opposite of what they want to do, and whatever."

And it comes off very aggressive, and it comes off very, I don't know, disorganized, and just not thought out. If we're running from our agency work, and we just need to get out, and we're in flight mode, you know, then we're just running and we don't even know what we're running to. And [CROSSTALK 00:26:336].

PATRICK CASALE: Probably just send a real shitty email to your awesome boss and tell him you know, what else? I'm out.

TARA HOLMQUIST: Yep, peace. See you later, you know? 100%. And the same is if we're in frozen, or in survival mode, and we're freezing, then we're doing what I was doing the first couple years of private practice, and just spinning my wheels, and going, I'm not moving, I'm not progressing, and I'm not doing anything, and I'm so paralyzed with this. So, whatever's happening is what's going to stay happening. And you know, what do we-

PATRICK CASALE: We also bury our head in the sand, if that's the case, right? That's when like, the things start to pile up that you're neglecting that you should be paying attention to, because it feels too overwhelming to handle or to tackle. It's like, oh, the insurance claims I haven't filed, or the notes I haven't done, or like, the things that start to really, really wear you down when you're like, this is the stuff that I don't want to be spending energy on. But I neglected it, because I'm in this state, because I am making these decisions out of reactionary mode.

TARA HOLMQUIST: That's exactly it. We're in survival and trying to keep our heads above water. And I can't be treading water if I'm submitting claims and trying to figure out admin stuff and all of those things. So, I'm just going to do nothing, and just keep myself above water, and I'm tiring myself out, anyways. That's exactly right. 

And, you know, to think about what do we need when we need to get ourselves out of survival mode, right? Well, we need support and community, which is why we run the group that we run, you know, we need to feel safe, you know, in our decisions that we're making. And so, in order for us to feel safe, and assured in the decisions that we're making, yeah, we need to be aligning with like, what feels good for us. And we can only know what feels good for us by checking in with ourselves and saying, okay, like, I'm making this decision, I'm having a late cancellation and no-show policy, and I'm going to do this. Why am I doing this? What will this serve? And what need will this meet for me? I'm setting my fees to be this, why am I doing this? 

And I think it's really important to be able to answer that question for every single decision that you make in your practice, every policy that you create, every procedure, and everything. You need to be able to say, yeah, this is why I'm doing this because of this, and then feel good about that. And I guess if you're answering the question, because I don't know that is what we do, you just have a late policy, you just have a no-show policy, then you're going to feel really bad every single time a client no-shows on you or like cancels, because they're sick or whatever.

PATRICK CASALE: What's going to happen, just to further that point, is every time a client cancels you probably wouldn't have discussed your policy with them. And sometimes you're going to ask the Facebook group, "What should I do?" And people are going to say, "Charge that client immediately, that's your policy." You're going to charge that client. They're going to say, "Why did you charge me, you never talked to me about this?" And that's going to create some internalized guilt and shame, because it's going to say, "Damn, I didn't talk to them about this. This was my policy. I didn't feel comfortable enforcing it, so I didn't feel comfortable talking about it."

And for me, even though we do have a cancellation policy, I will not allow my clinicians to charge their clients if they text me and say, "Hey, so and so canceled, what's our no-show policy?" I'm like, "Well, you're not going to charge them then because you haven't gone over it." And if you haven't gone over it, then it doesn't feel appropriate for you to charge them. It will feel like you're blindsiding them. Now's a good opportunity to discuss the policy, now's a good opportunity to ask them if they have any questions.

But you have to be okay with the policies that you have in place. And you have to be able to answer, like Tara said, why am I creating this policy? And listen, a lot of us, myself included, and a lot of you who are listening left your agency jobs out of sheer trauma response and panic response. And I did myself as well. And it did not serve me. 

The first year of my private practice felt disorganized, it felt chaotic, it felt like I didn't know what I was doing 99% of the time, and not just I didn't know what I was doing. But more like, I really don't know policy left from right, or what the hell's happening. And it really does take some introspection, and some reflection, and the ability to just take a step back, and press pause, and just ask yourself that question. 

And I really empower all of you who are listening to do that for yourselves, to ask yourself these questions, so that you can start off the new year going into 2023 or throughout 2023, and really just have a different perspective on how you're going to run things, whether you're going to do walk and talk therapy, or you're going to do pay-what-you-can, or you're going to do, you know cutting edge A, B, C, D, and E, it doesn't matter. But really try hard to take that step back and do some reflection, to try to figure out how to make sure that your business is in alignment with your values. Because if not, it's just going to feel like a grind. And I don't think any of us leave our situations that already feel like a grind, and feel oppressive, and feel like we don't have enough time to breathe, we don't have enough, you know, resource A, B, and C, we don't have enough support to recreate that environment all over again. 

And we do that when we are not operating in congruence with our values. And from, you know, just as a friend and a colleague, you know, watching you do what you're doing right now, I'm really proud of you. And it's really cool to see people show up and really take a stand of, this is how I want things to operate, and this is why I believe they should, and this is how I'm going to help empower other people do the same things.

TARA HOLMQUIST: I think, too, one thing that's important to consider that we've kind of been talking about this whole time, and to remind us that we're all therapists here, right? So, we might not have learned how to run businesses, but we are literally in the business of people and relationships, right? And so, to remember, you know, that we have a relationship with our clients, right? They're human beings. And so, when you're thinking about what types of practices you want, how you want to run it, what kind of policies you want to have, and things like that, like, you can involve clients, even if you're not actually talking with them. Remember what it's like to be on the other side of that, you know? Is this policy that's going to serve them, is it going to serve me? And it really doesn't matter what your answer is, it really doesn't matter what you come up with as long as you feel good about that, knowing that you're impacting and that there is a relationship to you, and the people that you serve, and your colleagues, and literally anyone else that's involved in your business in any way. 

And so, it's okay, if you don't know the business skills, we'll learn those, we'll learn those because even if we're making them up as we go along, and we all do, you know, we can also remember that we don't have to do it alone. So, not only can we get our support from our colleagues, but we can actually get support from our clients, and just see how best we can serve them, and what they need in order to feel good about, you know, the work that we do as well, you know?

So, to remember that we're people experts, that, you know, hopefully, we know how to build businesses that serve people, because isn't that what we're doing in the first place, you know? So, to remember that. 

We actually do have a lot more skill than we think. We may not have MBAs, we may not be, you know, Jeff, or Elon, or whoever. I don't want to be, so it's fine, but we certainly know how to be people, right? And I think that's an important skill, you know, that shouldn't be forgotten, especially, when we're running these kinds of practices.

PATRICK CASALE: Yeah, that's really well said. So, for all of you listening out there, I hope this was helpful. When you're second-guessing yourself, just rely on what we talked about today, circle back to that, really check in with yourself. And it's okay to ask for support. So, I hope that that's not how this is coming across, ask for support, ask questions, but at the end of the day, make your own decisions. Make your own decisions that feel good for you. And-

TARA HOLMQUIST: Still DM us though, it's fine. Please still DM us, we're still going to-

PATRICK CASALE: You have Tara, don't DM me. 

TARA HOLMQUIST: Okay, you could still DM me, it's totally fine. Like-

PATRICK CASALE: [CROSSTALK 00:35:08], you know, it's one of those like, I could do a whole episode on that. But it's one of those good problems to have, of like, damn, wow, like, I never expected things to turn out the way they've turned out, and oh, damn, not only do I struggle with missed notifications, so I have to respond to everything. And then like, I'm like, "Fuck, no, I don't want to answer this," But I also don't want the red dot on my phone, so like, where is the middle ground?

TARA HOLMQUIST: It's exactly right. I am the same exact way. Like, if you DM me, I am going to answer you. I might be grumpy about it, no, but expect [INDISCERNIBLE 00:35:39] continue to DM me, email me, whatever y'all want to do. And know that I'm going to follow it always up with, "Well, why? What's leading to this question? And why do you have this? And let me help support you through coming up with your own answer." So, I'm not going to give you the answer that you're expecting, unless you're asking me how I'd set this up, you know, whatever, you know, method it is. But I'm also going to ask you first, so please, you can DM me. DM me instead of Patrick, it's fine.

PATRICK CASALE: I'll put this in the show notes so that whoever's listening, you know, gets that information. But in all seriousness, this podcast wouldn't be successful, the Facebook group wouldn't be successful without the members and the listeners. And I do appreciate all of your questions. And I do appreciate all of your support. And going into 2023, trying to work on better boundaries for myself. But with that being said, this won't air until like, a couple of weeks into 2023. So, I guess that actually works out when we publish this in the Facebook group. 

But I just wanted to thank Tara for coming on, again, as a guest, and just being such a great friend and colleague, and just a great advocate in the therapist community. And Tara, if you want to share anything, or anything that you're doing, or where they can find more of your information, please feel free.

TARA HOLMQUIST: Yeah, I just want to say my goal for 2023 is to build more community and engage in my community a lot more. So, that being said, I'm here to support you, Patrick. So, you set boundaries for yourself, but send them over to me and I'll support you through that so we can build our community or at least strengthen it. 

But yeah, 2023 is going to be an evolving year for me as 2022 was as well. I am running a practice, I am quite full. At the moment, I'm not taking on any new clients, but I am open and doing consultations for pay-what-you-can, so those of you that are actually interested in, you know, creating a pay-what-you-can model or some sort of model that's similar to that, so you're practicing and need help, I'm open for consultation, that's also a pay-what-you-can practice and fee structure. So, feel free to reach out to me. My website is And I am Tara Michelle on Facebook. So, DM me all you want.

PATRICK CASALE: Careful what you wish for situation here. 


PATRICK CASALE: All of that information will be in the show notes for everyone to have access. And we'll also link the other episode where Tara was on talking about the pay-what-you-can model so you have more information about that and easy access to that as well. 

And I just want to thank you for coming on and you've been a great friend. And I also want to thank everyone for listening. New episodes of the All Things Private Practice Podcast coming out every Sunday. Like, download, subscribe, and share on all major platforms. Doubt yourself, do it anyway. See you next Sunday. Thanks, Tara. 

TARA HOLMQUIST: Thanks, Patrick.


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