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[00:00:00] Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. The BRIEF-2 ADHD form uses BRIEF-2 scores to predict the likelihood of ADHD. It’s available on PARiConnect- PAR’s online assessment platform. Learn more at parinc.com.

All right, welcome back, everyone. Thank you so much for being here. Hey, today’s episode is a really good one. I’m talking with Dr. Kim Dwyer, who is a fellow Coloradoan and testing psychologist all about values-driven practice.

You might say to yourself, what does that even mean, values-driven practice? Well, Kim has focused on values-driven practice for a long time, and even has a framework to help [00:01:00] guide practice owners through figuring out their values to guide their practice.

We get into things like how to identify your values as a business owner. Common values of a practice owner. We talk about where your values might clash with your business behaviors in running your practice. And then we also talk through things like how to handle it when you get emotionally charged in your business, which I think happens to all of us fairly frequently if y’all or anything like me.

So this is a really good episode, a little bit different from typical clinical interviews, but I think that you will find it quite helpful in thinking through the mindset in your business and getting you on the right path if your business is not working for you.

Let me tell you a little bit more about Kim before we jump in. Kim is a clinical psychologist. She’s practicing [00:02:00] in suburban Denver, and currently, like many of us is doing telehealth throughout the state. She really comes from a mindfulness-based cognitive behavioral orientation and relies quite a bit on Acceptance and Commitment Therapy (ACT). She excels at treating anxiety, stress, and managing transitional times. She also supports kids, teens, and families with learning disabilities and neurodevelopmental evaluation.

Her background includes practice in a variety of settings including school, inpatient, residential, community-based, and private practice. She also supports mental health providers and others as they launch, grow, and redefine their businesses using their values. Kim provides individual and group practice coaching. She has an active Facebook group devoted to practice growth. And she [00:03:00] recently published her Intentional Private Practice Workbook, which is really cool. I’ve got that check that out. And that is available on Amazon.

When she’s not at work, you can find her outside in the beautiful Colorado outdoors with her family: husband, three kids, dogs. She also enjoys yoga and watercolor painting.

We had a really pleasant conversation. Kim asked me some questions about my own values and got to work through some of those live with her, which was both terrifying and fascinating for me. So I hope you enjoy our conversation.

Before we completely transition, I will give a shout-out to the newly started next cohort of the advanced practice mastermind group. So like I said, our first cohort filled pretty quickly and now I’m onto a second advanced practice group. Right now, as of this [00:04:00] recording, there are 2 spots left. You can get more information at thetestingpsychologist.com/advanced, and you can also apply there for a pre-group call. Sorry, I always get that wrong. You don’t apply for a pre-group call. You just schedule a pre-group call to figure out if the group could be a good fit. I’d love to have you.

This is the group for those of you who have gone beyond the typical beginner stages. You’ve nailed down the referrals and the income, but maybe you’re looking to streamline your systems, do some hiring, expand your practice, take it to the next level, and you’d like to have some accountability in that process. We’d love to help you out. So thetestingpsychologist.com/advanced.

Okay. Let’s get to my conversation with Dr. Kim Dwyer.

Hey, Kim. Welcome to the podcast.

Dr. Kimberly: Hi, thanks for having me. It’s great to be here today. 

Dr. Sharp: Yes. I’m glad to be talking with you, a fellow Coloradoan. It’s great to have you here.

Dr. Kimberly: Yes.

Dr. Sharp: So you’re in Denver, right?

Dr. Kimberly: Yeah, I’m right outside Denver.

Dr. Sharp: Fantastic. Well, I know you know you’ve been a member of our Facebook group for a long time and are pretty active there. So I was really glad to have you reach out. As we’ve framed the podcasts prior to recording, it’s just gotten better and better, I think. So I’m really glad to be talking with you. And I think people take a lot away. So thanks for being here.

Dr. Kimberly: Wonderful. Yeah, it’s an interesting topic to talk about. I think we spend a lot of time, hopefully developing our clinical expertise and our focus of practice, but really thinking about the business piece behind it and what we as individuals are bringing to that business in terms of [00:06:00] our uniqueness, our unique skillsets and interests, our values and how they’re impacted by the stories we hear around us about what we should do and how we should be as providers, I think they’re just all really interesting things to be intentional about digging into and understanding, and then we can choose like, does this work for me? Or is this something that I picked up along the way that maybe isn’t serving me very well anymore?

Dr. Sharp: That’s a great way to put it. I think a lot of us jump into practice, maybe we do a business plan and maybe we…

Dr. Kimberly: I sure didn’t.

Dr. Sharp: That’s why I said maybe. Like maybe we did. I didn’t do a business plan. But if we get that far, but there’s not a lot around doing a values clarification and how that might drive the business side of things. So I think this is great. I’m really excited to dive into some of these things.

Dr. Kimberly: Absolutely. And as we chatted about this a little bit before, a lot of us, [00:07:00] I think by the time we’d get to private practice, we’ve got a number of experiences under our belt. We might have some ideas of like, I don’t want to do this, or I do want to do that, or no way am I going to deal with that aspect of practice.

And I hear from a lot of folks, I had to leave this particular situation. And seeing private practice as an exit strategy, it’s reality, but it’s probably not a good choice, not that the practice isn’t a good choice, but it’s probably not a good motivation for going in and starting a business because there are pieces to that, that again like getting really clear on what your mission and vision are for your business before you jump in feet first it’s going to make it easier to market. It’s going to make it easier to connect with people. It’s going to help to set up that timeline: where you’re going, what the direction is. The exit strategy is more like get me out of here.

Dr. Sharp: Right. [00:08:00] It seems like the difference between being proactive versus reactive in some ways. It’s hard to hold back and not just leap into it, but I do want to just get a sense of where this comes from for you and why is this important to you, values-driven practice?

Dr. Kimberly: I’ve been in private practice for 11.5 years at this point. When I moved into private practice, I had had experiences working in a school, working for a psychiatrist- it was a private practice, but it was very, very liberal. So it had more of a community, mental health feel to it because it was everybody who came in we tried to provide services to.

And then I had a move and a new baby and the options are, start figuring out what you want to do when you’re a grownup. And I knew I’d always wanted to go into private practice. And in that period of time between the moving and starting my own practice, I [00:09:00] had some opportunities to go back and look at potential jobs that at other points in my life, I would have told you that’s my dream job.

One of them was going back to a job I formerly had where I left as really well-liked respected. I’d been there long enough that I had shaped the job. The job was a little more fuss when I started it, but by the time I left, I had shaped it into what worked for me. The idea of going back to that would have been very comfortable for me. I also had the opportunity to go look at a job where I had done some of my training. So, that really feeds the ego, right? Here you were the lowly student. Now you’re coming back to be the staff member.

So, I considered two separate jobs, and both of them I walked from because I just felt like that’s not the direction that I’m being pulled into. That’s not going to help me grow and develop. And I realized it was it’s time to do it on [00:10:00] my own and go out into practice by myself.

So I went into practice. As I already mentioned, I did not have a business plan. I read some books. I did try. I did read some books about marketing. I’ve always enjoyed that aspect of it. So I think I was well-suited to even cold call people and tell them about my practice, and get it up and running.

So my practice was and continues to be about 50% testing, 50% therapy. So I got my practice going. And then over time, I noticed I would have colleagues frequently just organically come to me to ask for support with getting the practice going or helping them figure out some strategies around that.

I always knew I wanted to do coaching at some. And I started by, oh, I’m just going to do this general wellness coaching. And it was just way too broad. It was too close to therapy. I couldn’t distinguish it. I actually decided, okay, I’m not going to do coaching. And then just organically people start contacting me [00:11:00] for practice coaching. And I was like, oh, well, there it is. There there’s the piece that’s going to work because it’s something I’m passionate about. And I really think we have really great people in this field that come into this field for more than the paycheck or the expertise and knowledge and the letters and whatnot after their name and work.

We come into it to use what we know to help people to hopefully live fuller, richer, healthier, all the things kind of lives. So I see some people obviously really excelling with that and I see other people really burning out or they’ve got really great intentions and it doesn’t actualize and it’s discouraging. Like if you’re in private practice by yourself and you’re not getting clients and you’re doing the things that you think you’re supposed to do, and it’s just not panning out, I’ve seen people, basically go into practice and then close doors without a whole lot of time going. 

That’s sad for that [00:12:00] person, but it’s also sad for our field and our communities because we need people that are passionate about this. So I feel like when I’m helping people get their practice running, help launch their practice, help grow their practice, or I also see people that are at the point where they’re full but they’re not feeling fulfilled from it, they’re doing…

Dr. Sharp: That’s interesting. Filled but not fulfilled.

Dr. Kimberly: Yes, exactly. And frankly burnt out often because they are so full, but they’re not getting… like maybe they’re getting the paycheck that they need, but they’re not getting the soul-nurturing piece of the work because it’s not the work that they’re really aligned with doing. And then they’re at risk of burning out, you know? So then we get these people that have the skills that could be really valuable in their communities but for a number of reasons, they’re not reaching that. And then, as a result, I think everybody suffers.

Dr. Sharp: I think that’s so true. We were chatting beforehand about the lack of deliberate action [00:13:00] as we start our practices and it’s sad to see that like you said. So, could you maybe define when you say values aligned practice or values-driven practice what that even means, and where that’s coming from?

Dr. Kimberly: Sure. when I think of a values-aligned practice, I’m thinking about the decisions, the policies, almost like the scaffolding or the skeletal system almost of the practice lines up with what we feel deep in our core is right for us, right for our business, right for our community, right for the people that we’re serving. There’s probably a lot of different definitions of values, but I think of them as those guiding principles. They’re goals that we’re striving to attain.

In mental health, the values that I hear frequently from people are values of service, [00:14:00] values of community connection, knowledge, expertise, wisdom. There are also the values of the business and there are the values of an employee. Even if we are the business, we’re also an employee of the business, which I think is an important distinction that we can spend some time talking about in a bit.

But thinking about what does the business value, how does the business value the employees, even if it’s one in the same entity, and how do the actions that are happening the way we as individuals interact with our clients and our community and other providers, the way in which the business supports us as individuals, our clients as clientele, our community around us. How does that reflect those values? So are we setting up policies that are in good alignment? And that’s the part where getting intentional about it, I think is helpful.

Full disclosure, how did I come up with my original set of policies? I got them from a friend. I was like, [00:15:00] oh, well that works. Tweak that a little bit. I’ve done a much more thorough review in recent years of like, okay, exactly, why do I have this policy around cancellation payments? That’s the fireworks one and mental health. You can really get a good debate going about, do you charge for a canceled appointment or not? And if I really understand why I do that and it aligns with my values around that, then it’s so much easier for me to present that to a client without getting emotionally involved, because I don’t have to defend it. That’s just what works for my business. And I can understand where they’re coming from.

If it doesn’t work for my client, it’s not me versus you. It’s how do your needs fit with the values of this business and this business’s ability to meet your needs? And if we can align it great, if we can’t, I can still try and help you by finding you maybe an agency that has a more flexible policy because your work schedule does not allow you to [00:16:00] maintain appointments or something.

Dr. Sharp: Right. Yeah, that is a great example. Do you have other examples of values that tend to come up?

Dr. Kimberly: That tends to pop up? Yeah. Like I said, a big one is service. Another really big one is pleasing others. I think a lot of people in mental health really have a people-pleasing streak within them. Pleasing people doesn’t really sound like a value, but I guess it’s kindness. To be liked and be cared for is an important value.

A lot of us that go into running our own business have strong values of creativity. And I think that’s really important. It needs that space. There are different aspects of business growth and development that pull creativity stronger than others. Like we’ve got times where we’re just kind of maintaining and that’s okay. But if that creative [00:17:00] piece of us isn’t fulfilled, we need to find other places to get that from if we’re not getting it from our business.

Lots of us have values around learning. Continued development and growth expertise and competency in our field are strong values for a lot of us. A huge value, not just in business, but I think probably in our society in general is respect. So we have ideas about what it means to be respected. How do others treat me as a provider that shows respect? How do I treat my clients that show respect? How do I do that with my network and my colleagues around me?

Dr. Sharp: Right. I’d imagine it’s kind of wide open, right? I mean, there’s any number of values that you can choose from or generate. And I just want to take a quick step back just to put a little framework to this that you are really coming at this from the act framework, right? Like [00:18:00] an action aligning with your values?

Dr. Kimberly: Yes, exactly. An act like the acceptance piece around recognizing what’s happened, what’s led to this point, which could be colored by past experiences, thought processes, all those different kinds of things. And then using the emotional reaction in the present moment as a window into that to treat those emotions. I see it as that’s your lens into your value system.

And we don’t necessarily dig into it when we have really positive emotions and maybe we don’t need to really do that because it seems evident, right? Like I have a great connection with a friend. I feel joyful or grateful, like, okay, that’s because friendship is a strong value to me. I had that opportunity to connect and it really felt good to have that time together.

When we have those really negative emotions, that can be a whole host of them, anger, fear, worry, disappointment, embarrassment, guilt, [00:19:00] we could go on and on. Usually, there’s some conflict among values if we really sit and dig into it. So then when we have that negative emotion, our immediate tendency is to get rid of it. I don’t want to feel that. That’s no good. Get away from that person that makes me feel that way. And I just did air quotes for people who are listening.

Dr. Sharp: It makes me feel that way.

Dr. Kimberly: When that happens, if we can, rather than push the emotion away, tune into the emotion. And rather than judging it, good, bad, otherwise, what is it telling us? Why is it showing up at this point?

Dr. Sharp: I love that. A good framework is hard to beat. I’m just anchoring that for people a little bit, I think, and presenting it in a familiar language makes a lot of sense. This is not just something that you’re pulling out of the air.

Dr. Kimberly: This was strongly impacted by act and an act does have a big mindfulness component [00:20:00] to it as well. That mindfulness of emotion and thought as behaviors or processes in the present moment, that again, can be helpful, can not be helpful at times as well, but there are opportunities for some introspection and to practice that non-attachment, just even if it’s… I always think of it like taking half a step back from something to watch it rather than to just be so fused into it that it just drags you around like a horse by the rain.

Dr. Sharp: Right. I think I read this in some act book over the years, but it’s the difference between riding on the bus and driving the bus, right?

Dr. Kimberly: Yeah, exactly. The analogy I use a lot is watching a train come into the station and then deciding whether you want to get on the train or not, as opposed to being wiped, the train is here, I’m on it. Here we go. Not sure where we’re going, but it’s going fast, right?

Dr. Sharp: Sure. Oh my gosh. Well, and [00:21:00] there are so many people out there who are just getting on the train of their business without thinking about it like, how did we end up here? Where are we going? Can I get off? Do I have control over this train?

Dr. Kimberly: Yeah. And that doesn’t feel so great when you’re at that point. 

Dr. Sharp: No, I’ve been there. So how do people identify their values? And I’m specifically interested, I think this maybe come easier for some people than others. For example, I don’t consider myself super introspective necessarily. I wouldn’t naturally be like, what my values are here and really dive into that. And then even if I did, I have a great idea of how to identify those, to be honest. So, a two-part little nested question there.

[00:22:00] Dr. Kimberly:  Sure. I’m thinking of two specific ways. There is probably more than that, but two ways, one that seems to me, I don’t know if intentional is the right word, but more maybe contrived it would be, and there’s nothing wrong with it, contrived sounds negative, but specific, intentional, I want to figure this out, is just to even get a list of values. I’ve got one in a resource that I’ll share later.

You can just Google values lists online and find lots of them. And just because it’s on a list, doesn’t mean it’s exhaustive. You’ll come up with your own as you immerse in it and start thinking about it. But I like to go through those and do a quick scan, grab a highlighter and just start highlighting, these are important to me.

You can do that to narrow down to 15, 20 and then go through and just give it a good old suds rating. [00:23:00] 10 is super important to me. And even maybe super important to me to address because some of them might be really important to you, but you might feel really fulfilled in that area. So you don’t really need to do any work on it, right? But a 10 could be super important to me. And I want to address that now intentionally and one or zero is really low on the list of important things, or I just don’t need to deal with that right now because it feels like it’s going really well.

So then we can go through to keep it, if we’re going to work towards moving into behavior, I always like to just stick with 2 or 3, otherwise, we all know what happens when we have way too many goals at once. Everybody quits therapy. It doesn’t work. So, picking two and then moving from, I think of this as a value that I’m wanting, in this case, this is a value that I want in my business. How am I showing up with that value right now?

Let’s take the example of service. If I say a [00:24:00] really strong value for me is service and I really want to serve my community. And maybe I’m going to identify more specifically, how do I want to serve my community? What are the ways that service is going to show up for me in my community? And then start moving that into specific behavior. So maybe one is I am opening a business in this community and I’m going to provide these services. Another way in my mind to provide services, to make sure that people know how to find you because you’re really not good to anybody if they can’t find you.

So I think marketing is a service. There’s an element of marketing that’s educating people. So, maybe some steps on service with marketing are, I’m going to put together educational one-page handouts about this aspect of treatment or this condition, or what testing can tell you. And I’m going to get them to pediatrician’s offices or schools or a big stack of them in my local library so people can grab them. So that can be a way of providing service.

[00:25:00] Other aspects related to service where values may collide are money. And that’s a big one for us, right? We have a lot of stories about money. But thinking about how do we serve people when money might become a barrier. And is that something that we’re going to take on? Is that something where we’re going to have a certain number of reduced fee spots? Are we going to do some insurance contracts to help you fill in that spot? Are we going to volunteer our time to some aspect outside of our work, which all of those are perfectly acceptable? It’s more about figuring it out within each of us individually. So at the end of the day, we feel like we’ve shown up and done that in a way that feels authentic.

Dr. Sharp: Yes, I like that. I would imagine looking at a big list of values, it could be hard to winnow those down to the ones that feel really true. Do you ever run into that when you’re talking with folks?

Dr. Kimberly: Yes. [00:26:00] So then I think that’s where the distinction between the ones that you don’t indicate or you don’t highlight, it’s not that they’re not important to you, but they’re maybe not your main focus right now. I’m looking here. I have a list in front of me. I just want to take a peek at it. I’m looking at a list of some values. They’re in alphabetical order.

Determination is one here. I’m a determined person. I respect that in other people. When I approach my business, I don’t know if determination is the guiding value of my business. I’m sure there’s some determination and perseverance that helps me keep going, but that’s probably not. Like if I was going to say, how am I setting policies that align with determination, to me that doesn’t make a whole lot of sense.

Here’s another one I’ve got on this list is learning. So that’s the value that as a professional, learning [00:27:00] is part of my competency. It’s part of my board’s requirement to get X number of CEs every two years. So maybe I’m going to build that into my business policies and my business guidance that even though the point that I’m at with our practice right now, I’m chief cook and bottle washer, but maybe I’m going to think about how does my business support its employees.

And one of the ways might be my business allows employees to take time off for CEs, or my business provides X amount of monetary support for CEs every year, or as the owner of my business, I’m going to recognize my need for a business retreat and make that happen and take that time to invest back into the business by gaining additional skills that are going to be useful.

To address the question, yes, they might all be important values. Are they the key ones that need to be part of my mission statement and my policies and procedures? [00:28:00] Maybe they’re not the biggest ones.

Dr. Sharp: Yeah, I see what you mean. Are there any structured exercises that you know of or texts or anything like that that can walk people through this process a little bit?

Dr. Kimberly: Yeah. I have some in my workbook that I’ll share more about later. Similar to what I was describing, so going through and looking at values and figuring out where they show up. A nice in-vivo values exercise I think that we can practice at any time is noticing what’s coming up for us. And it’s great to do this if you have that experience before you start a business by reflecting on past experiences. These businesses are organic and can change and be molded as we go forward. So noticing what are the times that we have strong responses to things around us? So can you take [00:29:00] the Guinea pig a little bit with this?

Dr. Sharp: Yes, I can do that. Let it be known for the sake of my audience.

Dr. Kimberly: For the sake of learning.

Dr. Sharp: For the sake of learning in our field, I will go through this exercise. I’m excited about it. I’m joking around, but yeah when you mentioned this before we started the recording, I thought, sure, this sounds good. 

Dr. Kimberly: So I already shared that I view those times that we have really strong emotional reactions as a real opportunity if we can do it without judgment with practicing non-attachment to really dig into what’s coming up for us. So can you think of a time not too distant past or maybe far in the past, it doesn’t really matter, where you felt like you were having a strong emotional reaction somewhere related to your business?

Dr. Sharp: Yeah. Let me count the ways. [00:30:00] As a larger practice owner and just to stick with a business piece I can think of one instance among many of a financial dispute, for example. A family was really upset about the way that they were billed for an evaluation. So, you tell me, where are we going with this?

Dr. Kimberly: When you think about that situation, what were you noticing that was coming up for you emotionally?

Dr. Sharp: It’s a range. Initially, there is some I would say anger or defensiveness that comes up pretty quickly. Like, how dare you talk to me that way, or you owe us this money, what’s your place to try to challenge our policies, [00:31:00] that sort of thing.

Then, there’s usually a process of giving way to some, shame almost feels too strong, but something in that ballpark of okay, no, this was, this was our fault, which by definition means it’s my fault as a director. We didn’t make those clear. They’re actually kind of right. I feel bad. And then it’s like this conciliatory sort of, how do I make this right, and wanting people like me, that whole thing.

Dr. Kimberly: Yeah. So as you’re talking, I’m jotting down what I’m hearing and where I would go with this is, you described a range of emotions starting with anger and moving into something in the neighborhood of shame, and then moving into [00:32:00] I don’t know that reconciliation is really a feeling, but an urge to move into making it better.

So when you think about the anger piece, why do you think that that was showing up? What was that communicating to you?

Dr. Sharp: Let’s see. So that was telling me that, I don’t know, I think a boundary was violated somehow. And in this case, I think it was probably like the… Well, two parts. That someone would be unwilling to pay for a service that we provided that’s like, that was not our deal. We’re holding up our end of the deal. Why aren’t you holding up? So there’s definitely that component. And there’s just an element of the tone of this particular example that I’m thinking of. It was pretty attacking and hard to ignore.

Dr. Kimberly: Yeah. And I’m imagining, when somebody comes at us that way[00:33:00] well, I’m not going to tell you, I’m going to ask you before I tell you what I hear, but what do you think comes up value-wise? Like if you’re feeling attacked, we had this agreement, we do the service, you pay us X amount of money, and now the story’s changing. So I heard you say, it feels like a boundary is being challenged or crossed. If you’re thinking that in terms of language of values, anything that pops to mind fast?

Dr. Sharp: Maybe something around, we do have a value of treating clients really well and doing really good work. And we pride ourselves on that. So to see that that didn’t come through, that this person didn’t perceive it that way.

Dr. Kimberly: Yeah. So that conflict between this is what we’re trying to do. This is what this business stands [00:34:00] for. And here’s how you’re perceiving it, whether correctly, incorrectly, or somewhere in between. And then, I’m hearing in that also there’s respect. There’s an element that’s respect. We treat our clientele respectfully. We treat our employees respectfully. We look for open dialogue. And we hope to get that back as well. So if we do have a conflict or disagreement, it can be handled respectfully.

Dr. Sharp: Yeah, I think that’s actually important. So that’s maybe more of a personal value. I think it’s a practice value as well, but there’s definitely a personal component for me of like, I don’t talk to people this way. Why are you talking to me that way? If I were to try to say the same thing to someone, it would be very, very different. I don’t appreciate that.

Dr. Kimberly: Yeah. So there’s a sub value there of fairness, right? This isn’t fair. Don’t talk to me like that. I didn’t talk to you that way. And we love that value in this country. Things should be fair.

[00:35:00] Dr. Sharp: It should be, Kim.

Dr. Kimberly: Yeah. This is a charged time of the election cycle to talk about fairness. But what we do, and transparency, that’s a big button pusher for me. You’re not treating me fair. That’s what’s going to light up my anger like that. But the reality is we also know logically and some chunk of our brain that we’re not always dealing with people that are super, emotionally healthy, and sometimes to go into it expecting it’s still, mouth drops, eyes wide open when it happens because fortunately, it’s not the norm with most of our clients. But when it does happen, we probably would be well-served to recognize this is going to happen from time to time.

Dr. Sharp: Yes, exactly. And I have to say, at some point through the process, I can step back and I can say, this is not about [00:36:00] me. This is not about our practice. We play a role, of course, like it’s an event, but this is a lot about this other person’s values, whatever they bring to the situation.

Dr. Kimberly: Right. And that piece is a wisdom piece, to be able to separate these emotions are coming up. I’m feeling them. I’m noticing them. I’m also recognizing that a lot of this is not about me. This is about somebody else. And now that I recognize it’s not about me, now I can maybe move more into a helper mode or business owner conciliatory mode as opposed to, you want to fight, I’m going to fight. And that’s what the anger mode is. Anger is powerful. It gives us direction. And when you really care about your business, those feelings are going to come up. That’s pretty normal.

Dr. Sharp: Yeah, so true.

Dr. Kimberly: So the second part that I heard a little bit this too, that part of what came up was like that challenge [00:37:00] of, we’ve set up this transaction. If we think about it at its most basic, this is a transaction, we have a service that’s being provided. There’s a certain fee that’s attached to it. We’ve all agreed to it. And our field we’re super upfront about that with consent forms and fee schedules and all that kind of stuff. There should really be no surprises and now you’re challenging that.

Part of what I heard there too is this value of expertise. I know how to do this thing and I’m doing it the right way. And now, it’s not flowing that way. You’re not either… I mean, there might be some language of like, you’re not trusting my expertise or you think you know more than I know. What’s that challenge piece about?

Dr. Sharp: That’s a good question. Definitely something around not valuing the service or really valuing the knowledge that [00:38:00] was provided. Yeah, there’s an expertise component there because the subtext when people don’t want to pay, it’s like this wasn’t worth it. This wasn’t worth the time or the energy that you put into it, or then the knowledge.

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So there is a question there of expertise.

Dr. Kimberly: Yeah. And well, that’s something that’s really important to you. If we’re in this field at all, we’ve dedicated a decent chunk of time to education and to post-degree training and licensure and all of those things. So to have that challenge doesn’t feel great.

The piece that you brought up around noticing shame around this. What do you think that part is communicating?

Dr. Sharp: Ooh, well, what is that communicating? That part is probably the most [00:40:00] I would say powerful part. I mean, that’s the one that would stick with me the longest in these situations. Basically, you could have done this differently. It’s hard to because I was not the clinician, in this case, it was one of our clinicians, but again, you could have done this differently as a director. If we could have handled this differently, what could have gone in a different direction? How could you have trained the admin staff a little better to handle this because definitely, it was an escalation before it got to me?

Dr. Kimberly: What I’m hearing in that is responsibility. And maybe that’s a stronger value as a practice owner, and hopefully, employees feel responsible too, but I think there’s this overarching. You’ve got this business to run. At the end of the day, if [00:41:00] that’s your reputation, that’s your business. So the responsibility for like now I’ve got to figure out how to keep this from happening in the future. Make sure everybody has the training and knowledge that they need. I need to get in there and be responsible for the problem, take responsibility for it, apologize, figure out how to move forward with the client.

Dr. Sharp: Yeah. I think that’s very true. Responsibility is a big value, certainly. I’m a big fan of this book called Extreme Ownership that you may have seen. And it’s all just about, if you’re the leader, you are the one who takes responsibility. So that’s that runs very strong, certainly.

Dr. Kimberly: Yeah. 

Dr. Sharp: When that goes awry, then it all kind of comes crashing down to like, oh, you don’t know how to do this. How can this happen 10 years into the process?

Dr. Kimberly: We derive a lot of identity from our work. [00:42:00] So, when I was talking earlier about the creative creativity piece, creativity is a strong value for a lot of entrepreneurs. And when we get into a rut in our business, sometimes I feel like it’s almost…. the business might be well-oiled and running smoothly, but it’s just not super creative. And we could find some ways to be more creative, potentially. Like I’m going to start this group or I’m going to develop this new aspect of my work. But maybe those things don’t really align really well with the mission and vision of the business.

So at that point, I think myself as an employee of the business needs to fill my own bucket outside of work a little bit better so that I’m not coming into work and taking on these projects that are going to burn me out, burn out the business, not align with the direction that I want to go in or create this chaotic atmosphere, like how come you do this thing and then you do that thing? They don’t really go together very well.

So I think that the same thing with what [00:43:00] you were just describing, like responsibility, leadership, strong values and they can get filled very well from work. And sometimes they don’t get filled very well from work. There are times where that doesn’t always happen. But when that’s a strong part of identity, then we just don’t feel good.

Dr. Sharp: Right. Those are the worst moments in the practice, certainly. When these sorts of things come up, it’s easy to question my leadership skills. 

Dr. Kimberly: Yeah, but then the tapping back into it, I’m feeling this way. I also heard you say that then it becomes an opportunity for clarity, an opportunity for change, an opportunity for training. We can also reframe all of that as, dare I say this was actually a good thing, right? 

Dr. Sharp: Yeah. Well, and for me, I don’t want to blow up the model or anything, for [00:44:00] me that really is the way that I frame it. It’s like, when all of this is done, what gets me through it is being able to step back and say, this is an opportunity to build that muscle of leadership, taking responsibility, and learning how to work with people when they’re unhappy. And this is all happening over, I don’t even know, it could be like three hours. It could be for four days. It’s variable for sure. But those are the good moments.

Dr. Kimberly: Yeah. Well, and some of that, I am thinking of a recent situation that I had where I got all my buttons pushed in a clinical situation around, it was similar kinds of things, values around holding my boundaries, being talked to respectfully, being asked to do things that did not feel ethical to [00:45:00] me. My immediate was like, you’re off my caseload. I can’t deal with this. Avoid, avoid, avoid, make it go away.

I consulted with one of my mentors and explained the situation. And one thing that she said to me that really stuck out, she was like, “You know, you don’t have to do any of this”. I was like, oh yeah, that’s right. I’m choosing to do these things super fast. […] `And I was like, yeah, you’re absolutely right. And I think there was something in the freedom of like, it is my business. I can ultimately decide. Hopefully, I do it in a professional way, but I can ultimately decide, do I continue working with somebody or not?

And it gave me the pause. I think the rattling realization of you don’t have to do this anymore, made me step out of it, and it gave me the pause that I needed to leave it alone, to wait 12 hours and respond the next day, the whole thing went fine. I actually figured out how to manage the situation in a way that I think my client really felt heard even though [00:46:00] ultimately I was in disagreement, but they felt really heard and I gave them an easy way to manage the situation. So they didn’t necessarily have to take 100% accountability for it.

That’s running a business and figuring out how to how to do client care. But at the end of the day, I still held my boundary and I was perfectly happy with the outcome. Had I jumped in immediately and fired off an email or a response, I probably would still be upset about it.

Dr. Sharp: Yeah. I think that’s always a good rule. If you can train yourself to just not respond immediately, that is really, really helpful.

The place that I get stuck, I’d be curious, Kim, how you maybe deal with this personally or have found others deal with it is, I can hold off on responding. I’ve trained myself to do that. But then it just festers until I do [00:47:00] respond. I have found over the years that it sometimes helps to discharge it a little bit by talking to my wife or another who’s a therapist or another practitioner, practice owner, or something. But that whole process of just step back. You don’t have to engage in this is easier said than done sometimes.

Dr. Kimberly: Yeah, absolutely. And I do agree. I think we all need we need our practice buddies that are in the field that know what it’s like, that know us well enough that they can say, hey, this is your hot button. This person I was referring to that I went to, was able to say, hey, you tend to get fired up over this stuff, which was enough for me to step back and be like, yeah, you’re right. I’m personalizing an aspect of this that I don’t need to own that. Like, I don’t need to personalize it. I don’t need to let it into my life to the degree that it could upset me.

So I think that’s important[00:48:00] to do that. And I think it’s back to the same thing. I’m like, we don’t have to respond immediately. There’s so much in our world that’s demanding an immediate response. Text messages, notifications, beeps on our computer, emails that come in.

I always think like, okay, if I was a psychologist in the 50s, I wouldn’t even be answering my phone. I’d probably have an administrative assistant that would return all my phone calls. And I wouldn’t be dealing with three-quarters of the stuff. People would be sending me mail that I would get three days later and my response would take three days to get to them. So we would have all this built-in and be managed okay. Just because we can get information out to people quickly doesn’t mean we have to, or we should. So, just giving ourselves that freedom of it’s okay not to respond immediately.

Dr. Sharp: That’s a great point. Yeah, just putting that window between stimulus and response is huge.

Dr. Kimberly: Yeah. And that’s the quote, I had this pulled up on my computer earlier today that [00:49:00] Victor Frankl quote about the space between stimulus and response. That’s where we grow and that’s where we have freedom.

Dr. Sharp: I love that. I heard that for the first time back, I think on the internship when I was doing mindfulness-based stress reduction groups and it stuck with me ever since. It’s just like, broaden that window.

Dr. Kimberly: So it’s broaden the window, but it’s also back to what you were saying about not letting it faster. We don’t want to just be in that window feeling uncomfortable and feeling like, oh, this is thrilling. Do something about it, make it stop. But moving into that window and then digging deep into like, what is the message? What’s the story? Why is this bothering me? What is the emotion trying to tell us?

And it’s almost like getting rid of all the chatter of like, here’s how I could respond. And if I say this, then they’ll say that, and then they’ll say this, and then this other thing, right? These conditional logic paths that we go down, that our brains are so good at doing and often lead us into worry and [00:50:00] fear and anxiety. But to really come back down, like once that chatter has gone, what’s the most important piece there?

And often that helps us to have compassion for ourselves, have compassion for the other entity, business, community, relation, client, whoever that might be, and to hear both sides. And then hopefully we can move into doing something again, that’s next to each other rather than butting heads with each other.

Dr. Sharp: Right. Yes, as we’re talking about this, I’m just struck by how much reflection needs to happen and really how much importance there is in defining these values as best you can ahead of time. Knowing that some will happen as a learning experience in the moment when these situations arise, but the more work you can do in defining your values ahead of time, then you have it [00:51:00] to fall back on. Like when these situations pop up, then you can say, oh, this is that value around responsibility, respect. And here’s how I act in those situations.

Dr. Kimberly: And the trap is, if we don’t do it, it still happens, but we might not be as clear about it and they might not necessarily just be our values. I think a lot of people, like I know myself especially if you’re training, like a lot of us have training that has a lot of community mental health center work or community-based agency work or state hospital, those are the places that we get practicum and internship. We go through that and the messages that we’re getting are going to become ingrained. Some of them are great and some of them really don’t align with running a business.

I have lots of stories that I got told about money. Money, again, that’s a personal hot button for a lot of people.[00:52:00] It’s a business hot button for a lot of people. And if you’re in business, unless you’re running a nonprofit, even nonprofits have to deal with money. But certainly, if you’re running a for-profit enterprise, there’s a transaction going on there and money’s going to be involved and you better get clear with that, or it’s going to wind up being your Achilles heel because it’s going to get challenged a lot.

Dr. Sharp: Yeah, absolutely. I wonder if we might talk about that a little bit, just some examples around money. If you have stories around money or I can definitely go into that. I’ve done a lot of work around that. I think that’d be helpful for people because that is a big one for folks in our practices.

Dr. Kimberly: Yeah. In thinking about supporting practice owners and providers around this, what I see happen a lot is the conflict between service and money. I don’t know if we call money value, but wealth is value. And when I [00:53:00] say that, in my head anyway, it sounds like wealth- I’ve got to have like piles of money that I’m swimming in. Like this is the character from Donald Duck’s uncle. Whereas, a realistic value of wealth for myself is, being a little live at the standard that I want to, be able to save for the kinds of things that are important to me, for other values, for education, for travel, for these other things that are part of why I get up and go to work in the morning. And those are all okay.

And then we have these values of service and how we’re serving, who we’re serving, what the value of the products that we’re providing is both from how we view it, how we value the product that we’re providing, how our client views the product that we’re providing, how mental health in our society is viewed and valued as a product.

There’s a lot of stories there [00:54:00] I can tell you. I heard coming through a public mental health training that the real work, I’m doing air quotes here around real work, the “real work” is serving the underprivileged. And that’s great. And if you’re called to do that, you do that.

There are also messages around that of how folks who dedicate their careers to that aren’t being reimbursed for that, how they’re being supported as far as quality of life, the size of caseload, how sustainable that is. There are some messages there as well. So, when we as trainees come through and take on those values around work, then we have feelings around guilt and shame. Is what I’m doing enough? Am I doing the real work? It feels like the real work, right?

Dr. Sharp: Well, sure. That’s so true. Yes. There’s so much to say about that. I’ve talked about [00:55:00] Tiffany McClain a lot on my podcast. She does so much work around money mindset and values and that sort of thing that I think we just got to dig into it. Like you said, there are stories that we learn from our families of origin, from our graduate training, from society, from our jobs, and being really deliberate to figure out how does this fit?

I don’t know what you would say, Kim, but I feel like there is a way to balance service and even serving “underserved populations” and that being financially viable. I don’t know that they are mutually exclusive either.

Dr. Kimberly: Oh yeah. Absolutely. I was reading something recently where somebody was reflecting on how raising their service rate allowed them to basically meet their financial [00:56:00] needs with a certain cap but that opened up additional time that they could then provide service. And again, you can provide that service through your business, but there’s no law about that either. That’s a little bit of a hot button for me. Like, I don’t know that we do those other fields. I don’t know that we ask plumbers to do their charitable giving by donating their plumbing services.

And if that doesn’t align with you as a business owner, that’s wonderful. You do you. You figure out how that works for your business and for you as a person. And at the end of the day, if charitable giving is an important piece for you, find a place to do it. If it doesn’t let you up to do it through your business, then don’t do it through your business. There are plenty of ways to serve.

Dr. Sharp: Well, there really is. Yeah. And I think that’s such a good point that to really think about. This is really important. What are your values? Because so often people will put the, Oh, I’m trying to [00:57:00] think how to phrase it, like the wellbeing of others or the other’s values ahead of their own. And I’m thinking of these situations where people don’t charge an equitable rate or take too much insurance or take the wrong insurance or whatever and end up getting burned out and then you’re conflicting with your values with self-care and maybe how you show up for your family and your friends and all of that kind of stuff.

Dr. Kimberly: Yeah. And then when you get into sustainability. How sustainable is that to keep doing this? 

Dr. Sharp: Yes. So, there’s a lot to say about this. I think we’re just hitting the tip of the iceberg, but the more I think we can put it out there, especially about money the better because we just don’t do a lot of talking about that in our field.

Dr. Kimberly: Another place that I see it really gets impacted can be around the scope of practice. As professionals, [00:58:00] this was drilled into my head in graduate school, we didn’t use the phrase, stay in your lane in 1998. But that was basically the message, stay in your lane, know what you’re competent to do, when you’re not competent, refer out. Then you get out into the real world. It’s not quite as simple as no, I can’t do that. Thanks for calling. Have a great day. Bye.

I worked in really rural practice. We had people drive up to two hours to get an evaluation. I had like one situation, and I think I was there for two years, I had one situation in two years where I said to the director, this is outside of my scope of practice. I can’t do it. And I basically got, you’re all we have. Figure out how to do it. And I almost got a threat. Like if I didn’t, I’d be replaced, which I had to deal with that. That was basically a smokescreen, I think, or just a hollow threat to get me to do it.

And in some reflection around that, I was able to [00:59:00] figure out a way to do that particular evaluation where I limited what I was responding to and let other people who had more competency in a different area take on a different piece of it. But it wasn’t so simple as what you got in ethics class your first year of graduate school, just say, no, you can’t do that. Refer it to somebody.

And if you’re in a great big metropolitan area, that’s a lot easier, but I’m now in a great big metropolitan area, and I’ll tell you, it still comes up either because I’ll speak to a prospective client, they’ll start telling me what they’re needing, my internal signals will come up of like, ah, this isn’t what I do, or this is a really bad fit for my business for whatever reason. And when I set that boundary, I’ll often get, oh, but, but I really need that or, but, oh, it’s not really that thing that you’re saying you can’t do. I really like this about you and I could really benefit from this.

And in those moments, I get irritated. It’s [01:00:00] what you described earlier. It’s that boundary. I just set a boundary for you. I set a boundary based on my professionalism. When I feel that being pushed, now you’re challenging my professionalism which is exactly why you called me because you wanted my help and you wanted my support, my expertise.

So, it’s recognizing that stuff as it comes up and really knowing there’s the scope of practice issue. There’s the service issue. There’s professionalism comes in. With that example I just gave you, professionalism comes in.

I have a story that I have in my workbook of when I had first started my practice, I got a referral from a training director that I respected. That’s great, right? You’re a fresh practice owner. Here’s this training director that you’ve known through internship who’s sending you a referral, a horrible referral for me with lots of red flags all over it. High conflict situation. Definitely wanted a specific [01:01:00] type of intervention that isn’t exactly aligned with what I do, but my ego was like, oh, they like me. Like this piece wants to please people, that wants to be liked, that wants to be part of the grownup table, right. That piece was all like, do this, do this, do this thing. You can do it. You can make it work.

I took the case on and after two appointments, the whole thing blew up. The conflict piece that I rationally, at least some piece of me knew would come and in hindsight, definitely should’ve known it was going to come came up full center. It wasn’t a horrific thing, but it was early termination.  

And in hindsight, I knew people. I shared office space with people that were much more skilled with this particular type of clientele and this type of intervention. If I had referred immediately to somebody else, I think it would have [01:02:00] […] better if that’s proper grammar. The client would have been happier. My colleagues would have been delighted to have this referral. I probably would have benefited from being more in the long run instead of getting paid for two appointments, somebody would refer somebody to me in the long run. I would have kept a better relationship with the person that made the referral. So, there’s a lot of pieces that come up around.

Dr. Sharp: Yeah, there are so many examples. I think I like this because it really brings it to life. And I’m guessing people are thinking through situations that they’ve experienced as well that fit.

I feel like we could just keep going. There are so many or so many of these examples of where your values get triggered or pushed however, you want to phrase it. But I want to be respectful of your time. So for folks who are like hey, this really resonates with [01:03:00] me. I want to dive into this. What are some resources that you know of? I know that you personally have some resources and then others that you may have found that you’d love to point people in the right direction?

Dr. Kimberly: Absolutely. So something that is brand spanking new that I made for this podcast is a little guy that I made called the mental health providers guide to values-aligned practice development. So you can get to it through my website which is intentionalprivatepractice.com. I’ll also give you the link specific to that guide that’s through my member vault portal. That will really help go through values, how to identify values as they come up, how to sit with values, even use a little bit of a meditative exercise to connect with values.

And then the last part of it is a values-aligned practice chart. So I have a little chart in there that you can fill out [01:04:00] where you identify the value. You set some intentions around the value. How does it show up in my business? With who, how, when how many times, you know, we can get super, super-duper behavioral. How many times a week do I want to show this value? In what way? And then If I need to, I can make a little checkmark that I did this thing that I said I was going to do.

And then this is the part that I think is super important. And this is where these plans fall apart is to think about the obstacles. So what is keeping us from aligning with our values? What makes it hard for those behaviors to play out when we’re in the trenches and doing the thing that we do every day. It’s problem-solving those obstacles and barriers are going to give us more information about competing values or competing needs and urges that come up at the time.

And by doing it reflectively and outside of the emotional response to it, I think that’s how we solve it. That’s how we move on to how do we understand all the different parts that [01:05:00] are going on with it and then move in the direction that we want?

Dr. Sharp: I agree. It sounds like a fantastic resource.

Dr. Kimberly: So that’s there. That’s a great thing that people can download. I also have a newly published workbook called Intentional Private Practice Workbook. You can get that off Amazon. That has a lot. This values piece is that skeletal piece that weaves through it but really breaks down into running a practice in terms of mindset, in terms of management, money marketing. Those are the four M’s of practice. And I think that’s a great resource if you’re getting started, if you’re looking to grow or again, if you’re in that place of I’m full, but not fulfilled, I need to refine, redefine, repurpose. You don’t have to scrap the whole practice, but maybe it’s time to reorganize it a little bit and generate some new passion for it.

And those are some resources that I have. I also have a Facebook [01:06:00] community that’s linked through all that kind of stuff where we talk about those sorts of things.

Some other resources that I like, I just think a total jam is Jon Kabat-Zinn’s Mindfulness for Beginners book. I love that book. I don’t care how much you’ve done. In each little chapter is like… The book is like 5 inches tall, maybe. It’s a little book. And then each chapter is just like 2 or 3 pages. And there’s so much wisdom and richness in each part that you could probably read that book every day and get something different from it. And that one has at least it used to, now that we’re in MP3 phase, I don’t know, but my version has a CD with it. So there are some guided meditations that you can do along with that.

Another one for more of a framework around act I think it’s Steven Harris. Is that sounding right to you?

I’m going to look it up [01:07:00] super quick. Sorry.

Dr. Sharp: Is it Hayes?

Dr. Kimberly: It’s Steven Hayes, not Steven Harris. So Steven Hayes’s books on ACT are great. I also have a book that I really like it’s called Mind and Emotions and it’s a workbook. So it’s a transdiagnostic model. And it’s great for working with clients, but I have gleaned a lot myself from using that when I’m working with clients. It’s by Patrick Fanning, Matthew McKay, and Zurita Ona. And again, it’s a transdiagnostic model, but I think it pulls heavily from ACT. It talks a lot about values-aligned behavior. So that’s a really good resource as well.

Dr. Sharp: Nice. Yeah, I’ll put all of those in the show notes so that folks can check it out. Well, thanks, Kim. This was good.

Dr. Kimberly: Yeah, it’s fun to talk about. I agree. We could probably talk about it for hours, but it was [01:08:00] neat to see where the conversation took us and I enjoyed it. 

Dr. Sharp: Good. Yeah, thanks so much. I appreciate you turning the tables a little bit and making me go through it myself. I think it’s valuable. It’s got me thinking about a lot of things here as we wrap up.

Dr. Kimberly: Yeah. Well, thank you for being a good Guinea pig.

Dr. Sharp: Of course. All right, well, thanks again. And we’ll see you in the Facebook group.

Dr. Kimberly:  Okay. Thanks. Bye-bye.

Dr. Sharp: All right, y’all. Thank you so much for listening to my episode with Dr. Kim Dwyer. I hope that you’re walking away with at least some thoughts around values in your practice and maybe even some actionable behaviors that you want to take to realign your practice with your values.

Like I mentioned in the beginning, if you’re an advanced practice owner and you’d like some accountability to reach those goals that you have set for yourself, or even define some goals for yourself in your practice now that you’ve gone beyond that beginner stage, I would love to help you out with that.

[01:09:00] I started a cohort of the advanced practice mastermind group here in the fall, and it filled pretty quickly. Due to popular demand, I have opened another cohort. We have two spots left in that group. So if you are interested in streamlining your systems, defining your processes, hiring, taking your practice to the next level, this could be the group for you. You can get more information at thetestingpsychologist.com/advanced and on that page, you can also schedule a pre-group phone call to chat with me and figure out if it could be a good fit. Again, that’s thetestingpsychologist.com/advanced.

Okay. We will continue with the business and clinical episodes. I’ve got some good ones coming up. So stay tuned. If you haven’t subscribed to the podcast, now is a great time to do that. And let’s see, the last time I checked, actually I haven’t checked in a while, we’re still just 2 ratings short of that 100 [01:10:00] rating mark in the podcast app on Apple. So if you’re still holding out and you have a minute, jump into that apple podcast app and give a quick rating, you just tap on the stars, and let’s get us over 100.

I hope you’re all doing well. I look forward to talking to you next time. Take care.

The information contained in this podcast and on The Testing Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or [01:11:00] treatment.

Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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