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[00:00:00] Dr. Sharp: Hello everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

This podcast is brought to you by PAR.

The Neuropsychological Assessment Battery offers the combined strengths of a flexible and fixed neuropsychological battery. And now you can score any of the NAB’s six modules on PARiConnect, PAR’s online assessment platform. Visit parinc.com\nab.

Hey folks, welcome back to [00:01:00] The Testing Psychologist. I’m thrilled to have a guest today talking about a topic that we have not talked about much at all on the podcast, and that is designing a practice around older adult neuropsychology.

I am honored to have Dr. Seda Terzyan here to talk to me about her practice in Orange County, California. Seda is a neuropsychologist and founder of Perspectives Psychological Services. She has her doctorate in clinical psychology from Loma Linda University. Her training emphasized both evidence-based treatment and differential diagnostics through neuropsychological evaluations. During residency, she worked in private practice settings across the developmental spectrum, working with children, adults, and older adults. Her group clinic is currently specialized in working with geriatric populations, providing both diagnostic evaluations and treatment for medically and psychiatrically complex populations.

As you can tell from the title, we primarily talk [00:02:00] about Seda’s journey in building this practice around older adult neuropsychological services. We talk about older adults and working with them in general. We talk about some of the considerations there, the topics that are most meaningful for older adults, and primary recommendations for older adults during the evaluation process.

We also spend a lot of time on the private practice component. So we talk about basics and how Seda got her start and got the train moving with referrals and business in the practice. We talk about the practice environment and accommodations choices she has made to specifically support older adults. We talk about hiring, recruiting, and finding good folks for your team when you work with this population, and a number of other things.

This is illuminating for me. We [00:03:00] primarily focus on kids but have older adult services as a component in our practice. So, this was a fantastic conversation.

I did not explicitly ask in the interview and want to make sure to mention that if anybody enjoyed the conversation or wants to connect with Seda, you can check the show notes for her email address. Make sure to reach out if you want to connect, talk about the practice, or even interested in working with her.

Without further ado, let’s talk about older adult neuropsychology with Dr. Seda Terzyan.

Dr. Sharp: Seda. Hey, welcome to the podcast.

Dr. Seda: Thanks, Jeremy. I’m excited to be here.

[00:04:00] Dr. Sharp: Me too. We have not done a whole lot of content on adult neuropsychology as long-time listeners will know. I’m excited to have you here so we can dive into that area a little bit. So, grateful for you to be here. Thank you.

Dr. Seda: Thank you.

Dr. Sharp: Well, we’ll start with the question we always start with, which is why is this important to you? I know it’s a big area, adult neuropsychology, and we can drill down within that, but why spend your time in that area of practice?

Dr. Seda: Honestly, I think for me, I fell into it mostly with therapy. I enjoy working with adults in therapy. I’ve worked with kids in the past, but I have more of an affinity for… the type of therapy I do seems to go better with adults. It’s a very different world with children, but with neuropsychology, particularly, I think there’s a big need, especially with geriatric neuropsychology with the [00:05:00] aging population and mild cognitive impairment becoming so much more of the forefront with research and everything. And the more we learn about it, the more it seems if we catch it earlier, we can intervene and help people change their lives a little bit more drastically so that we can avoid those more severe consequences of dementia.

I’m all about, let’s get people tested earlier and more often, and neuropsychology is at the forefront of being able to do that effectively. You can get an MRI and it could look great even if you potentially have dementia already. So it’s misleading at times. Imaging techniques don’t necessarily do the job that neuropsychology does in finding these subtleties. So I’m passionate about that and helping people with managing their cognitive health, and emotional health, and it’s all intertwined together.

Dr. Sharp: For sure. A lot of us pursue areas that are personally relevant for one reason or another. [00:06:00] I’ve always been a kid person, kids, and teens, but now that my parents are getting older and are having some cognitive concerns, I do find myself, my mind is drifting a little bit to much more interest in adults or aging neuropsychology kind of stuff. I don’t know if there’s any of that for you or if you just find yourself drawn more to adults versus teens.

Dr. Seda: Like I said, it was a bit of a draw to the adult population just because that’s where I enjoy and feel active as a therapist. I’ve always been a therapist first and neuropsychology has come after. So that’s what got me into that world I think more so, and then I got interested in evaluations. 

But I will say, on a cultural level, I’m an immigrant. I was born in Ukraine. My dad’s from Armenia. It’s a culture very much, I’d say, organized around, the elderly are a very important part of our culture. I’ve always respected my [00:07:00] grandparents. A huge part of our culture is always helping the older generations.

Coming here, my parents didn’t even speak English. So my sister and I were very much involved in helping with translating and this and that. And as they age, I do find myself having a warmth to these older people and wanting to take care of them. The world is changing pretty drastically. And I think, as people age, it gets more and more confusing whether you have dementia or not.

I enjoy creating a space for them to come and help them understand the process and work with them in a way that helps them still feel independent because that’s very important to me. I want people to hold on to their independence and not just get… You see it often where the children start to make all the decisions for their parents and it’s easier that way, but [00:08:00] I think it’s really important for people to keep their independence because that keeps you sharp. It keeps you more cognitively involved in your life.

Dr. Sharp: Right. It’s a two-way relationship I would imagine, like staying more independent helps keep you sharp, staying sharp keeps you more independent. 

This resonates. I think it’s just a function of where I’m at in my life and getting a little bit older myself and a little existential dilemma here, but also aging parents. All of my grandparents have died at this point. Seeing some of them go through that process, I’ve been thinking a lot about the idea of aging with dignity and what it looks like. And just struck by the potentially important role we can play in that process. You can speak to that a lot better, but I’ve been thinking about that a lot myself.

Dr. Seda: I agree. What comes up for me is what I was just talking about is, [00:09:00] families are so important when working with older adults. It’s a little bit similar to working with children. You’re always working with the family. I think family education is so important. So when I work with the older person, and then their children or whoever is helping and is part of the family unit, educating them on what the person’s going through, what they need, and what they don’t need, like I said, I think it becomes this… It’s easier, it’s faster to get things done for the person to take over, but like I said, that takes away that dignity piece.

Something I hate seeing with older adults is they get quieter and quieter and quieter and start pulling back. I don’t think that has to happen. I think there’s so many ways to maintain that level of independence even if changes are happening, but to maintain a stimulating life is [00:10:00] so important, and I think social connection is such a big part of that.

It’s not just basics, like, oh, you go to the social event. I mean, it’s better than nothing, but truly what the research shows is social connection like involvement in your community and your family, maintaining an important role, that is what keeps people healthy emotionally and cognitively to keep that connection strong.

Dr. Sharp: Sure. These are super important ideas. I think we’re going to touch on a lot of different aspects of this work as we go along, but just framing it and putting it in context. Our population is getting older. There are a lot of folks who are going to need these services as time goes on.

Dr. Seda: Yes. I think it’s important to note, I do think some people pathologize aging. Of course, I do accept none of us make it [00:11:00] alive but aging does not have to be like this disease process. It’s not typical for aging to develop dementia and all these things. Aging can be done, I believe with dignity. Of course, there are things that are out of our control, but there are so many ways to intervene early. It’s all about education out there to inform people of what’s the most important thing to maintain cognitive health and emotional health.

Dr. Sharp: Right. Since we’re talking about this, I want to talk a lot about your practice, honestly, how you’ve built that and developed it, but we’re diving right into almost recommendations, I suppose, at the end of an eval. I’m willing to go with this for a little bit. I’m [00:12:00] curious since we’re here, there’s a lot of nuances to the battery and the testing and everything. I don’t know that we want to get in the weeds with that necessarily, but as far as recommendations and how you are working to support older adults as we finish the evaluation and they move on into the community, what are the high-level, big picture things that you’re thinking about?

Dr. Seda: It all depends on each person, some more, but I’d say overall, one of the big things I like to do is I always like to involve the family in that process to make sure the family has a really good understanding of what’s going on for the person, what we want to help create for the person because, for the success stories that I’ve seen, the family has been more involved and much more open to helping the person make some changes.

 I’ll say, a big [00:13:00] thing I find myself recommending is to help develop more of a healthy routine and structure because again, I find that it diminishes with age, especially as people retire, lose social connections, friends are dying, their world starts to shrink down. I find there’s this change that goes towards more passive activities rather than active ones. So you’ll see people, they’ll be spending more time watching TV and doing these types of activities that pass the time, I guess.

What I end up recommending, the main thing is that let’s create a structure where you have a morning routine, you have an afternoon routine, and an evening routine high level and then really work to identify those pillars of health. Like, are you exercising? What is your diet? Making sure, are we eating [00:14:00] at a consistent time throughout the day. And then again, incorporating that social piece.

So, sometimes I’ll work with families to say, hey, can you guys set up a time once a week or twice a week so the client knows, I know we’re all going to have family dinner once a week on these days. And it’s something you learn is going to happen. That consistency is really good for people that are struggling with some cognitive changes.

And then, of course, it’s support groups. I’ll find support groups in the area. A few of the community hospitals here have some good resources. Some people are more willing to do that, some aren’t. I’ll say the senior centers also have a lot of good programs. If you could just get people past this… some people have this block around, like, going to a senior center. So introducing them to like it’s just a place where people network, hang out, and do things. Once people get past that initial stigma, [00:15:00] it can get them going and reconnected in their community.

Another big challenge is, if people have any kind of mobility issues, I’ve noticed a lot of older people resist using walkers. They’ll try to keep using their cane as long as possible, even if it’s creating significant limitations for getting out in the world. This has come up so many times now, but we’ll sit through and talk about the pros and cons of accepting the walker to be able to get out there more verses again, fighting these stigmas around aging. It’s amazing what I’ve seen. People will not go out there and not do things just because the stigma is so strong around being out there with a walker.

Dr. Sharp: I would imagine that’s where being a therapist first comes in handy because [00:16:00] that’s the loss of identity stuff, self-esteem, and who are you without… There’s just so much wrapped up in that and being able to support people through that would be crucial.

Dr. Seda: There are so many identity shifts in aging. I think retirement is one of the big ones I see often. That’s one of the first hits. And then there’s a series of others that follow. The way people deal with the adjustments, I think everything in life ends up being an adjustment disorder. However you adjust determines where you’re at, but there’s a lot of them that hit people in the later years that we sometimes forget about. There’s a lot that emotionally and mentally has to be coped with. It’s not just, oh, people are developing dementia or aging. It’s also a lot of these stressors that are coming and how people are responding to those makes a big difference.

Dr. Sharp: 100%. As we talk about recommendations and keeping people healthy as long as possible, I think [00:17:00] about that book outlive. I don’t know if you read that or heard of it. 

Dr. Seda: I’ve heard of it. I haven’t checked it out yet though, but yeah, I’ve heard of it.

Dr. Sharp: This concept he calls health span. So it’s not just lifespan, but health span and the three pillars. It’s basically relationships, diet, and exercise and making sure those are dialed in.

Dr. Seda: It does. It sounds so simple, but it’s not as simple as it sounds in reality to make all that happen. It’s really difficult. And that’s what it is. These things make it sound simple, but to me, it comes down to how are we in our lives day to day. How do we take care of ourselves? What our relationship with ourselves is really what determines it.

Interestingly enough, I went to Loma Linda University for graduate school. Loma Linda is considered a blue zone in the US People living into the 100s. I was involved in a study there [00:18:00] with professors doing research studies. A lot of people do research on that population. Again, it comes down to, a lot of studies trying to differentiate what are the factors.

There are a lot of 7th-day Adventists in Loma Linda; a lot of community around the church. People tend to keep these strong social connections alive. Interestingly enough, 7th-day Adventists, they’re vegetarians and they don’t drink caffeine. Many of them don’t smoke, or drink. So all these health things are well controlled in this population. Lo and behold, they’re living extremely long and healthy.

Dr. Sharp: Right. And we play a crucial role, I think, in helping folks go down that path if they want to.

Dr. Seda: Yeah. I think emotional health is such a big factor in whether or not people will take care of themselves; whether or not people will exercise or eat right. If you don’t like yourself on a basic [00:19:00] level, or you’re just so stressed out, the last thing on your mind is I need to eat right or I need to take care of my body.

Dr. Sharp: Of course. We have a neuropsychologist in our practice who works with older adults primarily, and she talks about the immersion in conversations about existential angst, dying, losing people, and so forth. I wonder if that’s true for you as well that these are just topics that you get comfortable with as someone who works with older adults.

Dr. Seda: Yeah. I think you have to be. In a way, honestly, I think you have to be no matter what, if you’re a therapist.

Dr. Sharp: I think you’re right.

Dr. Seda: It comes up just as much with my younger people as it does with my older. If anything, strangely enough, I’ve had a lot of experience with older adults where they’ll talk about their mortality in such a matter-of-fact way that it almost [00:20:00] makes you feel anxious because they’re so at peace with it. So there’s an interesting thing that I… That’s what I’ve noticed more so that is striking is at peace with it for some, not all, and of some of them, just a welcoming, because maybe a spouse has passed and they’re like, I’m ready.

I think some clinicians could confuse that as suicidality, you do have to be careful with this, but I don’t see it as that. I think it’s something very different and I think it on some level does start to make sense, but helping them find purpose now is so important, rather than, it’s like, you’re checking the clock for when you get to leave. That’s not healthy.

Dr. Sharp: You’re right. That’s a fine line.

Dr. Seda: It is. Somehow, it’s almost like I’ve had more experiences of the opposite end of it where the older are a little more looking forward to it in a way, [00:21:00] in some cases, not in a depressing way, but they’ve come to an acceptance, which I think is not a bad thing. Whereas I have younger people that have extreme angst about what if I die? Who’s going to take care of my kid? Whatever issues I see more often in middle age adults. I see that more.

Dr. Sharp: Yeah. It’s relatable. But not about me. Let’s let’s pivot to your practice a little bit. I would love to hear some of the ins and outs of building a practice around older adults and older adult neuropsychology. I would love to hear a brief bio of your practice. Can we start there?

Dr. Seda: Sure. I’m trying to think of where to start. A lot of my experience is through practicum internships. They all ended up in the adult realm. I’ve had a few pediatric [00:22:00] experiences.

On postdoc, I worked with a lot of geriatric patients. That happened to be the population at that time. Also at Loma Linda, I did work at Loma Linda Hospital in their rehab unit. And again, ended up working with a lot of older adults. I was dealing with not only an adjustment to whatever trauma they’ve just gone through physically, or stroke or TBI or something. It ended up being a lot of older adults.

That was probably my big introduction to that world of working with families, helping older adults navigate and making sure they’re understanding, making sure they’re making decisions and they’re not, for good or bad intentions, being influenced too much from their family, whether well-intentioned or not. I became very aware of that at that point of how important that is to make sure they understand they want to do it whatever way they want to do [00:23:00] it.

On postdoc, I did more outpatient. It was all outpatient. We got a lot of our referrals from neurology. That’s where I realized neurology and neuropsych have a lot of overlap in terms of the patients we see and the conditions we treat.

Once I was licensed, which was during my postdoc experience, I started to see patients. I found a little space. I am living in Orange County. So I found a space, I think it was in Corona Del Mar. I found one little office space. It’s great. Really nice. I loved it but it was tiny. And I started seeing therapy patients. It was easier to start as a therapy practice. Neuropsychology has a lot of materials and things, and expenses involved. As I was seeing therapy clients…

I honestly [00:24:00] started seeing therapy clients from Psychology Today referrals. I was already working at other practices doing some contract work. As I got my own space, I transitioned there. Some people followed and some people didn’t, that’s just how it works. But Psychology Today was a great resource for me starting in therapy. I did get a lot of referrals from there for therapy clients. But I wanted to build the neuropsych side. That’s what I wanted to do. I wanted it to be a neuropsych practice.

In retrospect, it seems serendipitous how things happened, but if I think about it, there was a lot I was doing at the time to position myself for these encounters or meetings with certain people. I even joined a BNI- Business Networking International group. I did that for a few years trying to get entrenched in the community. It ended up being a cool experience [00:25:00] where I wasn’t working with other psychologists and neuropsychs. It was just real estate agents, and attorneys, but just learning. It was a really cool experience to just do that.

Through all these efforts, I did meet this really cool neurologist who at the time had a practice, I believe it was Mission Hospital, a small outpatient practice. And he just said, I have a lot of patients that need neuropsych and I don’t know anyone to refer them to. So I came in-house and started doing neuropsych for his patients as a contractor.

I started off there. I already had my practice doing therapy and through that, I think it was about a year or so that I did that, as that practice was closing, there was another neurologist that was working there and we were there on off days. We never actually met. But he saw some of my reports. So as we were leaving that practice, he said, Hey, I want to send you more patients. Are you [00:26:00] seeing people?

That I define as the point where it started the neuropsych side. This doctor started sending me referrals. I started getting rather full and I very quickly jumped on getting credentialed with insurance. So that’s where that started because this doctor is like, I have these patients, but they want to be seen through their insurance. And I already knew this, but that was the fire that was like, I need to get paneled with some insurance so that I could see these patients.

So I did. I got with Medicare and started to work on these hospital HMOs. He helped me introduce me to some people at certain hospitals in the area and got medical staff privileges. And it started taking off. I will say, I knew I was going to take insurance, but it was at that point that I got on it. 

And the reason is I [00:27:00] had experienced, even on postdoc when you’re getting referrals from medical professionals when you don’t take insurance, it creates a really difficult bridge to cross for patients, especially when I think we talked about a little before, but especially with geriatric referrals, the testing that we do isn’t necessarily for the patient, it is, but it’s a referral question. I’m serving more so the neurologist. The neurologist wants to know, hey, what’s going on here? So they’re sending the patient for an MRI for an EEG for neuropsychological testing. We’re one of those specialty stops for the patient.

It doesn’t even necessarily make as much sense in this field to charge the patient directly because it’s such a specialty report. I write my reports to serve the patient 100% with the recommendations and all of that, but I guess that’s how that works. The patient sometimes is [00:28:00] like, why do I even have to do this? It’s a different vibe from when I worked in a pediatric outpatient unit. They’re coming to you. The parents are coming. They want to know. It’s a very different interaction.

Dr. Sharp: That makes sense to me. That’s an interesting perspective that we’re serving the provider versus the patient, but I get where you’re coming from. You live in this world more than I do, but even doing consulting, I haven’t found any older adult neuropsychological practices that don’t take insurance. It just seems really hard.

Dr. Seda: Yeah, at least medicare. It would be difficult. I don’t know how they would, I think therapy is a different animal, that’s different. You could probably build a practice for any age range for therapy without insurance. But for neuropsych, I would be very difficult.

Dr. Sharp: Right. I want to go back and put a fine point on the [00:29:00] getting started part where it seemed like these neurologists played a pretty huge role in launching your practice, so to speak, and just making sure.

Dr. Seda: Yeah, and I guess me seeking them out. I think when I acknowledged that that’s the connection I wanted, I started putting myself in those situations just because I could. They were already ingrained in the medical system that I was striving to get integrated into. And that’s such a big goal I still have to have more of the seamless integration. So it’s not like medical and then mental health that we’re all sort of intermix, which I think is how it just should be. I don’t think there is a…There is no difference between mental and physical health. They’re one thing. I like collaborating with people, especially people in interdisciplinary side. I just think it’s really fun.

Dr. Sharp: Well, and it’s just nice to have the full picture or as much of the picture as you can. 

Dr. Seda: Yeah, it helps. I have access now [00:30:00] to the notes like APEC; the hospitals use APEC. I get to get access to that. I could easily find MRIs that they’ve done and all this testing. So it’s all there. And it’s so nice to have all the information. The patients love that too. When they come in, you actually know who they’re seeing, what they’re diagnosed with, what medications they’re taking. It makes the process so much more connected.

Dr. Sharp: Absolutely. You mentioned the hospital privileges a little bit ago, and I wanted to ask you about that from a business development standpoint, but also because I am so jealous because we have such a hard time getting records from people. I would imagine being plugged into the hospital system has some real advantages. So I’m curious, just for anybody who might not know, and I include myself in that, what exactly does it mean to have hospital privileges [00:31:00] in this context? And how did you make that happen?

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Let’s get back to the podcast.

Dr. Seda: Yeah, it’s complicated. I’ll use the easier example. We provide neuropsych [00:33:00] consultation inpatient services at St. Jude Medical Center. That’s in Orange County. So that is how that first connection happened because we had to have privileges to work inpatient and they needed that, they don’t have a neuropsych in place, they’re contracting us to do that service. Basically, it’s like a credentialing process like anything else. So you go through a credentialing process with the hospital, but we obviously have this purpose, we were asked to serve this inpatient population.

So, you go through the whole credentialing process, but obviously, we had someone that was inviting us in. So I’m not quite sure how that would work if you can just apply to be medical staff or something. I’m not sure how that goes, but it’s a credentialing process. And then you get the privileges that you need. [00:34:00] So if it’s inpatient privileges with other hospitals, the privileges aren’t that specific. I’m considered medical staff and I’m able to take patients on their HMO. So I can see patients that are credentialed with that hospital so I can see them with that.

And you get other privileges. You get your badge. You have some access to the hospital. You can go to the cafeteria, that kind of thing. I don’t have admitting privileges. Obviously, if you’re a psychiatrist, you would need that, but it’s things like that that you would get. 

Dr. Sharp: Got you. That does sound similar. We have done some work with an outpatient clinic that’s affiliated with a local hospital and very similar process. We were also invited in though, and that sounds like a crucial part of this. Who was it that invited you so to speak?

Dr. Seda: I had done some work with St. [00:35:00] Jude before on postdoc. I had been acquainted with some of the people there and they had then found out that I had an office that I’d set up in Fullerton, which is very close to the hospital. It became this connection that was made. Are you doing this? Are you able to do this? And it happened from there.

Dr. Sharp: Great. It sounds like you’ve got your hands on a lot of different things, even though it’s all around this theme of older adults neuropsych, right? Would you say that most of your referrals are coming from neurology and other kind of medical folks, or is there another main referral source for older adults or what?

Dr. Seda: I’d say that’s our main one. It does tend to come from neurologists. I will say probably the second popular is primary care doctors that are serving other people because they’re the first ones that [00:36:00] see if there’s some issue and people are saying, I’m concerned about my memory.

Neuropsychology is out there, but it’s not as well known as if someone has a memory problem, send them to neurology. And so I find what happens is primary care will send them to neurology. The neurology will send them to us to get the clarification, but sometimes they’ll come from primary care directly.

We do get adult referrals as well. A lot of those come from psychiatry or people find us themselves. I get a lot of requests for adult ADHD testing. That’s a popular one right now.

Another one that I’ve seen quite a bit of, and that’s from neurologists or primary care as well as people with Long COVID and all of that. That’s a really sad, interesting population, but we’ve had quite a few of those come through.

Dr. Sharp: Same here. We’re starting to see those pick up as well.

Dr. Seda: Yeah.

Dr. Sharp: Talking [00:37:00] more about about your practice. I love the origin story. It’s like a lot of us. It’s this combination of being in the right place at the right time and then putting yourself out there and having the skill and it lines up, but you took the leap. Now you have a group. It seems like you’ve been deliberate about building this group and creating a certain vibe to serve this population in particular. Can you tell me about that journey and how you took the leap?

Dr. Seda: Yeah. The leap, I don’t even know, it didn’t feel like a leap at the time. I feel like I was so careful, like, okay, now I could get this space. So it felt very careful, but I agree, it was a leap. And then it felt like a flood and then keeping up with the flood that’s happened. To me, it felt almost like the train started moving and I was on the train. I had that feeling. I’m almost trying to slow the train down to [00:38:00 get oriented to what I’m trying to do so it doesn’t get too much control. 

I have always felt very intentional about what I wanted to create in terms of the client experience as well as the provider experience. I think that a lot of that happened just based on a lot of my experiences coming up in the field. I always think of this time where I was doing these evaluations. They were long evaluations.

I feel like everything in grad school is like these massive comprehensive evaluations and so unnecessary, but that’s what we did at that time. It was like a storage closet. There’s this tiny room with stuff everywhere, no windows. It was just so uncomfortable. Like, why would we do… I’m like, I never want to do this. And so many of [00:39:00] the experiences were like that. And that was the same for therapy as well. I’m like, how could you do work like this? 

Dr. Sharp: I get it. I feel like it must be a conspiracy of some sort between graduate program. Our doctoral program was in the basement of this cement block building. It was tiny, it was cold, it was sterile and I’m like, what are we doing here? This is a terrible metaphor for trying to take throught to better place.

Dr. Seda: Yeah, and I was always so stuck by that. I’m like, we’re in this field where, we should know better than to put people in this environment. I don’t know. So, for me personally, the environment always had an impact. I mean, you get through it. You’re in survival mode. When I look back, I’m like, I’ll get through anything. I got to get this done. And you don’t notice necessarily at the time. But when I look back, I’m like, I really don’t want that. That must not have been good for anyone in the situation.

[00:40:00] Dr. Sharp: Just like many other things in grad school, we just do it and don’t question it.

Dr. Seda: It’s sad. I have a lot of thoughts about that too. Why are we doing that to our future creating this unnecessary stress sometimes? I think there’s just a better way to do it.

Dr. Sharp: I agree.

Dr. Seda: I think on a basic level, that was one thing. I’m like, I want to create a space where the providers come to work and they feel healthy, there are windows, and they don’t feel like they’re in the stressful, like, I have to see a million patients today, or all this stuff that I feel like was not conducive to the work we do.

Again, this is my experience, but I don’t do well personally if I see too many people back-to-back in one day. I’ve definitely pressured myself to do it in the past, but particularly for therapy and for more difficult.

I will say, we see pretty complex patients psychiatrically and medically, [00:41:00] and we’re often giving people some bad news when it comes to their diagnoses with cognitive issues. It does have an impact. I’m very aware of that. I try to create an environment and space and a support space too to make sure that providers can come talk to me or can talk to each other when things like this are happening because I do think it takes a toll. I think it leads to burnout if you’re not careful with overdoing this type of work that we do.

Dr. Sharp: Absolutely. I think that gets lost sometimes the environment and the atmosphere for providers. And it sounds like you’ve been deliberate about it, though. I think there is research around windows are one of the top three…

Dr. Seda: I’m sure there must be.

Dr. Sharp: … best features of a job or something, like, does it have windows? And that’s highly correlated with satisfaction. So even simple things like that, but then the community aspect and making sure that folks have [00:42:00] support and ability to consult or talk with one another.

Dr. Seda: Right. And that piece I’m trying to keep growing. I try to be deliberate about, let’s do monthly meetings, let’s go have lunch, let’s go be somewhere out there and get out of the space. That’s where I want to grow. I have this vision of this great group of people hanging out and working together and able to consult with each other, not in a strictly professional way, but in an authentic way, like, hey, that really hit me hard today. I need to process this. And again, I guess that’s where the therapy first comes in.

I do look for this when I hire. I do feel with the population that we serve too strong of a diagnostic value system doesn’t always work too well in this setting. [00:43:00] I look for people who have a therapeutic lens that they look through or that they start from when they work with people. Those are people that I connect with more easily in general. So that’s probably part of it as well.

I’ve learned a lesson, which is I try to bring people to the team, this might sound selfish, but I try to see, do I connect with them. That’s one of my pillars for deciding is this person a good fit. There’s others, but I find that that always works better. Like, do we vibe, do we connect? Because if we do, we’re probably going to be a good fit in this atmosphere. 

Dr. Sharp: Yeah. Well, it’s funny you say that. I don’t know if it’s selfish or what, I do the same thing. Before I knew what my metrics for hiring were, that was the original metric. 

Dr. Seda: That is good to know. I missed that initially. I would look at competencies. I totally disregarded that. Honestly, I was just [00:44:00] like, well, that doesn’t matter. I’m looking for this, this, this, and that. I had to reverse and say, no, it does matter. It’s a really good way to gauge where a person is at.

Dr. Sharp: I agree. I would imagine building a team around it with you or the owner is the hub in the middle. If everybody gets along with you pretty well in different iterations, they’ll probably get along with each other too. And then that contributes to better outcomes.

Dr. Seda: That’s the goal.

Dr. Sharp: For sure. We’re dipping our toe into the hiring and recruiting process, which I think is hard for a lot of folks right now. There seems to be a lack of neuropsychologists.

Dr. Seda: It is so hard right now.

Dr. Sharp: I’m curious how you are finding folks. If it’s [00:45:00] deliberate or them coming to you or what recruitment process.

Dr. Seda: I got lucky with quite a few. I think that it’s done. The luck is over. I can’t keep counting on my network. That’s where I’m the most comfortable. I love that I had a lot of people that I knew through my network or someone that I trusted. That’s how it worked for me in the beginning. And if I want to keep growing, I need to branch out. I’m not as comfortable in that. I like the idea of knowing the person.

As my practice has gone on, I’ve gotten a little less protective in that way. Maybe it’s loosened up some of my anxiety about who comes in. I’ve accepted that I have to open this up a little more. If I want to create that kind of team that I want, I can’t be so like, I have to know who you are personally before. I am more comfortable with that now, but I’d say in the beginning, I wanted [00:46:00] to have people that are strictly part of my network, and that worked out, but I will say, it’s just harder now if I want to keep growing.

Something that I do, I’m not sure what this is about, but I do have an affinity for providing an opportunity for new graduates coming into the field. Maybe I’m not that far away. It’s been a while, honestly, now that I think about it, but I still feel close to that time in my life.  I think there’s a bit of an interest or a passion I have for having people come after postdoc to have a space where they can have this type of experience, so I do end up recruiting or trying to recruit at least, I’ve been trying to set up meetings with PsyDs that do postdoc training for neuropsychology or even just grad programs, like alumni and things like that. [00:47:00] That’s been my technique in the past, but even still, I feel this need to branch out and who’s out there.

Dr. Sharp: That’s fair. I think I’m going through a similar process.

I wonder about the interviewing process. Once you get in front of people, or they get in front of you, you mentioned the vibe check, which is great. Are there other things knowing that you work with older adults that you’re looking for either personality-wise or ways you structure the interview to gauge individual ability to work with that population specifically?

Dr. Seda: Yeah. The vibe test is a big one. I like to use vignettes. I hated when people did this to me when I interviewed, but I think it [00:48:00] has utility for sure, especially with some of these very common older adult situations that come up and have come up with people that work with me. I’ve seen people respond to them in very different ways. So that’s where I like to use that to ask people, what would you do if this happened? Or what would you do if that happens?

It’s not even as important to me necessarily. The answer does matter, but just gauging how they respond. I always find that I look for, are they exuding warmth in whatever interaction that they’re talking about with this vignette. If I notice more of coldness or too much directiveness, like, well, we have to do this now, or we have to get this done because you need this testing. If I notice too much of this rigidity to get the work done before [00:49:00] being with the person, making sure they understand why they’re there, being flexible and saying, I want to work with you. If we can’t do this today, I can have you come back, or let’s do a little bit today and then we can reschedule and get you in for more later if you’re too tired.

There’s so many of these situations that come up and I’ve noticed when people have a more rigid approach, it just never goes well. The person gets upset, especially if we are dealing with some dementia. There’s a lot of agitation that’ll come up. So I think you have to be very good at de-escalation to work with adults that have dementia or in that spectrum. If you’re not good with de-escalation, you’re not going to do well with that work. So that’s something I look for, but I’d say flexibility is a word. I’ve been having it in my values for my company. Flexibility is so important to me. Like, are you a flexible person? Do you like flexibility in your life?

[00:50:00] Just the way the clinic is structured for providers, I’m passionate about, I want you to tell me when you want to see clients, what times work for you, how many do you want to see a week. I want people to control this for themselves. I don’t care where you write your reports. Do it wherever you want to do it. That’s my vibe. I want that in the clinical realm as well. Worst case, if this patient is not there, you have to let it go, or we have to be flexible about this and not get so rigid that you have to get this done today. 

Dr. Sharp: I think that’s a great point. We work with kids. It feels pretty relevant there too. You have to be flexible.

Another thing that we have found is, I’m curious about your experience here, I don’t know what your admin team looks like, but we’ve had to recalibrate maybe our [00:51:00] admin team as well because we found that older adults need more time on the phone and they want us to mail paperwork instead of sending it over email or electronically. And they, personality-wise, need a lot more warmth, support, and flexibility. And so we’re finding it on that side of things too. I wonder if that’s come up in your practice. 

Dr. Seda:  Oh my gosh, I’ve gone through so many admins. It’s just that patience is so important to be a patient person and to be flexible and go with the flow. I have a great admin right now. I get such good feedback because she’s very warm, very patient.

Do we push for getting people to do the forms online? 100%. I was telling you before I use IntakeQ. It’s a very simple process. [00:52:00] Sometimes what we’ll do is, if the person’s struggling with it, we’ll at least first ask, do you have someone that can help you try to do this? Because it’s going to be easier for you to do this now online. If I send you the paperwork, you’re going to be more overwhelmed with the amount of pages you’re going to see. It just doesn’t look as long online.

We do encourage, as a last resort, once they come to the office, we have a nice space set up for that purpose; a little sitting area with a desk and a pencil and a pen for people to sit and comfortably do the intake paperwork because it happens often enough that we just have to accept it.

Another one is, we do often, with payment stuff, we try to get insurance cards, a credit card on file prior, and that sometimes doesn’t happen. I’ve had staff that were so rigid about this, like, well, we can’t book you if you can’t. We’re like, we don’t need to do that. Just let it go, [00:53:00] They’ll come in, once I explain it to them in person, they’re not going to be afraid of it anymore. We have to accept that there’s this generational difference around trusting technology.

Dr. Sharp: I’m so glad you touched on that. We have, not a lot, but a substantial portion of our older adults are very cautious about giving us credit card information over the phone, which makes sense, right? There’s all this information out there about older folks getting scammed and taken advantage of. But when it comes to the practice flow, I’m like, that’s falling outside of our workflow and we got to figure this out. But it’s just part of the deal. 

Dr. Seda: It is. And if you create a thing about it, you lose people or they come in with the wrong impression if there’s too much of this. It is what it is. What I found, honestly, though, with my [00:54:00] admin right now, she is so warm and inviting and patient that many more patients have been completing it and have gone with the flow, whereas that was not the case before where it was maybe a little bit more pushy and we have to have this. It’s made such a big difference.

I’ve also given her more of a language for how to explain to them why we need it, what’s the importance of it, and also that we’re okay. You can give it when you come in. When they hear that you’re not pushing them, they often are like, Oh, fine, I’ll just …

Dr. Sharp: You mentioned a lot of environmental tweaks or decisions to support your population. Are there other things that you’ve done with your environment, either the space or the layout or even technology or lack thereof that you’ve done purposefully to cater to this population?

Dr. Seda: I like using technology as much as [00:55:00] possible. I have been using the iPads and Q-interactive since that was a thing. I like doing everything digitally. The big things have been being flexible too. That’s just not going to happen. Everyone’s not going to do it. So we just have to let that be part of the practice.

I’m always trying to find ways to just simplify it; simplify the paperwork, simplify everything to make it more likely that people will just do it online and go with that flow. I’d say that I don’t think I’ve done anything too much more special than, like, I said, having my little desk for people to do their paperwork. That’s been a big one. It helps.

Dr. Sharp: Yeah. It’s little things like that. It does a nod like, Hey, we were thinking of you and what you might need and there’s a space for that. I’m with you.

So, you mentioned trying to slow the train down at this point. [00:56:00] Say more about that from a business development standpoint and maybe what the future looks like for your practice. It seems like you’ve mastered the launching and the growing and now it’s what happens next?

Dr. Seda: I felt like it just got going so fast which is a very good problem to have. I can’t complain about that. I always found myself in the struggle of trying to get into the, and you would know about this, getting into the more creative side of business development, but being so inundated and having so much clinical work you’re doing that it’s just…

I had to accept this at some point. I always thought, oh, I could just see a client and then sit down for an hour and do this and then switch back. It’s not that easy to switch between those hats, right? It’s that creative mindset. I feel like I need to dedicate [00:57:00] a few days to be in that mindset to think about where I want things to go. What am I doing? I want to drive the train more instead of the train, I’m just a passenger in it, which is sometimes what it feels like.

I could let it be the way it is because it’s going fine, but I think I want to control it more. I want to get back to having more intentionality in building connections with providers. I want to build a team that is cohesive and more long-term term too, that stays together and grows. I’d like to have more of a training experience, not lower-level training. I want to keep it to the postdoc level. I want to have an infrastructure in place for that [00:58:00] to happen. I’ve done it making it happen here and there, but it feels so scrappy. I want to step back and do it right.

I’ve more recently become very intentional. I take the last week of the month, and I try hard not to book clients, like, really hard. I still end up doing a little bit, but I take that week and I try to do development. I let myself think and come up with ideas and concepts and start implementing them instead of pretending I’m going to do it if I don’t block the time because I just won’t. It’s not possible.

Dr. Sharp: It never happens. I know the story

Dr. Seda: I have a baby now. That probably is what pushed it. Once I had my daughter, I was like, I do not have the luxury of time anymore. I used to be able to do things at night and the evening and it just doesn’t. I’m like if I [00:59:00] don’t book it, it won’t happen. And it’s been a blessing, really positive for me to have that structure.

Dr. Sharp: That’s good to hear that. It’s almost like kids, especially little kids force you to take a real close look at your schedule and make sure that it’s working for you.

Dr. Seda: Yeah. I was very much a victim of, I forget the theory that this is called, but essentially, if you have the time, any one task will fill the schedule and take off that entire time. I was guilty of that. I’m like, Oh, well, I have this report and I have all day to do it. I’ll work on it all day. And it’s like, you don’t have the luxury of that anymore. And you didn’t need that whole day to do that. 

Dr. Sharp: I’m with you. This is super commonplace for practice owners is how to find the time to do the business, to work on the business. 

Dr. Seda: Yeah. I just wanted to be… I’m not even super clear on it yet, but ​[01:00:00] I want to bridge the gap between the medical and mental health world. I feel like it’s been fun because I do feel very integrated with these medical professionals. I feel like I’m one of them. It doesn’t feel like this I’m proving myself thing that I’ve experienced when I was in training. It’s very natural and it feels awesome. I want more providers to be in that world. I loved it. We’ve had those.

Insurance is a big struggle. It is what it is, but as much as I hate it, I still see it as such an essential piece to accessibility for people. It’s just that I wouldn’t be seeing the people I’m seeing if I didn’t take insurance. I wouldn’t see the complexity or the ease of connection. None of that would be there. I don’t think it would if I wasn’t able to take so many insurances from people.

[01:01:00] Dr. Sharp: Sure. I want to go back and double-click on that. I don’t know if you use the word imposter syndrome with working with the medical community and you said it was seamless. I wonder if there was more of a process around that. Like if you ever felt a little bit of imposter syndrome or maybe not. I’m just curious how you got over it. 

Dr. Seda: I felt it a lot through various experiences I’ve had in going through internship, postdoc, all of those experiences and jobs because I didn’t feel integrated. And that is what I hated so much about those times. It felt like neuropsychs would come and consult with the team, but I always felt like we were on the outside. I felt like I always had to prove myself or the supervisor. Even I had this feeling I had to prove why this was important to the [01:02:00] team. I always had this feeling of needing to justify why I was there in a lot of experiences. That comes with imposter syndrome. So I’m like, well, why are we here? Clearly, they’re fine. We don’t need to be here.

I think it’s not there anymore because I do feel so needed by these providers. They sought me out in a way. I was positioning myself, but they’re like, we need neuropsych, or we need somewhere to send these psych patients. I get all kinds of referrals. It’s sad, but the psychologist does become this catch-all, like, if the Medical side doesn’t know what to do with someone, they end up sending them to psych. It is what it is but they need it. They recognize the need, which I think I haven’t noticed before, or maybe it was just where I am in my professional development that [01:03:00] it’s different. But I never felt like I was trying to prove myself or prove why services are needed. I think it’s been very understood that it’s needed.

Dr. Sharp: That’s fantastic. Well, that goes a long way to feel needed or wanted a lot.

Dr. Seda: Instead of forcing herself; Hey, this is why you guys need psychology. It’s like, why are we doing this? Of course, you need it.

Dr. Sharp: Yeah. Well, from what I know of the history of neuropsychology that is baked into the history and the lineage are trying to prove ourselves as a legitimate field to neurology and other medical professions. And so it makes sense from that perspective.

Dr. Seda: It does. I think we all carry that still. I do think it’s there, but it has been interesting, maybe it’s the team of people I’ve found myself with. I mean, it still does come up here and there, of course, but overall, it’s not been very present for me [01:04:00] that feeling, which I’m very happy about, because I didn’t like that. I didn’t like that feeling. I didn’t want to be in places where I had to do that. It just felt so uncomfortable. It’s nice to be valued, right? That’s what you said, needed or valued. It feels good.

Dr. Sharp: Absolutely. Well, we’ve covered a lot of ground. I feel like we’ve talked about a lot of aspects of this practice and this work. I’m grateful to be able to have this conversation and dive into the nuances of a mainly older adult neuropsych practice. So, thanks for being here.

Dr. Seda: Thank you so much. This was fun.

Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.

If you like what you hear on the podcast, I would [01:05:00] be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.

If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.

[01:06:00] The information contained in this podcast and on The Testing Psychologist website are 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 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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