96: Building Self-Trust as a Therapist in Private Practice
Updated March 2024
Why Therapists Struggle to Trust Themselves
When therapists are in training, they are often told not to trust themselves. Therapists in training are advised to follow the manualized interventions precisely as written, re-route personal questions back to the client, and avoid sharing anything of themselves.
While manualized interventions certainly have a place in clinical work, therapists are taught to question their inner wisdom during clinical training. Even “rapport building,” when therapists connect with their clients to create a climate of trust and understanding (Zakaria & Musta’amal, 2014), is limited to a handful of prescribed questions.
I remember sharing with a clinical professor that responding “what makes you ask” when a young client asked me how old I was with the client deflating are retreating from our work together. I’m a mixed-race woman–those are things I can’t easily “hide” in the therapy room. When appropriate, I have no problem disclosing to a client that I have struggled with mental illness. Humanity and connection are a cornerstone of the therapeutic process, but it’s been so sterilized in therapy practices that it can feel cold.
It’s no wonder that therapists struggle to trust themselves, especially when being a private practice owner. When transitioning to owning a private practice or learning strategies to grow a private practice, many therapists do what we do best: research what someone else does and follow that model.
Reassurance Seeking
One of the most common ways I see private practice therapists limit their self-trust is reassurance seeking. Reassurance seeking is when a person seeks out proof that things are ok by asking others, asking themselves, or researching. In private practice therapists trying to fill or grow their practices, I see therapists lean on external validation and researching as the most common forms of reassurance seeking.
For reassurance-seeking as external validation, this looks like a therapist asking their peers, supervisor, or others in the online space if what they are doing is ok. These self-doubt questions look like “is it ok to leave insurance panels?” or “when is it ok to raise my rates?” or even “am I a bad therapist if I don’t want to work with X?”
Frequently looking for evidence, either in online forums, groups, or via google and Reddit, is another way therapists seek reassurance on the business side of their practice. Examples of this include spending too much time debating between EHR companies, trying to figure out the right shade of blue for their logo, or coach- and program-hopping. Coach and program hopping looks like a therapist going from coach to coach or program to program, seeking reassurance from them on how to run their business.
Therapists with Low Self-Trust
Self-trust is when a person can trust in their own knowledge, feelings, beliefs, and values. When therapists don’t trust themselves in private practice, they can experience negative self-talk, and their practices can suffer too. Here are some examples of how a therapist in private practice might have signs of low self-trust. They . . .
Seek external validation and advice from others “more successful” in private practice
Ask for additional information and opinions when deep down, they know what they want to do
Underestimate their unique skillset and its contribution to a successful practice
Hold off on raising their rates, reducing their caseload, or changing their schedule until they get enough validation from others that it’s ok
Engage in distraction or avoidance when it comes to taking action on something in their business that makes them feel uncomfortable
Underemphasize their own thoughts, feelings, and insights about what’s best for their practice
Self-Trust Mindset & Exercises
Instead of reassurance seeking and self-doubt, I invite private practice therapists to strengthen their self-trust. When I coach and work with private practice owners, the business strategies and tactics that work best for them are the ones they can trust feel good for themselves!
Cultivating self-trust can happen via self-trust mindset practices or self-trust exercises. A few that I like are:
Finding a self-trust mantra that works . Not all mantras are created equally. Some feel really cheesy or just aren’t applicable. When I was a student, my test-taking mantra was, “you know more than you think you do.” To this day, I use it when I’m giving a presentation, getting ready for a new client, or doing something like this and recording a podcast!
Ask yourself a time-based question to help elicit an answer. For example, “If I had to choose a logo by the end of the day, which one would I choose?” or “If my website went live tomorrow morning, what would be the most important thing to have included?”
Practice self-compassion by celebrating wins. Most therapists are versed in the importance of practicing self-compassion, but we rarely celebrate our successes. By including self-praise, you can strengthen that inner voice that says, “wow! You did it!”
Congruence check-in. Ask yourself if what you’re doing in business aligns with your business and personal values. For example, “Is cold messaging 30 people on Facebook to see if they want to work with me in alignment with my values of respecting a person's inherent dignity and worth?”
Ask for help. In private practice, therapists tend to “do it all.” Cultivating self-trust also means knowing what you are good at, and where you could use a hand. Asking for help with things like marketing, accounting, or fee-setting if those are things outside of your area of expertise is a way to practice self-trust.
Building Self Confidence in Business
Building self-confidence in business is hard, and it takes time. I regularly say that being a small business owner unearths many issues I thought I’d addressed. Being a private practice owner means facing a lot of uncomfortable realities: it’s not just “have an easy-breezy schedule and swim in money” like so many in the therapy coaching space, and online business space will have you believe. There are also periods of intense loneliness, confusion, and mountains of self-doubt.
I believe that if you want to have a successful private practice you can IF you do it in the way that works best for you. When you are growing your business, ask yourself how you want to show up, where you want to show up, and what is in alignment with your energy. Getting external help and accountability will help as long as you seek it out from a coach or program with a similar philosophy. Don’t be afraid to shop around to find the type of support that best works for you. This is a great way to practice strengthening your self-trust.
Raina LaGrand (she/her) is a biracial (Black and white) therapist and coach based in Ypsilanti, MI. In her practice Root to Rise she helps people struggling with stress and trauma related to identity, oppression, and belonging through the use of somatic modalities, Parts Work, and inquisitive practices that call forth the power of culture and the context of intergenerational and systemic trauma in healing. Raina also coaches other somatic therapists in building clinical confidence and a rooted therapeutic identity through her group coaching program, The Container.
Additional Self-Trust Resources for Therapist
If you are a therapist or allied care provider in private practice and are struggling with self-trustI can help! Sometimes when we struggle, we really need clarity and guidance on what we need to focus on in our practice, learning how to market our practices, or something else sustainably. I’ve got a suite of mini-courses just for private practice therapists here:
-
Welcome back to the podcast. Last week I shared I'd be recording an episode on therapists and retirement. I changed my mind for a few reasons. But I promise I won't leave you hanging if you were interested in covering therapists and retirement, I kind of sat with it and realize that it definitely requires a deeper dive and more spaciousness than a quick hit podcast. So instead, I'm partnering with Heard to talk about retirement today at 3 pm. So me, Lindsay from Mind Money Balance and Andrew from Heard, we are going to talk to you about the basics of retirement for private practice therapists. We'll cover what retirement means, what business entities are available, why they matter what retirement plan options you can choose from and how to contribute to them. And if you attend live, you'll have time to ask Andrew and myself questions. And if you are listening to this after 3 pm, on March 28 of 2022, don't worry about it, it will also be available to purchase, whether you attend live or purchase the recording, it will be $39. And I will link to it in today's show notes. As always, the show notes are at MindMoneyBalanced.com/Podcast1, that's the number. And then from there, you can see all of the different podcast episodes and all the different links to things that I cover. And then that's the second reason I wanted to shift gears and talk about building self-trust as a therapist in private practice was because last week, I spoke about the problems with free therapy summits. And as a quick refresher, it was not about saying this person is bad or these people are bad for hosting them or for being speakers, it was about saying, like let's think curiously and critically about why these are happening and why these are popping up and how we as therapists can advocate for more economic and financial equity within the online space by saying no to working for free and by checking in with ourselves and seeing if we're actually going to get something out of it. And so social media doesn't tell me everything, but I posted a few little audio clips and posted a few graphics pulled from the podcast. And what was really interesting was that people were not willing to comment directly on the reel or on the Instagram post, but instead, a ton of you slid into my DMs and that gave me some really good insight that a lot of you were not comfortable, which is totally fine. I I've been doing this for a minute, but a lot of you were not comfortable saying hey, I agree with you, Yes, these summits can be really exploitative or I never knew why they felt so bad, Thank you for putting words to them. And I'm happy that I was able to do that. But I got so many DMS with your fears about being in these summits or participating in these summits anxieties about how then to go about asking for financial compensation. And this discomfort of saying yes I wanted to speak at that event. And then after I signed on I realized just kind of what kind of scheme the hosts were pulling and I felt really uncomfortable but I'd signed a contract and couldn't back out. And then truly ironic, but like you can't make this shit up fashion. I literally had someone DM me two days after last week's podcast episode went live, asking me to be a speaker at their therapists who are moms event without compensation, and I was like, am I being catfished right now like Is this a joke? Like I just spent? You know, all week I felt like talking about the importance of therapists asking for compensation or for at least equitable exchange. And I had somebody asked me to work for free, so it also sparked this idea. This is all the more reason for today's topic on the importance of building self-trust as a therapist. In today's episode, I'm going to dive into why I think therapists struggle to trust themselves. How it tends to show up as reassurance seeking and for therapists and private practice. How having low self-worth low self-trust can really impact their private practice’s financial bottom line, I'll offer some ideas on different exercises or mindset tips, you can try out to help work on building that self-confidence in business.
Okay, so let's start with why I think therapists struggle to really trust themselves. And I think this goes back to our education in our education and our training. We are told time and time again, not to trust yourself to follow the manual to a tee, exactly as written to reroute personal questions that a client asks, and to be really cognizant of not disclosing anything of yourself of really being a blank slate. And I'm not discounting the importance of manualized interventions, obviously, they've been evidence-based, and they've been tested and studied and it makes sense to have those as a foundation in clinical practice. But we're really taught to question our inner wisdom, during our training and during our education, even something as simple as rapport building. So just to refresh your memory, if it's been a minute since you've been in school, rapport building is when therapists connect with their clients to help create a culture and climate of trust and understanding. Even when we're talking about rapport building therapists are limited to a handful of prescribed questions like, What TV show are you watching? What snacks do you like to eat? And only those types of questions are the types of questions that therapists are allowed to disclose of themselves? It's so incredibly limiting. And of course, it's going to make us judge ourselves when we want to say something maybe a little bit more authentic, maybe a little bit more improvisational, if you will. We question ourselves because our professors, our supervisors, our trainers have told us don't do that. That's not what this you know, 65 year old manual says it's not 65 years old, a lot of those CBT manuals are like 40 years old. So anyway, I mean, I can remember an interesting example, I did my internship, like many people at a community mental health, and I had to kind of debrief with my supervisor or professor, I can't remember the exact title of the person. But I remember sharing with them that I followed the rules, a young client had asked me, you know, what are you? And for those of you who can't see me or who have never seen a picture of me, I am a white-passing mixed Asian woman. So it is not uncommon to be asked about my race. So when they asked me, What am I? I responded to this young client, who is probably just being very genuinely curious and wondering if they could join with me because we were both of mixed heritage is, I had to say, what makes you ask? And I can remember that air just like flowing out of the room or being sucked out of the room, whatever that phrase is. Because here's the thing, I can't easily hide that I'm racially ethnically ambiguous. I have no problem disclosing my racial background, I have no problem disclosing when appropriate, my religious practices, I have no problem disclosing when appropriate, that I too have struggled with mental illness both not both all anxiety, depression, and an eating disorder. To me, humanity and connection are a cornerstone of the therapeutic process, but it has been so sterilized in therapy practices, that it can feel cold.
And so when we are trained, don't trust yourself don't really build rapport unless it's super strategic. It can make us feel like we can't trust ourselves. So when it comes to transitioning into being a private practice owner, it can be really tricky to ask ourselves as therapists and private practice, do I know what's best for me? And what's best for my practice? And can I trust myself? Because historically in my training, and in my clinical teachings, I've been taught and told to not trust myself so it can be really, really hard. So I find a lot of therapists move into like the next best thing which is reading a lot of books. And in private practice. There are a handful of books about how to start a private practice, but more commonly today, what therapists and private practice are doing is researching what someone else does and trying to follow their model or their flagship steps or their signature, you know, 10 STEP program to filling their practice whatever it is. Like, we love a manual, we love a model, so we want to do that. And one of the most common ways I see self-trust manifest in therapists who are in private practice is by reassurance seeking. We all know what reassurance-seeking can look like from our client and right that's when a client or a person is seeking out proof that things are really okay by asking others by asking themselves or by researching. So in private practice therapists who are trying to fill or grow their private practices, so many therapists lean on reassurance seeking in the form of external validation and research, I don't see a ton of therapists doing this internal reassurance-seeking like asking themselves because again, our self-trust--we've been told not to trust it. So when it comes to real reassurance-seeking, I shared that there's kind of these two things, we're looking for external validation and we're looking for research, we spend a lot of time online or listening to podcasts or following people on social media to kind of soothe our anxiety. So when it comes to reassurance-seeking, this can look like a therapist asking their peers supervisor, or other people in the online space if what they're doing in their private practice is okay. So we've seen so many of these questions show up whether it's, you know, people DMing me, I'm no longer on Facebook, but what I was, I would see these types of questions everywhere. Is it okay to leave insurance panels? Am I a bad therapist? If I don't want to work with X population? When is it okay to raise my rates? Right, we're seeking for somebody else to tell us an answer that we inherently and intuitively already know the answer to, but our self-trust has been so shattered that we seek external validation. Then the research nowadays really looks like looking for evidence outside of themselves; so in online forums, in therapy groups via Google via Reddit, this is another way that I see therapists seek reassurance on: am I doing the right thing in my business? And so examples of this can look like spending way too much time debating between EHR companies, trying to figure out the right shade of blue for their logo, or coach and program hopping, like, I need more info, I need more info, I need more info and not really spending a lot of time implementing and trying and seeing what feels good in their bodies and seeing what works in their business. So a lot of this reassurance on am I doing this right by researching?
So when therapists have low self-trust, they can experience negative self-talk, and of course, their private practices suffer as well. So we want to think about how can we move towards self-trust? And self-trust is when a person can trust in their own knowledge, feelings, beliefs, values, ideas. And when we don't trust ourselves, it can really impact the way that we show up in and out of the therapy room, and specifically for today's podcast, how it shows up in the therapy room, but also how it shows up in our businesses. When a therapist experiences low self-trust, they might be seeking external validation and advice from others who they deem to be more successful in private practice. They might ask for additional information and opinions of others when deep down they know what they want to do, but they still want to hear it from somebody else. They might underestimate their unique skill set and how their unique skill set identity view of the world, the experience of the world might contribute to a successful practice. And instead, they kind of push it aside and seek out more conferences, more continuing education credits, more certifications, instead of just trusting that they have so much to offer. They also might hold off on doing things on the business side that feels bad when it comes to money. So they might hold off on raising their rates, reducing their caseload, or changing their schedule until they get enough validation from others that it's okay. They may also engage in distraction or avoidance when it comes to taking action on something in their business. That makes them feel a little bit uncomfortable. So they might put off taking the next step in their practice. And finally, another way I see low self-trust show up as in therapists and private practice is they under-emphasize their own thoughts, their own feelings, their own insights about what's best for their practice.
Instead of reassurance seeking and self-doubt, let's move into what can we do? What are some exercises/what are some practices that we can take to start strengthening our self-trust? When I coach and work with other private practice owners, the business strategies and tactics that work best for them are the ones that they actually want to do, or the ones that know like duh, that they feel best about. So cultivating self-trust can happen via self-trust mindset practices, or testing out a few self-trust exercises. So a few things that I like are finding a self-trust mantra or affirmation that works for you. As always, when you're trying on a mantra or an affirmation, give it a little bit of spaciousness by putting something like someday all... Someday I'll be able to confidently raise my fees, or I'm working toward... I'm working toward making a decision on what my ideal client is. When I was a student, I had some pretty intense test-taking anxiety. So my go-to mantra then was Lindsay, you know more than you think you do. And to this day, I used that phrase, you know more than you think you do when I'm giving a presentation, when I'm getting ready to onboard or do an intake for a new client, or when I'm doing something like this and recording a podcast and putting my voice out there. Other types of practices I like are asking yourself a time-based question to help elicit the answer that's already within you. For example, if I had to choose a logo by the end of the day, which one would I choose? Or if my website went live tomorrow morning, what would be the most important thing to have included on it? Asking ourselves these sort of time-based questions can help elicit an answer that may already be within us. I also like to invite clinicians to practice self-compassion, not just being nice to ourselves, but by celebrating wins. We're really well versed in practicing self-compassion. And by being kind to ourselves, or at least we are familiar with that idea. But it's so rare that we celebrate our wins in the therapeutic space, it's so rare to be like, holy shit, I just had a breakthrough with a client--that felt amazing! Like, we just like keep that to ourselves. And when it comes to self-trust, we can also dial it up by including some examples of times when we trusted ourselves and when we had good outcomes. So it could be a good outcome clinically, or it could be a good outcome in your business, right. So for example, celebrating a win for a private practice therapist could be, Oh my gosh, I networked with this amazing wellness-based primary care provider, and the two of us are going to do a collaborative workshop and it feels like such a good win for both their clients and my clients and whoever may be in the room with us, right, that could be a really great referral source and network win. I also think it's important to do congruent check-ins, right, this is coming from more of that psychodynamic lens, but is what you are doing in your business, and alignment with the values of the version of yourself in a sustainable business. So is cold messaging 30 people on Facebook to see if they want to work with you, really in alignment with your values of respecting the inherent dignity and worth of a person? You might be like, Yes, that feels so good. It's so in alignment with my highest version of a sustainable business owner, or you might be going No fucking way. I'm not doing that. And just because a business coach told me to do it, I can really stand in my strength and say No, that that tactic is not going to work for me. And finally, asking for help. It can sound weird to lump asking for help into self-trust. But in private practice, we really have a tendency to do it all. And cultivating self-trust also means knowing what you're good at. And knowing where you could use help, or you are not doing something that is really the best use of your time, energy or frankly, like even things that you just don't want to do. So asking for help with things like marketing, accounting or fee setting, if those are the things that are outside of your area of expertise is a great way to practice self-trust. It's saying I trust that I can knock out of the park my clinical game and I know the type of niche of client I want to work with. But when it comes to getting those words out of my head and writing my website, copy, that's really where I need some backup or I know what my fee should be, but getting it updated on my practice as policies and putting it on my paperwork and actually telling clients is-- I'm just frozen and I need a little bit of coaching help through that.
So building self-confidence or building self-trust in business is a process. It takes time. And I regularly say to my other small business owners that being a small business owner really unearths so many issues within us, right? It really kind of cracks us open in a way to be incredibly vulnerable and have a lot of things out there in the world that we thought maybe we could kind of stuff away. And being a private practice owner means facing a lot of uncomfortable realities. It's not as easy-breezy as like throwing up a beautiful website, and then you'll just be swimming in money tomorrow, like so many therapists who are in the coaching space and online business space will have you believe. While I love being a private practice owner, I say it all the time. I'm about 80% thrilled with my job, really, I love what I do. But it doesn't mean that I don't experience intense periods of loneliness as a small business owner of confusion, and wrestling with a ton of self-doubt and walking myself through those very same self trust exercises and questions that I just walked you through. I'm a firm believer that in order to have a successful private practice, you have to do it in the way that works best for you. I talked about that a little bit last week, when I said when it comes to ethical marketing, you're going to show up more authentically when you want to do it in the way that you want to do it. If you love writing newsletters as though you're talking directly to one person, then write an email newsletter. If you love speaking, and being on stage, you could have a podcast or pitch yourself to be a paid speaker. If you really are a social media junkie, and that is where you hang out and where you spend your time, then by all means, pick a social media platform where you want to hang out and show up there. Your business will grow. When you ask yourself, How do I want to show up? And are these different marketing techniques or these different marketing techniques in alignment with me? Can I trust myself that I'll show up in this way? Can I trust that this is in alignment with my energy and congruent with the version of myself I want to be? So getting external help and accountability will help you right, I'm not opposed to getting a coach or joining a program, or membership or whatever it may be. As long as the coach or program or membership is really clear about what they do. And you can go check, check, check. That's what I want. That's what I need. They have a similar set of ethics and values and a mission as me. And that feels like a person I can safely grow with versus the coach who is saying things like if you don't hire me, you're gonna end up back in your agency job tomorrow. I'm obviously being dramatic. I don't know any people like that. But I'm sure those types of folks are out there.
Before I wrap up, if you are a therapist, and if you are thinking about investing in your financial future, I want you to think about your own retirement accounts. Are you saving money regularly in a retirement account so that you can actually hang up the therapy scarf and put away the therapy mug someday? What does your version of retirement look like? How are you preparing yourself for the financial realities of retirement? If you have questions about therapists and retirement, a reminder that I'm partnering up with Heard and we are going to answer your questions about therapists and retirement. We are going to cover what retirement means, what business entities are available to you, what different plan options you can choose from as a self-employed person, and how to contribute to them. I will link to the therapist and retirement workshop in the show notes. It is $39 We are going live today at 3 pm Eastern. If you're listening to this in real-time, and if you miss it and you're catching this in in the future after we've already gone live don't worry about it. You can always purchase the recording whether you attend live or want to come later. The cost is the same. It's $39. But it is great if you show up live because we'll have time to answer your questions. And with that, I'll see you next week.
Transcribed by https://otter.ai