You can't do that! Building a practice where therapy isn't always embraced.

Rickie Mental health stigma is still prevalent in our culture. For some areas, it is truly evident and it impacts if, when and how people get help. Rickie Palmer lives in an area where culturally, therapy is something that is court mandated or forced on you. She will share how she has built a successful practice, with a specific niche, on only 1 insurance panel, in an area where she was told it couldn't be done. Mental health stigma is still prevalent in our culture. For some areas, it is truly evident and it impacts if, when and how people get help. Rickie Palmer lives in an area where culturally, therapy is something that is court mandated or forced on you. She will share how she has built a successful practice, with a specific niche, on only 1 insurance panel, in an area where she was told it couldn't be done.

Kelly: Hey, guys. Welcome to another episode of Real Life Stories in Private Practices and today I'm joined with Rickie Palmer from Albuquerque, New Mexico. She's an LPCC who has a group practice there. Welcome.

Rickie: Hi. Hi, everyone.

Kelly: I am excited for you guys to hear her story. She has a unique journey and process by which she has built her practice. So tell me first Rickie, when did you start your practice and why?

Rickie: I started it in April of 2016, which is fairly recent where all was done on the one-year mark. The why was to just be frank and honest with you was I hated working for my agency.

Kelly: That’s not the first time I’ve heard that. Oh, gosh we’re frozen.

Rickie: And I try to keep things upbeat, however there’s just more and more coming in of what we needed to do, but the turning point for me was I was a foster parent there, and I really wanted to give my kids the best experience, the most healthy experience and I had two kids with me and one of them got sick at daycare and my boss said, “No, you can’t leave.” That was when it started. Then I started just to notice other things like the control of our time, your salary, about your hourly.

Kelly: So that was the final straw of when your boss is saying you can’t go take care of a sick child.

Rickie: Right. I really got tired of hearing they’re not really your kids or we’re putting up with a lot from this and I’m a type of a person that’s a really hard worker and I dedicate all my time and so I think it was difficult for them to see me actually starting to set boundaries and say, “This is something I need” and there was a lot of pushback.

Kelly: Wow.

Rickie: Then I reached out to the bootcamp and I talked with you. I remember that talk because I was so energetic and you guys were so energetic and matched my energy and I didn’t feel like it was raw. So I just signed up. I did your bootcamp I think three months in, and then I did the perfect day worksheet and I kept it with me on my desk for like -- this kind of makes me emotional because I kept it on my desk for those three months and then one day my boss came in and kind of just started this whirlwind of a storm and it was so far from that perfect day worksheet that I said, “I’m done.”

Kelly: Wow.

Rickie: And it’s hard to leave my clients because I worked with kids, but at the same time you have to take that step to make your life what you want it to be rather than be kind of kept and locked down in a certain way. It wasn’t healthy. I had to take that step.

Kelly: How long ago was that?

Rickie: That was I want to say this February, the incident happened in February and then I left two weeks after that which was in March.

Kelly: 2016 for those people who aren’t going to hear this in March. Wow. You know, I remember the first time we did talk. One of the things I believe we talked about is your location being in Albuquerque. Do you mind sharing a little bit about that? I know we were chatting briefly before we started recording about Californians. We are often seen as a little bit more flashy or where therapy is a little bit more of a part of the culture. I don’t how to say it but we have a lot of therapists in this state and you being in Albuquerque what was that like for you to grow a practice there?

Rickie: Well, I think you made an excellent point. There is kind of this cultural thing in California, Colorado, New York where therapy is a norm and here in Albuquerque a lot of people go to therapy because it’s been forced upon them either provision or law or you know, we have a huge CYFD here which is our child, youths, and families division so it’s really difficult because clients here have to use their Medicaid. We have a huge Medicaid population in New Mexico and just getting through the barrier of people reaching out to private practices for treatment is a huge barrier because people on probation get referred to certain agencies, and I’ve worked with those agencies and there they treat the client's kind of like a customer at a McDonald’s drive-through so to speak and they -- fit them in a box, get them in and get them out and I’m a different therapist because I really like tuning to my clients. I really like connecting with my clients and sharing with them and helping them feel connected to the world. So in Albuquerque, that’s been one of my barriers, but we have broken through that now with the group process, and it’s really forming good relationships that I think is overall positive for my clients.

Kelly: Right. So when you think about someone’s listening because I hear this often, you know, where I live, it’s a lot of Medicaid or it’s highly insurance-based and you do only cash pay or are you in panels Rickie?

Rickie: I’m on one panel. It’s called New Mexico Health Connections and it’s our primary insurance panel here. They actually have a pretty good track record as far as payments and having good relationships with their clinicians and their clients so we really reached to that and got on that panel, but for the most part we struggled with the fee structure in the beginning because I had a somewhat higher fee because of my expectations in that fee setting really took some time to kind of allow some movement for the client than to keep what I needed to make for myself and for my partner so finding that fee probably was the hardest thing.

Kelly: How did you do it?

Rickie: Kind of meeting in the middle. Some liked the perfect in outfit that I needed or that I wanted and then finding ways to eliminate expenditures so that I could come down a little bit and then finally could come in because at downtown you have to pay for parking and in order to show up for session in time you have to come about 10 minutes early and then 10 minutes over and it’s a dollar per 20 minutes.

Kelly: Right.

Rickie: So that can be a lot. So what we did is we started paying for the parking, validating the parking then the clients would pay more for their session and so that worked out.

Kelly: Nice. See I like that. I liked that meeting in the middle and looking at like what you can give in order to get to where you need to be too and not to sacrifice your health or sanity.

Rickie: Well, of course.

Kelly: So I’m thinking in this past year you’ve built it, you’ve built up this practice, which is an awesome job by the way. Congrats.

Rickie: Thank you.

Kelly: All those thoughts of like, “Oh, this is a Medicaid town and people don’t seek out therapy”, what has helped you break through those barriers?

Rickie: Just communicating with the client. Once they call you and they say, “I really need help with this” or “I really need to understand this about myself” but I need to use my Medicaid.” I just connect with them in that personal call and we talk a little bit when we kind of understand why they need to use their Medicaid because that could be an additional stressor. So I just ask things like what would it be like if we did an initial on sliding fee scale and you can come meet with me and if it’s not a good fit then we work around it because a lot of times your expectation of therapy here at least it was about 90% of the people I meet have a really low expectation of capital that have been to the agencies before.

Kelly: Yeah.

Rickie: And they expect just somebody sitting there and going, aha, aha. But we’re never going to do this. Then when they actually do come in the door and they meet with me and they feel that it’s different then they say, “Well, you know what? Actually, this is something I want to pay for. This is something I want to do.”

Kelly: That’s awesome. I have chills Rickie. I do because you’re changing people’s perception about how therapy can help them and one of the things if you guys aren’t picking up on is Rickie changed her process, how she talks in the initial consult, how she still lays out the options and how she knows that how she serves is different than what the average clinician in the area’s doing an in agency where they’re overwhelmed and short-staffed and all those things. So really it sounds like did it really change much in terms of how you marketed? Did that shift? Because you’re working with different clients or the calls came and was just shifting how you worked with the calls that came in.

Rickie: I think it’s a little bit about what I think are bits of the communication just getting the phone calls in and the communication and really trying to meet their needs and see where they’re at because colleague, she’s just an amazing substance abuse professional that works with motivational interviewing and she just has all these extensive training and so that was another barrier for us too is that even though substance abuse is prominent here in New Mexico, our substance abuse professionals are extremely underappreciated. So we had to kind of reform how she talked about herself too because you don’t say, “I’m just a substance abuse professional. I’m just that.”

Kelly: Just is always the red flag word.

Rickie: Right. So then as people started to call and say, “Well, I have substance abuse issues” I would encourage them to talk with her and when they talk with her, she’s so relatable that they were like, “Okay. Now, I can feel myself getting sober rather than somebody just laying the label of alcoholism on me or laying the label of addiction and addicted on me.” We had that at first. Then we moved to about four months ago we signed on for Brighter Vision and they took our self-designed WordPress website.

Kelly: I do remember it by the way.

Rickie: Huh?

Kelly: I do remember it.

Rickie: It was a cool website before, that a non-professional could do.

Kelly: Yes.

Rickie: But then when we moved it over to Brighter Vision and he changed it, I think their name is perfect because the whole website became brighter.

Kelly: Yes, it did. I was like, “This is not the same site.” Yeah.

Rickie: And he did something wonderful with it and then like I remember with the WordPress site just to get the logo to fit in the top, with this title it took me like two-and-a-half, three hours and I was like, “Come on Rickie. You can do this.” We go to Brighter Vision and we had one meeting and I was like, “Can you make that a little bit smaller?” and he did it like a quarter of a second. And I was like, “Oh, my gosh.”

Kelly: This is where I will say for those of you listening, outsourcing that which sucks up your time and is not your expertise is a good idea sometimes, because those three hours you could spend seeing clients or spend at home with family, instead of trying to resize a logo. Now, I am a total DIYer for sure, but even I outsource some of it just because there are bits that I get frustrated with so good for you. I mean, the site looks awesome. I’ll put the link to it in the notes. I do want to talk about you being in a partnership and starting out in a partnership, correct? Tell me about that because it’s a little unconventional in terms of what we say, what we usually, how these people start out in a single private practice, then as they have enough clients, they have some stability then adding. So do you guys own the business together or it’s a contract to employee you. What is the setup and why did you go this route?

Rickie: Well, like you said it’s unconventional but the reason we did it this way is Lisa and I have been colleagues and best friends for about six years so it really just felt right and also part of me, my insecure part, I’m a very boisterous person. I’m a very outgoing person, I’m a very like petal to the metal person and she’s the exact opposite of me.

Rickie: She formulates. Thinks positive.

Kelly: She’s great.

Rickie: And so I said, “You know what? If I’m going to do this, I will really like to know if you want to do it too.” She was a little hesitant because of the “just” word: I’m just this, I’m just that and I encouraged her and I just said, “Just really think about this because this could be our future” and I gave her the perfect day worksheet and I said, “Try this out” and she came back to me and she’s like, “How’re we going to name it? How do we find what name we want?” This was what, back and forth, back and forth Albuquerque names, therapy names and it’s been good just kind of sitting there with her like, “We just want people to kind of accept themselves for who they are and it’s just effective and so we came up with the name. So then once we had a name, she was at 100% that we were going into this together. It was a vision together.

Kelly: Awesome.

Rickie: Did that kind of answer your question?

Kelly: Yeah, I mean, I think you bring up a very good point. I say if you’re going to partner with someone they need to bring something that you don’t have. You know, people could look at Miranda and me and think like, “Oh, we’re both extroverts.” We’re actually not. Miranda is more like an introvert and I’m the extrovert. Miranda is widely creative. I am, in other ways unlike her, but I’m pretty like methodical. Like this morning you know, we had a meeting and we were talking about designing and all this stuff and I was like, “Let’s talk about the process.” I’m the organizer. She’s the gatherer of information. She has a memory like no other. So I think that just like in a marriage, it’s complementary and being really aware that the other person has what they’re bringing and for your partner being a substance abuse counselor, it’s different, you know, too than what you’re doing in some ways so it kind of enhances the practice. I just wanted to highlight it because it is a little different than what is recommended or talked about. But how has it worked out for you guys?

Rickie: Oh, it’s been amazing because something I wanted to know is actually the freedom to do that came from watching you two. I mean, using your website, it’s Kelly and Miranda and it bestirs this closeness and this connectedness and so when people talk with us that it used to be funny because there was never Rickie without Lis or Lis without Rickie, but we’re actually very strong independent counselors, so it benefited our business because if I get a client in and their depression is really what’s driving their drinking, I can help work on their depression, and we kind of satiate their need to not feel so alone and we can be connected. However, they can also meet with her in addition and to get techniques and relapse prevention stuff to really feel like they have a team behind them. They connect with me in a different way they connect with her, but it still feels like they have a team. We have a particular client who has been on methadone for three years and trying to really figure out something different and the second that person started meeting with us, there were shifts and changes that you know, she’s down to half a dose and we’ve been seeing her for about six months, and it just shows that the connectedness works.

Kelly: Yeah. I love that. See, seeing your strengths in your practice sort of like you’ve been just elevating the experience from when they come into parking, to having someone else that has an expertise for what traditionally is thought of, at least in California, in my experience. When you have a client on methadone and so it’s like, “Well, go to this agency that contracts you know, and they’ll manage that” versus doing it privately and some of the value of that, it’s really cool that you’re doing it. I don’t know. It’s one of the things I liked about when I first met you. I was like, “This is unique and special and very much needed.” It’s not like that mentality of like how am I going to find clients? You don’t need a thousand. It can just be you know, 20, 30. I don’t know, whatever that number is, but it’s not everybody and that you’re able to help in a deeper way, in a way that the clients really feel and appreciate, something to be proud of too.

Rickie: Yes. Thank you. That makes me feel really just awesome that you say that.

Kelly: Yeah. I am sure anyone listening, I’m hoping you guys are inspired too by Rickie’s story that going outside the box can really pay off and also learning to confront some of these ideas or these barriers that we perceive and finding ways to work around them or work with them if they really are true barriers, is important, and now you’re thriving in your practice. What do you think is up ahead for you guys?

Rickie: Oh, growth and opportunity for training. Lis and I are exhilarated, experiential, dynamic psychotherapy people who have remained for the past like year-and-a-half, and so we’re extending on that because that’s a new therapeutic technique by Diana Fosha, and just I woke up yesterday and I had gotten a text Sunday night that told me that my professor from a college I went to, right after high school, in Wyoming, was traveling from Texas to Arizona and he’s coming through Albuquerque, and if I had still been in an agency I wouldn’t have been able to meet with him, but I’m in a private practice where I can go get coffee when I want. I can go to the bathroom when I want and I could go meet with him. I could actually sit and have coffee with him and talk and it’s those points where you have to just really open your eyes and see it’s just a goal that I set so long ago and I made it. That kind of makes me tear up because it’s like you know, you fight for something and you get it. Like you deserve it.

Kelly: Yeah. You’re a hardworking girl, seriously. I’ve seen it. I know behind that boisterous is a lot of determination too.

Rickie: Yeah. I’ve worked hard.

Kelly: So when you think about the perfect day that was sitting on your desk, how’s it going now?

Rickie: Oh, I actually should do the worksheet again because I achieved that.

Kelly: Awesome.

Rickie: So I need to kind of go more future because I just desire to really make this everything because what I do for the next 20 years and then also what I do to retire, I do find you know, you too are an inspiration to changing counseling because even clinicians coming out of grad school are talking with me and they’re saying you know, what’s it like to be in a private practice? That sounds scary. I can’t do that. I need to go an agency and they go to an agency for $14-$15 an hour, and that’s sadly lower than what we pay most of our best student workers here in a Albuquerque.

Kelly: Yeah.

Rickie: And so they’re struggling to pay back their student loans, they’re struggling to have cars, their clients actually have more than they do and there are counselors really themselves on the edge of helping people and so like you’re an inspiration and Miranda an inspiration to really break that mold because they’ve taught that in grad school.

Kelly: Yeah.

Rickie: This is your penance. You have to do this.

Kelly: The penance.

Rickie: And you know, if anything, that’s where I feel inspired to go next is to make sure that that belief is shifted a little bit, shifted a lot.

Kelly: Are you really involved with other therapists in your community?

Rickie: There’s a Southwest Behavioral IPTA that I affiliated with. They are actually on the forefront of kind of arguing with NCOs. They manage care organizations to say what private practices can provide, and so I really like what came with that. Right now, I’m just kind of on the welcoming committee when people call because I’m not too well set in the community, but it’s just offering my time and paying you know, dues to be in. That type of organization means a lot to me too.

Kelly: Great. Well, if people want to reach out to you, if they need training and some of the stuff that you do, where they can find you?

Rickie: At, well, my website?

Kelly: Yeah.

Rickie: It has through Brighter Vision, has a beautiful, beautiful contact web email at the top. Before I couldn’t even figure how to put them on the web page. It’s from acceptance(A-C-C-E-P-T-A-N-C-E)counselingnm(for New Mexico).com.

Kelly: Cool. Rickie, thank you for sharing your story. I’m inspired to keep doing what I do just from hearing about the changes you’ve made in just a year. It’s really awesome and congrats to you and your partner. I’m excited for what next year holds for you guys. Let me know what happens with your new private practice vision. I’m curious what’s going to be on there at these rounds.

Rickie: It’s what I’ve put.

Kelly: And for those of you guys that are listening, give Rickie a shoutout below in the blog. Say hello. Share this with someone that could use it. We all need to be talking about out practices and being honest about the process, what’s helped us, what the barriers have been, kind of demystifying all of these. There’s no need for that. There’s a lot of people in our world that need help and we all can be serving them and still making a living wage doing so. Please share these stories and in the comments below, if you have a story you want to share, please feel free. All right. On the next time guys, see you then.

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