MIranda Palmer, LMFT she/her (00:00)
Hey everybody, welcome back to the Starting a Counseling Practice Success Stories. I have Dr. Kristen Kroll here today sharing her amazing success of creating a highly niched, super impactful practice. Kristen, you wanna share with people where you're at and what your niche is?
Dr. Kristin Kroll (00:24)
Yeah, thank you. so we are a virtual practice based out of Austin, Texas, and we serve children, adolescents, and young adults. And our our focus is really on providing evidence-based care that is when and where families need it. So that's why we chose the virtual only model and really make sure that we have top-notch clinicians who can help families on the evenings and weekends so we're not pulling kids out of schools and parents missing work.
MIranda Palmer, LMFT she/her (00:50)
It's amazing. And I always like to start with this fun little question, which is like in a minute or less, why did you decide to become a therapist?
Dr. Kristin Kroll (00:59)
I think a lot of psychologists we're all trying to work on ourselves. So I think, you know, starting with me feeling why am I a little bit more worried than other people, why I'm a bit more anxious. And so as I I learned to try to to help myself worry less, I learned that how helpful that psychology can be as a young person. So then I wanted to be able to kind of spread that message and and do my best to help other kiddos, especially teenagers who'd been struggling as well.
MIranda Palmer, LMFT she/her (01:23)
Awesome. And when did you start to when did you decide to open up a private practice?
Dr. Kristin Kroll (01:29)
So I started I decided to open up a private practice about five years ago. I'd
really enjoyed my career in academic medicine at Children's Wisconsin and the Medical College of Wisconsin. But then with my work life balance, I realized that private practice was a better fit for me and for my family. so started about five years ago and have really enjoyed the work life balance and being able to reach people more quickly and being able to really tailor care a bit more than if I was in more of an institutional.
Setting it up.
MIranda Palmer, LMFT she/her (02:00)
Yeah.
And did you do fully online from the very beginning or did you kind of bounce back and forth?
Dr. Kristin Kroll (02:08)
Yeah, so I I've always been focused on virtual. You know, but in my academic medicine I I worked as the attending psychologist for a cystic fibrosis clinic. And so before COVID, I was actually doing research on telehealth for group therapy since cystic fibrosis patients can't be in the same room. Then a couple months later after that project, c COVID hit. So I w helped that that hospital, you know, really get their v their standard operating procedures and all of their clinical measures ready.
for the the rapid switch to telehealth after COVID. So it's something I've felt really passionate about, especially having grown up in in more of a rural area of Georgia. You know, just the the piece about access and really reaching fa families who need it. so that's really been a a point of pride in my work.
MIranda Palmer, LMFT she/her (02:57)
That's amazing. I was actually just looking up this information today. As of twenty twenty six, forty percent of Americans in particular are in underserved mental health areas. Like forty percent is on average taking people forty six days to get access to care
if they can even find it, which is it's it's not great numbers when people are really struggling.
Dr. Kristin Kroll (03:18)
Well I think it's you know,
it's access to care but also access to evidence based care. So are they getting the treatment protocols that are most effective for their condition? And that's kind of what but the whole focus at Little Dove has been.
MIranda Palmer, LMFT she/her (03:30)
Yeah. Talk about that because
It's an interesting thing I found with providers that some providers are like, my gosh, yes, I know what I'm doing is working and I love to track these outcomes and I love to see what I'm doing is working. And then you have this other group that are like, I'm client centered and like I just I know it must be working because they keep going back. And I I have very strong feelings about that particular
Dr. Kristin Kroll (03:59)
Sure.
MIranda Palmer, LMFT she/her (04:00)
statement. But what do you think it is?
your work that that you've been able to implement that makes it easy and sustainable for you to be able to track outcomes, to know what you're doing is working, and do it in a way that feels good for you as the business owner, for you as as a clinician, for the parents, for the kids, for everybody. Because that's a big group of people to keep happy when you're trying
Dr. Kristin Kroll (04:28)
Sure.
MIranda Palmer, LMFT she/her (04:28)
to navigate all of that.
Dr. Kristin Kroll (04:30)
I think for me it starts with, you know, I always have an intro call. So as the owner of the practice, every patient I I speak with them first before we even schedule with another clinician. Because I want to first make sure that the virtual environment's right for them. You know, there there are some conditions where that we aren't the first that are as evidence based as in person. So we we cannot do play therapy as effectively. So if they need play therapy, I want to make sure they're with the provider who that would be their best fit. So making sure that they're fit for virtual and then also seeing what
is the presenting concern coming in so I can help find the clinician who might have the best expertise for them. Because with my clinicians, we purposely all have our own little fiefstums of, you know, someone is the DBT guru, someone is the medical psych guru. And so really making sure given our our breadth of experience in depth that we really make sh that we fit the patient with who can provide the best care. And so having that kind of screening has helped it
really mesh where we have great retention rates with our patients because we were we're able to fit them with a clinician that's a good fit for them. And also what we worked as a clinic was during staff meetings, what are the two or three screenings or screeners we want to use to help measure progress? Because I am a a more traditionalist CBT theoretical orientation whereas some of my other partners in the in the practice come from more of an attachment based and there's room for all of
those and so how do we have as a clinic come up with measures we can all use to help screen and track act outcomes. So we picked an anxiety-based measure, depression measure, and then a just kind of a patient's perception of progress so that we have it where every six sessions, you know, those measures are sent out for us to review during the next session so we can at least have an idea of not just symptom improvement, because that's only one piece of the puzzle, but
MIranda Palmer, LMFT she/her (06:27)
Yeah.
Dr. Kristin Kroll (06:28)
their perceived progress.
and that's something that you know the clinicians from different theoretical orientations, different trainings. We've got a neuros neuropsychologist, psychologist, licensed psychological associate, these were the measures we agreed upon as being a good fit to serve our population.
MIranda Palmer, LMFT she/her (06:46)
Love that. And and I think you you touch on something that a lot of people don't think about in like
in logistics like the idea of like I want to have an integrative practice I want to have
all these specialties where it's a one-stop shop for families that they can get what they need in particular but then you get into the logistics of how that works and there's a there is some pieces when you're coming from these different theoretical orientations when you're coming from these different specialties that there's a lot more to integrate as the leader as the owner
in terms of balancing all of that, where if there have been any areas where you've like realized, that balance was a little harder to find or this was a little more complex than I thought it would be bringing all these different amazing experts under one roof.
Dr. Kristin Kroll (07:41)
I think the
The thing is that I I had to fight the most was imposter syndrome of, you know, why am I saying you should do these assessments at these these screening intervals? And so what I found helpful to kind of help with that imposter syndrome as well as to respect the expertise of the other clinicians is I'd come in with the agenda meeting with a topic and a preliminary draft of what I thought we could use as a a frequency of cadence for our screenings or the types of measures, and then throughout that meeting work from that draft to get their input.
So that we're able to move forward and achieve that goal in a you know an efficient manner of time, but also making sure that, hey, someone has more experience in, you know, we have more patients with ADHD. Are we really making d is this the right measure for this population? So getting everybody's area of expertise while also making sure that this is a we have a decision at the end of the meeting.
MIranda Palmer, LMFT she/her (08:35)
Yeah. Have you found in terms of hiring in particular, are there p some particular like personalities that or traits or skills that you realized, I need to make sure that that is the kind of person I'm bringing in under this umbrella to keep that kind of collaborative group space in place?
Dr. Kristin Kroll (08:58)
I
think for me it was during the this the the interviewing process. I'm a a pretty direct, open speaker, and so I'm I'm very clear on expectations and so someone who's also being clear about what they expect from me, where it becomes a dialogue of how do we make this a good fit versus me just saying this is what I need you to do and not having feedback from the clinician. You know, for example, you know, we we just started introducing you know, psychological testing and evaluation because we hired two nurses.
neuropsychologists. I am not an S an expert in assessment and I did not feel comfortable being able to provide virtual assessments without being up to date on the latest research on what has been normed on that population for that instrument. And so helping them allowing the neuropsychologist to kind of lead the discussion and help pick out the the measures and what patients will see and deferring to their expertise for that service line.
MIranda Palmer, LMFT she/her (09:53)
Awesome. What was the most surprising thing for you in terms of starting the
a practice, the thing that you felt like least prepared for?
Dr. Kristin Kroll (10:05)
Oof, social media. I
Well I I'm a bit of a Lud Eye at heart and I'd actually been off social media for ten years. had no interest of going back on. I I don't even know if I had a LinkedIn, frankly. and then once I started the business realizing that no, this is part of the process. This is a a part I don't like, but this is something that I have to do. And so frankly, after a couple of months, I actually have outsourced it to to another little small company in town that does a great job and you can tell the difference. And I can tell
looking at the metrics of where the referrals are coming in that the online pre presence is starting to kick in for us.
MIranda Palmer, LMFT she/her (10:44)
Mm.
Dr. Kristin Kroll (10:45)
So I think it's being okay with knowing your strengths and being willing to outsource when needed because it did it did make a difference.
MIranda Palmer, LMFT she/her (10:53)
Yeah. And that it it is an interesting space, right? In terms of that
personal feeling of like, I don't like this, I don't want it, I don't want people to be on social media. I would love for people to be off of social media and then being like, and yet they are. And so what does it look like to meet people where they are in that space and how much unfortunately it seems like right now, even in terms of SEO, there are certain markers in terms of being findable when somebody searches you that are connected sometimes to
Dr. Kristin Kroll (11:28)
Mm-hmm.
MIranda Palmer, LMFT she/her (11:29)
some of those
those profiles and some of those activity levels. So it's a a sneaky little sneaky little side.
Dr. Kristin Kroll (11:37)
Well, I would say in the business
school there was this one course on I think the the SEO that really helped me understand what even were keywords. My keywords were completely off from what I should have been using. and just feeling more confidence that yes, I don't like putting a post out. This is not how I want to spend my time, but now I know I'm doing it with the right mechanics, so it actually can have an impact. I think that was really important for me to see.
MIranda Palmer, LMFT she/her (12:03)
Can you give an example of like, if you recall, like what you thought you should be using as your keywords for your website versus what the data actually told you when you learned how to access it?
Dr. Kristin Kroll (12:14)
absolutely.
So, you know, with my background in health psych, I've always had a passion for helping kids with severe medical problems. And we still serve some, but that was kind of a main selling point of my practice. However, if you look at the keywords, nothing was popping up. Not and not happening at all. So we've been able to, you know, find patients who can meet that niche, but that's usually through them searching for ADHD or a comorbid condition for us then to be able to serve them.
MIranda Palmer, LMFT she/her (12:41)
Yeah.
I think I remember when we were doing that during maybe even a sprint or something where you're just like, no, this is really needed. I'm like, it totally is. Like it's you're like, it's what the words people are using. I'm like, it totally is. And they are not searching for it. And so it's a it is like a frustrating thing sometimes initially, but I think it also comes back to the idea of what we think or what we know from like one perspective versus like what the evidence says. So like what we know from one perspective.
perspective is in the hospital this is the language from like a doctor
Dr. Kristin Kroll (13:15)
Ahead.
MIranda Palmer, LMFT she/her (13:16)
referral standpoint, like this is the language to use. But if we're
Dr. Kristin Kroll (13:20)
Mm-hmm.
MIranda Palmer, LMFT she/her (13:20)
going direct to consumer, it the language changes and so we need to like expand our ability to engage with people with the language that they're using.
Dr. Kristin Kroll (13:30)
What and I
think it bec it one thing I noticed was that I was so used to giving DSM five diagnoses that I was treating it on my website of major depressive disorder. When people are not looking for that, they're looking for depression
MIranda Palmer, LMFT she/her (13:44)
Yeah.
Dr. Kristin Kroll (13:45)
or my child's behavior or something like that. So it just helped me kind of educate myself on stop being a nerd, really focus on
MIranda Palmer, LMFT she/her (13:53)
yeah.
Dr. Kristin Kroll (13:53)
what is will translate.
MIranda Palmer, LMFT she/her (13:56)
I well, you say nerd, but like like the professional
Dr. Kristin Kroll (13:58)
Yeah.
MIranda Palmer, LMFT she/her (14:00)
I think there is something and it's an interesting space. when I first started at a like at a non profit
And I went in and it was a very it was like a collaborative program. We had a psychologist, we had social workers and therapists, we had caseworkers, and then we had the nonprofit people that were domestic violence specialists. And I was coming in and I was starting my master's program, but I was there as a domestic violence specialist, and one of the specialists was like, All of you people talk in a way that nobody else can understand you, and you use all this stuff and you don't talk to real people.
So I'm gonna watch you and I'm gonna see is does it break is like is this like I'm watching you through your program and for good
Dr. Kristin Kroll (14:48)
Mm-hmm.
MIranda Palmer, LMFT she/her (14:48)
or for bad, right? It was really something that like stuck in my mind and so sometimes I like I I will notice in most spaces I tend to
Dr. Kristin Kroll (15:00)
Sure.
MIranda Palmer, LMFT she/her (15:01)
talk in a very like fifth grade level, not as a talking down,
Dr. Kristin Kroll (15:04)
No.
MIranda Palmer, LMFT she/her (15:05)
but just like I'd rather start here and then move up.
Dr. Kristin Kroll (15:08)
Well, from
a health literacy standpoint, it's what we should all be doing, but it's easy to to forget.
MIranda Palmer, LMFT she/her (15:13)
Yeah, because everything that we're doing in most of our programs and is about showing that we have mastery of this information
Dr. Kristin Kroll (15:21)
You're here.
MIranda Palmer, LMFT she/her (15:22)
and mastery of the jargon, and then suddenly we get out into this business world and into like direct to consumer and now we have to show mastery in reverse. Like can I
Dr. Kristin Kroll (15:33)
Mm-hmm.
MIranda Palmer, LMFT she/her (15:34)
take all of this complex information and all this jargon and all this really technical evidence-based research and now can I put it in the
space that meets
Dr. Kristin Kroll (15:44)
Sure.
MIranda Palmer, LMFT she/her (15:44)
people where they're at where they haven't spent years thousands of hours
Dr. Kristin Kroll (15:48)
Mm-hmm. Yeah, exactly.
MIranda Palmer, LMFT she/her (15:52)
awesome and then tell me about the even we didn't talk too much about this decision. Did you start as a solo practice and then expand into group practice or did you start from group practice from the beginning?
Dr. Kristin Kroll (16:04)
I
started a solar practice for the first year or two. then
My family and I moved to a different state and so I had to restart over and at that point
I thought I want to move straight from just being a clinician to managing the practice and and growing it from there. So then had had the pleasure of of hiring two women who've been fantastic and with me the whole time since then. And then as our patient volumes have grown, you know, after our work in the business school and with coaching, now the addition of of two other neuropsychologists and we're taking on a doctoral student for supervision.
Thank you.
MIranda Palmer, LMFT she/her (16:39)
Nice.
So let's talk about that just for a moment. You you mentioned a couple of times that you joined business school. Why and when did you decide to do that as a path? Because obviously very educated, very very very goal-oriented and very logical. Like like I can see like anyone can
Dr. Kristin Kroll (17:00)
Yeah.
MIranda Palmer, LMFT she/her (17:01)
listen and see that. So why?
Dr. Kristin Kroll (17:03)
'Cause it wasn't working. 'Cause
I was trying to grow the practice and my patient volumes weren't increasing, even though I was spending more time on
you know, the social media piece on pr trying to line up presentations for schools and pediatricians and the the it wasn't working. So I knew that, you know, if if it ain't broke, don't fix it. Well it was definitely broke. so it was going back to all right, I've got to get away from I don't need to refine my clinical skills more. That's not what I'm doing. What I need to do is refine my business skills, of which I had very few because we didn't get that in our PhD and master's programs. And so okay, gotta go back to school and do it in a
way that you know logistically made sense for me to keep working and for my family.
MIranda Palmer, LMFT she/her (17:47)
And what were the biggest things that you implemented along the way that you noticed really like changed or like turned the dial or like made a shift for you?
Dr. Kristin Kroll (17:59)
I would say a lot of work on the website and the social media was a big piece. I would say also just learning more about where are referral sources and and some of the personal coaching calls was, you know, where do I I'm sending out these cold emails, you know, but no one's responding. How do I get that warm connection? and so just kind of thinking outside the box, because I had already been thinking inside the box, done everything that I could think of, and it wasn't working. So having someone with a fresh perspective say, you haven't
Trying this approach, you know, and and having that as a as a new you know action.
MIranda Palmer, LMFT she/her (18:36)
I think it is interesting how sometimes too it can be like a even a little bit nuanced of somebody says, you just introduce yourself to to local professionals in your space and you're like, I have done that and I've done that for six months or for two years and it's not working and then you tweak a letter or you tweak a little bit of the way that you engage with someone and you're like
that's what you meant.
Dr. Kristin Kroll (19:01)
Yeah.
MIranda Palmer, LMFT she/her (19:02)
like like and I think the same thing with our website, right? Like, okay, I had a website, I was out there and putting the information and then like we tweak the way of it and it's like,
Dr. Kristin Kroll (19:11)
No.
MIranda Palmer, LMFT she/her (19:13)
this is that part. But I think it's it's really hard when you're in the in the middle of it and like you're
Dr. Kristin Kroll (19:21)
Yeah.
MIranda Palmer, LMFT she/her (19:21)
inside of it. So tell me about that part.
Dr. Kristin Kroll (19:23)
Absolutely.
MIranda Palmer, LMFT she/her (19:24)
Were there any moments where you're like in the middle of it, where you're like
this isn't working and you started to like second guess like maybe this isn't right. maybe private practice
isn't a thing anymore. You know, maybe like were there any places where you started to like go down another rabbit hole of like maybe maybe
Dr. Kristin Kroll (19:45)
sure. Yeah. Every
now and then it still sneaks in. But just kind of deciding is this the right niche? Did I is it too narrow? Should it be broader? You know, is this
I'm a more of an introvert, so can I run a private practice where I'm having to network a lot? That was kind of a a big thing for me is is that how I want to be spending my time? Can I do it well? and will it become more comfortable over time? So, you know, lots of those, you know, thoughts have popped up. And I think it's just having the discipline of every day I'm spending an hour doing some part of the business that I may or may not like, but I need to do, and then just being trusting in the in the process that as long as you're running that mile.
Every day you will be ready for the marathon, you know, at that time. And so just putting in the work and be and staying focused on that.
MIranda Palmer, LMFT she/her (20:34)
Yeah. I think that that that space of like well, I think it's twofold. I do think there is that like the marathon part and the like and and putting in the training so that you can get there without breaking yourself
Dr. Kristin Kroll (20:48)
Okay.
MIranda Palmer, LMFT she/her (20:49)
down completely. But I think there's this other part of like the internal knowing that like, this is the race I wanna run.
Dr. Kristin Kroll (20:58)
Mm-hmm.
MIranda Palmer, LMFT she/her (20:59)
Like this is truly the race. And so I'm
Dr. Kristin Kroll (21:01)
Mm-hmm.
MIranda Palmer, LMFT she/her (21:02)
curious, do you have any tricks or or ways when you're feeling unsure where you come back to like, yes, I want to be on this marathon. I wanna be on this track. I did sign up for this. I wanna be like, how do you find your center when maybe
Dr. Kristin Kroll (21:19)
Yeah.
MIranda Palmer, LMFT she/her (21:20)
s you're seeing stuff on social media or something's on the news or I don't know, something funky happens with the family or a parent and you're like, Did I? I don't think I want
to do this anymore. How do you find your center?
Dr. Kristin Kroll (21:32)
I think for me it's thinking about the impact on my daughter. You know, I've got a seven year old and you know, by staying in private practice, I can be the one picking her up in Carline. I can adjust my sessions. And at this point in my life, that is a priority. And so ha seeing her smile when I when I pick her up, that makes me smile of like, you know what, that marketing wasn't so bad this morning that I get to pick her up from school and see her smile. Or, you know, just thinking about her role modeling, yeah, mom was doing the dishes, but now she's gotta
meeting and is going out dressed professionally and you know she can do the work life balance too. And so just being aware of the impact on my daughter has always kind of been centering for me of, you know, hey, this is worth it. This is why you made the decision you did.
MIranda Palmer, LMFT she/her (22:18)
For anyone else who's thinking about starting a group practice specifically around kids and teens, because that is a a smaller niche, right, across the United
States, what advice would you give them?
Dr. Kristin Kroll (22:31)
I think the biggest thing is just knowing that logistically
You're looking at evenings and weekends of when the prime appointments are. And so if you're not able to see those patients being able to hire clinicians who are wanting that schedule, I think the other thing is knowing you'll be working with the parents most of the time. You know, most of our sessions, we have the parent involved in in every session. because at the end of the day, we you know, we teach an evidence-based technique, but they need to be practicing it at home, and that's where the parents are so heavily involved. And so knowing that the parents, you've got to have a good relationship with them and make them
integral even though y it's child therapy.
MIranda Palmer, LMFT she/her (23:10)
And I think that ability to engage a parent to to really have them see it as partnership, I think that
Dr. Kristin Kroll (23:20)
Mm-hmm.
MIranda Palmer, LMFT she/her (23:20)
is a particular skill set. Do you find that the people that you hire naturally have that skill set or that you need to train in that skill set?
Dr. Kristin Kroll (23:31)
You know,
for me I've I've only hired people who have already had pediatric experience and and liked it and and wanted to pursue it. Because I feel like it is you either love it or you hate it. And you know, I didn't want to take a risk on well, maybe it's a bad fit. I also feel like the training is very different and specialized. So I won't see patients past the age of thirty anymore. 'cause I was more of a generalist in my training, but at this point I'm more up to date on the literature for thirty and you know, twenty four, thirty and under. And so
So for me, I wanted the the clinicians who this was their niche as well. And so the hiring process took longer and that was okay.
MIranda Palmer, LMFT she/her (24:07)
I think that space of like I think as a profession and and I will say this yeah, I was like so c you know, 'cause we work with a lot of psychologists and psychiatrists or what have you.
I think it's more prevalent in master's level, but I've seen it in all spaces, is this idea of being a generalist practice without really taking on the onus and the ownership of that that's a really broad level
Dr. Kristin Kroll (24:40)
Yeah.
MIranda Palmer, LMFT she/her (24:40)
of research to stay on top of. Like
Dr. Kristin Kroll (24:42)
Sure.
MIranda Palmer, LMFT she/her (24:43)
unless you're spending two hours outside of every person that's coming in your door doing the research and really doing your treatment planning, you're probably
going more based on vibes than you are based on what the research
Dr. Kristin Kroll (24:57)
Right.
MIranda Palmer, LMFT she/her (24:58)
says and so it's really an important aspect to be to be honest about there are limitations to having that
Dr. Kristin Kroll (25:07)
Well I think
MIranda Palmer, LMFT she/her (25:08)
general practice for your client.
Dr. Kristin Kroll (25:10)
And even if you narrow it down to an age group, you know, I would still say, I don't see autism. That's not where my my most of my training has been. So we have a
clinician in the practice, she has the expertise there. And so it's being okay that you might be narrowing your niche, but there's also respect when you when other providers learn about it of like, no, she's actually trying to do the right clinical practice and we'll refer later on.
MIranda Palmer, LMFT she/her (25:34)
Yeah, it's it's really powerful. Well, I think this is awesome. Any last bit of advice you'd have for anyone who's listening today?
Dr. Kristin Kroll (25:43)
No, I all I can say is that like the
I was really worried about spending money on the business school because I'm I'm pretty frugal and I was like, I could use that on something else. It was definitely the worth worthwhile for the investment. For me, the the private coaching, it complemented it. So that was a great package for me. I think it's really just kind of thinking, all right, where you're not expected to know everything. So what are the parts of the business you need to learn and focusing on that? Just like if you were working with a new patient population, how you would you'd learn up for learn and and train on for that population.
MIranda Palmer, LMFT she/her (26:16)
Wonderful. Well I'm so glad that we got to chat today. Thank you so much.
Dr. Kristin Kroll (26:21)
No, thank you.
