Episode 379: Diana on the disaster of saying yes to everyone

You have a client who cancels twice and then stops responding. You have one who came in for grief, which is not really your thing, but you took them anyway because it was February and the schedule looked thin. You have one who told you last week they feel anxious on the drive to your office, and you have not quite decided what to do with that.

None of these show up on a spreadsheet. There is no line item on your P&L for "clients who quietly disappeared." So the whole thing lands somewhere much worse: in your sense of whether you are any good at this. That is the part almost nobody says out loud, and it is exactly what Diana said out loud on this episode.

Diana is an LMFT in Menifee, California, working with anxiety disorders and complex trauma using EMDR and Internal Family Systems. She is EMDRIA certified. She also spent years working for the county, which is where this story actually starts, because the way she learned to do intake there was the same way she tried to run a private practice, and it did not go well. Kelly Higdon hosts this conversation, and they name early on that this is the kind of thing therapists carry privately and rarely compare notes about.

Lesson 1: Private practice is not county with better parking

Diana worked for the county because she got pregnant and needed health insurance, which is one of the most honest sentences anyone has said on this podcast. She liked it there. Steady hours, benefits, and programs that took everybody who met criteria. You did not pick your clients. You got assigned the next person on the list, and you got very good at working with a wide range of presentations.

Then she opened a private practice and did the same thing. Phone rings, you say yes. That is not a character flaw, it is a trained reflex, and it is one of the most common reasons a new practice starts hurting. We see this constantly in Business School for Therapists: burnout in private practice often looks like someone faithfully replicating the conditions of the job they left.

The takeaway: The intake habits you inherited from agency work are the first thing to examine, not the last. What made you competent as an employee can quietly sink you as an owner.

Transcript

Kelly (00:00) Hey, it's Kelly here. Welcome to the Starting a Private Practice podcast. I'm joined today by Diana, an MFT in Menifee, California, not too far from me. Today we're going to be talking about what success can mean clinically, because I think this is a topic that often goes undiscussed and unexplored, and it's an important aspect of creating a successful practice. So buckle up and let's get started. Hey, Diana. Diana (00:36) Hey. Kelly (00:37) So glad you're here. Tell me a little bit about why you went into private practice. What prompted you to start it, and when was that? Diana (00:47) Private practice was always my dream, always something I wanted to get into. When I was younger, I worked for a private hospital and I went into private practice before I was licensed. I was doing pretty well. I had a nice little private practice going through the hospital, and then I got pregnant. I needed health insurance for my son, which even at that time was very expensive. So I went to the county, and for me that was a very nice job. I liked the benefits, I liked the consistent hours. When I was doing private practice with a newborn baby, people would call me on Sunday, and back in those days we had to take those calls. Things were different then. Kelly (01:43) The technology was different in terms of what existed. Diana (01:45) The technology was way different. So I really enjoyed working for the county and I liked the benefits and the health insurance, but I always yearned to go into private practice. In 2019, I decided to jump in. I went to Bunco and met an LMFT there who was in private practice, and she said, "Hey, I'll let you use my office on Saturdays." Not only that, she gave me a client. Kelly (02:20) Nice. Diana (02:21) It was really nice. I started seeing clients on Saturday and I got credentialed with Kaiser. What I didn't know back then is that because I worked for the county, where we had our own programs but took everybody who fit the criteria for the program, I really wasn't aware of having a niche and getting clients who were a fit with me. So I would take everybody who called, and it was a disaster. Kelly (02:54) Well, let's talk about the disaster of that. When I worked in county mental health, you were just the next therapist on the list and you got assigned. There were rare occasions where someone might be assigned to a specific therapist for a reason, but generally you got really good at diagnosing and working with a wide range and variety of issues. Diana (03:22) Yes. Kelly (03:23) This is something we do talk about in business school at zynnyme: how sometimes the burnout and the struggle in private practice happens when we replicate what we know from our previous employers. So I could see you thinking, I can work with anybody. When you say it was a disaster, what does that mean to you? What does that look like? Diana (03:51) I had a lot of clients dropping out without any closure. I had a lot of clients come in when it wasn't a good fit, or I wasn't really well versed in working with their specific issue, and then they'd drop out, or cancel and never return, or just ghost me. I wouldn't know why or what was going on, and I just wouldn't see them again. And I kept replicating that. I'd take on new clients and go round and round and round. There were a few that were really good fits, who stayed with me and graduated in a timely manner and made a lot of good progress. But a lot of them didn't. Kelly (04:38) What did that do to you personally? Diana (04:43) I believed I was a bad therapist. It took a toll on my self-esteem. I had huge issues with imposter syndrome, thinking that I didn't know what I was doing, that I wasn't a good therapist. Kelly (05:00) But you were simply replicating the "if they call, I work with them" model, because that's what you do. Diana (05:07) Exactly. Kelly (05:09) Did you start to find something about the ones who stayed versus the ones who didn't? What was the difference there? What did you notice? Diana (05:18) They were either struggling with an anxiety disorder or complex trauma, issues I was well trained in working with. And they were a specific type of client who came in and did the work, as opposed to looking to me to give them answers. Some are just a good fit and you don't know why; they're just a good fit. And some were not. Some came in with issues I had no idea how to deal with, like OCD. I had never worked with OCD before, but I took them on anyway. Or they'd have grief issues that I had no idea how to work with, and I took them on anyway. Kelly (06:08) Right. I first want to say I think it's brave for you to share this, because it's something I don't think people talk about. It brings up shame, it brings up confusion, and I really appreciate your vulnerability around it, because I do think it's a common thing when people start their practices. Maybe it's about money, the fear of, if I don't take this client then I won't have income. Or it could just be fear of turning people away. Our ethics are really clear: we have to be clear about what we are able to do and how we can help, and if we're not the right fit, to refer out. Learning to do that is a skill. Learning what questions to ask so you can figure that out is also a skill. There's also the possibility that you don't have all the answers in your initial consult, but over time you notice this isn't working really well, and you intervene then. So there are many points along the path where you can come to this realization, and it's important to develop the skills around having some of those harder conversations. So let's start here: what have you done to shift that dynamic, where people leave without really completing treatment and you're working with everyone? What has shifted for your practice? Diana (07:44) Now I screen clients out when they initially contact me. I do a consultation call and I screen them very well, and I ask a lot of questions about how I can help them, what their expectations are, what their goals look like, what it would look like if they were doing better, and how they want me to work with them, or what they want from me. Then if it seems like a good fit for both of us, I go ahead and schedule them. And I do regular check-ins now and ask them, are you getting better? Do you feel better? Is there anything else you'd like to work on? I ask those questions regularly and that really seems to help. Because if they're not getting better, if they say I'm not getting better, then we talk about it. Maybe I need to refer you to another therapist, somebody who's more trained, or whose niche is more in line with what you're dealing with. That works out really well too. Kelly (08:49) Or sometimes it's just changing the intervention: okay, we've been trying it this way, can we try something else? What has it been like to ask those questions? I think sometimes we don't ask because we don't want to know. What was it like for you to start implementing more outcomes conversations in your practice? Diana (09:17) When I first started doing it, I was uncomfortable, because I didn't want to know. And some of the feedback I got was valuable, very valuable, but some of it wasn't always positive. Although taking in that feedback, the feedback about where I could do better, really helped me start doing better in those ways. Kelly (09:45) I think there's something about negative feedback being a sign of the environment you've created, an environment that allows negative feedback. How many of us are in relationships where we don't say the thing, where we don't have the hard conversation? To get to a place with a client where they can say, I didn't like that, that didn't resonate, this is really irritating me, that's a gift. They trust you enough, and they want to give you that information. So how do you decide what to do with it? Do you take all of it and run with it? Or do you sit with what's true for you and then get supervision or training? What have you done with negative feedback in the past? Diana (10:41) I take it in and I look at it as objectively as I can. In the past I was taking it in as negative about me: of course, I'm a bad therapist, I'm not doing a good job. But I've worked through that in my own training and my own therapy, and I do consults regularly. So I really look at it objectively and ask, is this really true? Can I make a shift here? Is this something I can change and do better with, or is it something that's out of my control and I need to refer out? Kelly (11:17) I think that's really important. What is within my control? If I were to shift this, does it still align with my values? Is this important to me, or is it actually just not a good fit? You can't take all the feedback and apply it all the time. If you did, everyone else would be telling you what to be and how to be. But it's good to internalize it and check it against your values, your experience, and your patterns. So as you started doing your consults differently, what did you notice shifting just from that? Diana (12:02) That clients are more specific with me about what they want, what they're seeking in treatment, and what they're wanting help with. And then I can be more specific about how I can help them, or if I can't help them. Kelly (12:21) Just so much more clarity. Diana (12:23) Yes, much more clarity. Kelly (12:29) Clear is kind, is what we say. Diana (12:30) Right. Kelly (12:33) And how often are you doing outcomes conversations with your clients? Diana (12:36) I try to do it every three months or so, sometimes four, sometimes sooner. If I get the feeling that they're not making progress, or they're telling me they're not making progress. I do EMDR, and I've had clients come in and say, I'm really anxious coming in to see you. And I'll say, okay, we need to talk about this, because it's not my intention to make you anxious about coming to therapy. Kelly (13:06) Maybe they need more resourcing first. Diana (13:13) If I get something like that, then I'll do outcomes a lot sooner, maybe every two months or so, or even once a month. Kelly (13:23) So now that you're doing that, what do you notice about your outcomes and the success you're getting with clients? Diana (13:34) That they're doing better when I do the outcomes with them. They say they're able to identify what's going better for them. And that they're able to graduate and say, okay, I'm done with therapy, I don't need therapy right now. Or, I can start moving to every other week, we can start tapering off sessions, and I have these coping skills I can use in between sessions or when I'm not in therapy. It looks a lot clearer. Kelly (14:05) And what does that do for you internally? Diana (14:09) That makes me feel very happy. Kelly (14:11) You seem so light, Diana. I love seeing it. There's more ease as you talk about your practice. Diana (14:22) Yeah, I feel a lot more ease in my practice. Kelly (14:26) And what does that do in terms of how you run the business side of things, when you have more of that ease? Diana (14:36) It makes all of it a lot easier. I feel a lot clearer when I'm running my business and thinking about what I need to do, in my marketing and my consultations and the whole business end. That's one of the things I was pretty good at from working for the county, the billing and everything. I never slacked off on my notes, because I wasn't trained that way. I never had that issue. Kelly (15:05) Lucky you. Diana (15:11) But overall, running my business, it does help. I do have a lot more clarity. Kelly (15:15) I think sometimes when people listen to this podcast, they're expecting success to mean the number of clients, or the amount of income, or creating a new program or product. But at the end of the day, are you successful if you're not getting good clinical outcomes? I think it's something people often forget. Before you overhaul your whole business model or get on a panel, look at the clients you're working with right now. Are you doing your best work? Are they getting the outcomes they desire? That's a great place to start. Diana (15:55) For me, that really has made a huge shift in my practice. Kelly (16:01) You said you worked through the feeling of feeling bad about yourself when you got negative feedback. What are some of the ways you did that? How did you work through it? Diana (16:15) I took Internal Family Systems training. I applied several times and I finally got in. I really like that model. In that training, it's very experiential. There's hardly any lecture, just a little bit, and then you get in groups and you practice, rotating through client, observer, therapist, and you keep doing that. And then you have an assistant working with you. I don't know exactly how it happened, but the assistant jumped in and started working with me on my parts. She did this whole exercise with my imposter part, and it was just beautiful. She walked me through the whole thing: what did this part look like, where did this part live. We burned all this part's clothes and changed everything up, and the part lives somewhere else now, not inside of me. It was almost life-changing. It was very profound. Kelly (17:44) We love that. That's so magical. Diana (17:47) It was very magical. It was a wonderful experience. Kelly (17:54) That's a great share, because different parts of us could be running our business. Are we running our business from our higher self, from our own energy, and not from inner children and small parts that are scared or protecting or managing a lot of things? Imposter syndrome can really hold therapists back from being seen, from doing their best work. So I love that a parts work process is what helped you navigate that. Diana (18:37) Yeah, it was very profound. Kelly (18:39) So how do you feel toward your business now? Diana (18:44) Very positive, very grateful, very inspired. I'm really enjoying my business a lot. It feels very satisfying. I feel very satisfied with it. This is something I wish I'd known 30 years ago, because this is something I wanted 30 years ago, but it just didn't work out that way. Now I have it, and it feels really wonderful. Kelly (19:13) I love that. What advice would you give to someone who's starting a practice? Diana (19:18) Know what your niche is, know what your clientele is, who your ideal client is. And join a program like zynnyme to get that support, because most of us are flailing around. I was flailing around. I was very lonely, very isolated. I felt scared at times. Having that support with zynnyme was so invaluable, because I really grew so much. Kelly (19:54) Whether it's a program or not, I think there's something to be said for being in community. Isolation is the system at work. The system wants us isolated and not talking to each other, because then we can be more of their robots, or just fall in line, versus continually serving people better and improving ourselves and the lives of others. That comes from connection. You have this imposter part, right? You could maybe have figured that out on your own, but what a gift to have someone see you and help you, so you didn't have to. Sometimes these things can be so heavy and challenging, and having support really can make a difference between staying stuck and moving through and healing. It doesn't mean those things won't come back up again, but as you get more support, you get comfortable with the idea that it's not just me, that I don't have to do this all alone. Diana (21:09) No, and that's absolutely true. We're not meant to do things alone. Private practice can be so isolating that it makes a world of difference being part of a group. Kelly (21:19) Especially now, when a lot of us are online too. You just stay home. I could not leave my home for a week. I have to be very intentional about getting out. And about the niche: what would you say your niche is now? Diana (21:35) It's working with anxiety disorders and complex trauma. And I do EMDR and IFS with my clients. Kelly (21:44) Beautiful. That feels very clear, instead of all the things. Diana (21:50) Yes. Kelly (21:52) The other aspect of that is that it's a journey. You have experience with a lot of different populations and pain points and diagnoses, and then it's finding where you land, where you feel confident, where you enjoy the work. That takes time and it can iterate over time. You weren't doing IFS initially; IFS got added in. So we have time. We have time to grow and to shift. Diana (22:18) Absolutely. Over time, things do shift. You may have something that worked for you really well before, but it doesn't work so well now and you need to change it. That's just part of the process. Kelly (22:32) And I love that you get clinical consultation. I always did when I was in practice. Even when I was licensed, I still paid for outside consultation. I thought that was really important. Sometimes when people are in private practice, they forget about that aspect, because they're so busy running the business and seeing clients. Then how do they nurture themselves clinically? Diana (22:56) That's true. Kelly (22:58) Well, thank you, Diana, for sharing your story. I love this conversation about clinical outcomes and how it contributes to a better practice. A successful practice means your clients are staying to the end and are really pleased with the care they're getting and how it's transforming their life. So thank you for your vulnerability and your bravery in sharing. Diana (23:23) Thank you. Kelly (23:33) And for those of you listening, I hope you can really take this to heart and see that we're not great with everybody. That doesn't mean we're not good therapists, or that we don't hold our own special value. You are valuable. It's just getting really clear about where you do your best work and with whom you do your best work. If you're starting out and the feeling is, I'll just take whatever I can get right now, that can lead to a lot of issues, like the imposter syndrome Diana shared, and not feeling good about your business. And when you don't feel good about your business, it's really hard to work. But if you start from a place of really offering your highest and best, checking in and caring about the outcomes with your clients, you're leaps ahead, and you're laying a really solid foundation for your practice. If you'd love to learn more about how we help, check out zynnyme.com. We have free trainings, we have our books, and we have information about business school. Until next time, take care.

Lesson 2: "I must be a bad therapist" is usually a fit problem in disguise

Diana described the result plainly: clients dropping out with no closure, canceling and never returning, ghosting her with no explanation. A few were great fits who stayed and finished well. Many were not. She kept filling the empty slots the same way, round and round.

When Kelly asked what that did to her personally, the answer was immediate. She believed she was a bad therapist. It took a toll on her self-esteem, and the imposter syndrome got loud. Notice what did not happen: she did not conclude that she had a referral-screening problem. She concluded she had a competence problem, which is a very different thing to live inside.

Looking back, the pattern was legible. The clients who stayed were dealing with anxiety or complex trauma, things she was genuinely trained in, and they were people who came to do the work rather than waiting for her to hand them answers. The ones who left included OCD and grief cases she had no experience with and took anyway.

The takeaway: Before you interpret a drop-out rate as evidence about your skill, check whether it is evidence about your screening. Those two conclusions lead to completely different next steps, and only one of them is accurate.

Lesson 3: The consult call is where outcomes start

What changed first was the front door. Diana now screens people during the initial consultation call, and she asks real questions: what are you looking for, what do you want from me, what are your goals, what would it look like if things were better, how do you want us to work together.

That is not a sales script. It is the first clinical assessment, and it does two jobs at once. It tells her whether she can help. It also makes the client articulate what they actually want, which most people have never been asked to do before they walk into therapy.

The effect she noticed was that clients got more specific with her, which let her get more specific back, including about what she cannot help with. Kelly's word for it was clarity. "Clear is kind" is the phrase we use around here, and it applies to the fifteen-minute phone call as much as to a fee increase.

The takeaway: A consult call that only confirms availability and insurance is a missed clinical opportunity. Ask what they want and what better would look like, and you will know more in ten minutes than you would in three sessions.

Lesson 4: Ask whether it is working, on a schedule

The second change is the one most of us skip. Diana does outcomes check-ins with existing clients roughly every three months, sometimes four, sometimes sooner. Are you getting better? Do you feel better? Is there something else you want to work on?

If a client says no, that is not a failure; it is information arriving early enough to do something with. Sometimes the response is a referral to someone whose training fits better. Sometimes, as Kelly pointed out, it is simply changing the intervention: we have been trying it this way; can we try something else? When a client told Diana they felt anxious coming in for EMDR sessions, that moved the check-in cadence up to every month or two and opened a conversation about resourcing.

She was honest about why she had not done this earlier. It was uncomfortable because she did not want to know.

The takeaway: Put outcomes conversations on a schedule rather than waiting for them to feel appropriate, because they will never feel appropriate. Quarterly is a reasonable default; shorten it when something feels off.

Lesson 5: Negative feedback is a sign of safety, and then it needs sorting

Here is the reframe that made this episode worth recording. When a client tells you that did not land, that was irritating, this is not helping, they are telling you something about the environment you built. Most people, in most relationships, do not say the thing. A client who says it trusts you enough to risk it.

But receiving it well is only half the work. Diana's earlier pattern was to take every piece of criticism in as a verdict on her worth. What she does now is take it in and look at it as objectively as she can, with the help of her own therapy and regular clinical consultation: is this true, is this something I can change and do better, or is this outside my control and pointing toward a referral?

Kelly added the filter that keeps this from becoming a different kind of trap. You cannot apply all feedback all the time, or everyone else ends up deciding who you are. Check it against your values, your experience, and the patterns you have seen before you act on it.

The takeaway: Getting hard feedback means you built something safe. Sorting it into "true and changeable," "true but not mine to fix," and "not aligned with how I practice" is the skill that keeps it useful instead of corrosive.

Lesson 6: Clinical outcomes are the business metric nobody counts

Kelly said the quiet part directly. People come to this podcast expecting success to mean caseload size, revenue, a new program, a course. But are you successful if your clinical outcomes are poor?

Before you overhaul the business model, before you get on a panel, before you build the group practice or the digital product, look at the people already on your schedule this week. Are they getting what they came for? That is both the cheapest thing to improve and the thing everything else rests on. Word of mouth, referrals from other clinicians, the confidence to charge your fee, your willingness to market at all: all of it runs downstream of work that actually helps.

Diana's description of the effect was not a revenue number. Clients could name what was getting better. They tapered to every other week. They graduated with coping skills they could use on their own. And she felt a lot more ease, which showed up in her marketing, her consults, and the entire business end of the practice.

The takeaway: Outcomes are not separate from your business; they are the foundation of it. Fix what is happening in the room before you rebuild what is happening around it.

Lesson 7: The part running your business might be the imposter

Diana applied several times before getting into an Internal Family Systems training. It was experiential, very little lecture, mostly practicing in small groups while rotating through client, observer, and therapist roles. An assistant in the training started working with her on her parts, and walked her through an exercise with her imposter part: what it looked like, where it lived, what happened when things got rearranged. She called it profound and close to life-changing.

Kelly's expansion of this is worth sitting with. Different parts of us can run our businesses. Are you pricing from your higher self, or from a scared part? Are you marketing from your own energy, or from a young part that learned it was safer not to be seen? Imposter syndrome does not just make you feel bad; it keeps you small in ways that show up on your website, in your fee, and in whether you ever say who you actually work with.

The takeaway: If the imposter feeling has survived years of evidence to the contrary, more evidence is not the intervention. Parts work, consultation, or your own therapy might be the business strategy.

Lesson 8: You do not find your niche alone

Diana's advice to anyone starting out was to know your niche and your ideal client, and to get support in a program or community rather than doing it solo. Her words for the before state were flailing, lonely, isolated, and sometimes scared. She has been part of zynnyme's community, and what she named as valuable was not a tactic; it was growth and not being alone with it.

Kelly's read on isolation is a systemic one. Isolation is the system working as designed. It keeps clinicians compliant, quiet, and easier to absorb into someone else's platform. Connection is what makes it possible to serve people better and to keep improving, and it is also how someone can see the thing you cannot see in yourself. Diana might have found the imposter part on her own eventually. Someone helped her find it faster and carry less weight doing it.

Her niche now is anxiety disorders and complex trauma, with EMDR and IFS. That did not arrive on day one. It arrived after a career's worth of populations and diagnoses, and the IFS piece came later still. Kelly's framing: this is a journey, and we have time to grow and shift.

The takeaway: Your niche is usually discovered through experience rather than chosen in advance, and it is much harder to see clearly from inside your own head. Community shortens the timeline.

Ready to Build a Practice Where the Work Actually Works?

Diana did not fix her practice with a rebrand. She fixed it by changing who she said yes to, asking harder questions earlier, checking whether therapy was working, and getting support with the part of her that had decided she was a fraud. The result was a smaller, clearer practice, clients who finish well, and a business that feels satisfying to run rather than something to survive.

That sequence is the one we keep watching work. Most therapists come to us thinking the problem is marketing. Often the problem is that they are trying to be everything to everyone, which makes marketing impossible to write, fees impossible to raise, and outcomes impossible to feel good about. Narrow the work, get honest about results, and suddenly there is something specific to say to the people you can genuinely help.

Business School for Therapists is our flagship program for therapists ready to build a practice that supports the life they actually want. It is a blend of live coaching and self-paced curriculum, plus a community of clinicians who normalize niching, real fees, and clinical depth. Twenty years in, it is the work we wish someone had handed us when we were spending our own weekends figuring this out.

If you are not ready for a program, start smaller. Add one question to your next consult call. Ask three current clients this month whether they are getting what they came for. Notice which answers you were afraid of. That is data, and it is free.

Learn more at zynnyme.com, or keep listening: more episodes are at zynnyme.com/blog.

Key Takeaways for Therapists

• Agency intake habits do not transfer to private practice; taking everyone who calls is a trained reflex worth unlearning.

• Drop-outs and ghosting are more often a fit problem than a competence problem, but they get interpreted as competence.

• The consult call is a clinical assessment: ask what they want, what better would look like, and how they want to work.

• Schedule outcomes check-ins every two to three months rather than waiting until it feels natural.

• Clients giving you hard feedback is evidence of safety; sort it into what is true and changeable, what is outside your control, and what does not fit your values.

• Clinical outcomes come before business model changes; they are the foundation everything else sits on.

• Imposter syndrome can be worked with as a part rather than argued with as a fact.

• Niche is usually arrived at over time, and community makes the path shorter and less lonely.

Resources

• Diana's practice: dianakoenenlmfttherapistmenifee.com

• Book a free fifteen-minute consult with Diana: dianakoenenlmfttherapistmenifee.com/contact

• Diana on LinkedIn: linkedin.com/in/diana-koenen-80642836

• Diana's EMDRIA directory listing: emdria.org/directory/people/diana-koenen

• EMDR International Association: emdria.org

• IFS Institute, Internal Family Systems trainings: ifs-institute.com

• Watch on YouTube: youtu.be/EREvVypKgxo

• Business School for Therapists and free trainings: zynnyme.com