Doubt Yourself, Do It Anyway with Patrick Casale

Patrick Casale (00:00):

Doubt yourself. Do it anyway. I mean, you really have to move into this mindset of pursue the things that you're passionate about, allow yourself to fail, allow yourself to make mistakes because you're going to and just give yourself permission to be human.

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Michael Fulwiler (00:14):

This is Heard Business School where we sit down with private practice owners and industry experts to learn about the business of therapy together. I'm your host, Michael Fulwiler. Welcome back for season two of Heard Business school. Thank you so much for the support for season one. It's been a few months, so it's great to be back. If you're just joining us for the first time, we're glad you're here. My guest this week is a good one. He's a neurodivergent entrepreneur, therapist and founder of all things private practice. He's a TEDx speaker, group practice owner, coach, retreat planner and podcast host. After burning out in community mental health, he launched his own practice and scaled it to a 20 person team. He was diagnosed with autism at 35, a turning point that now informs his work and content. He was also diagnosed with a rare condition that affects his vocal cords, which totally transformed his work and business. Now he helps therapists grow their businesses without losing themselves through international retreats. One of the things I appreciate most about him is his authenticity, which we dive into. As a disclaimer, this episode does have some strong language. Here is my conversation with my friend Patrick Casale. Enjoy Patrick Casale. Welcome to the show.

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Patrick Casale (01:37):

First person in a long time has got my last name right, man,

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Michael Fulwiler (01:40):

I practiced it. I want to say Patrick.

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Patrick Casale (01:43):

Yeah, people say Casal, Casali, all those things. Yeah, I've just rolled with it. I've always been like, whatever.

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Michael Fulwiler (01:51):

Yeah. Well, glad we nailed that to start the beginning here. Very grateful that you've made time to come on the show. You're probably the busiest guy that I know. I will say that whenever I send you an email, you almost immediately respond.

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Patrick Casale (02:08):

There's a reason for that

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Michael Fulwiler (02:09):

Though. What's your secret?

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Patrick Casale (02:12):

My secret is being ADHD or autistic, ADHD human and who has significant amounts of demand or drive for autonomy. I don't want to say demand avoidance. I have to clear my notifications, but it's a twofold thing. It's a double-edged sword. I need to clear them immediately. They bother me, but then I feel like I have to respond immediately so I don't forget. So it's a constant limbo process of not wanting to ever open my inbox ever and then opening it far too frequently to constantly be responding or clearing.

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Michael Fulwiler (02:47):

That makes sense. I'm one of those guys that I have, if you looked at my phone, I have 10,000 unread emails, which would probably stress a lot of people out. I don't know if we

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Patrick Casale (02:58):

Can be friends anymore. Oh, sorry man.

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Michael Fulwiler (03:01):

I hope we have a lot to cover. Very excited for this conversation. I've been looking forward to it. Would love to start with your entrepreneurial journey. When did you first get serious about becoming a therapist?

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Patrick Casale (03:17):

I don't know, man. I was very lost for very long times of my life, and I've always been drawn to just building relationships with people. I think in college, some of my friends would make fun of me for constantly talking to maybe unhoused people in Pittsburgh, New York and always checking in with them and wondering if they were okay. And I just knew connection for me meant everything because I've so often felt so disconnected in my life and I ultimately think that it was always a pathway. My mom was a therapist as well, but I tried to avoid it at all costs because so many of us have unresolved childhood stuff and I was like, I'm not doing what my mom did. That was a mess. And then as I fought through about an eight year gambling addiction, there was a lot of therapy involved. And there out of the other side I'd impulsively had moved to Asheville, North Carolina from upstate New York in 2011. I was just kind of running for my life, if I'm being honest. That was kind of a last ditch effort of maybe I'll figure out how to abstain from gambling and maybe I'll do it for a year and I'll go back to New York and finish my master's. It was going to be in school counseling. Fun fact is I despise kids. Just really wanted summers off.

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(04:38):

And then 2011 has turned into 2025 and I ended up working at a nonprofit here in Western North Carolina to help end homelessness here in the rural parts of the state and ended up going back to get my master's in 2015.

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Michael Fulwiler (04:54):

So you go back to grad school, graduate 2015. Did you go right to an agency from grad school?

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Patrick Casale (05:02):

I did a really fun internship at a methadone clinic where I had to be there every day at four in the morning, and then I took a job at a 24/7 walk-in behavioral health urgent care. It was one of the first of its kind, and I was like,

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Michael Fulwiler (05:18):

Yeah,

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Patrick Casale (05:19):

I finally made it. This is what I'm going to do for the rest of my life. And that certainly was not the case.

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Michael Fulwiler (05:25):

Was private practice on your radar at that point?

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Patrick Casale (05:30):

No, it was only a pipe dream and this vision of if I burn myself out enough and I get enough experience in community mental health, then I can finally start my private practice. And I just remember having a few friends and colleagues in town who had left their agency jobs to start private practices, and I was always kind of envious but also super proud, just like, damn, that sounds like an amazing venture. And I also have no idea what it means to do that. So I really thought that I would be in community mental health for my entire life and that lasted about two years.

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Michael Fulwiler (06:06):

You tell a story of when you were leaving your job in community mental health, you did an exit interview. What did they tell you?

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Patrick Casale (06:15):

You've done your research, Michael. It's a story I tell very often though. I remember going to this exit interview with my program manager and I was one of those people who was in middle management. So I was always damned if you do or don't and could never support my staff enough. We never had enough resources. But yeah, administrative staff was always like, we need more productivity with less resources. And I gave a 90 day notice and they replaced me in two days and I had written that 90 day notice so many times and was so convinced that how is my staff going to function without me? How are, how's the program going to run without me? And they're like, yeah, we don't care. You're gone. I remember going to the exit interview with the program manager at the time of the program I was helping run, and she was a friend or someone I considered to be a friend at the time, and she's just said, you're not going to make it on your own. Nobody does. You'll be back here in 30 days. And I was just like, that is a really bizarre thing to say. And I had to really wrestle with that for a while and I assumed some of it was just her own stuff being projected outwards, like that job sucked. And I can imagine it felt like grief for me to be leaving it, but it definitely hit me in a way where I was like, I'm going to use this as motivation every day of my life. Fuck that.

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Michael Fulwiler (07:34):

It seems like it's almost by design though, that the system is set up to keep therapists in community mental health where there's a lack of education about opportunities in private practice and kind of beyond community mental health, although I feel like that's changed. Would you agree?

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Patrick Casale (07:52):

Yeah, I would say over the last five years, especially when I was leaving community mental health, I think I only knew of Alison per year who's also here in Asheville Abundance Practice building, and she had her infamous Start Your private practice checklist, and I was looking through it day by day and I was like, I don't know what an NPI is or an EIN or how to actually get client all of the things, but we're so conditioned in this profession to shy away from risk taking and it's almost taboo to even talk about business ownership in grad school. The only times we ever talked about it in our program was the running joke of you don't get into this industry to make money and nobody makes it successfully. Or if you're in private practice, you're doing it or on the side or at night and on weekends to supplement income. And it was never talked about from the perspective of like, oh, you can actually have a really fulfilling career and make as much money as you want to and help so many people doing significantly less hours of work. And it was never discussed. But fast forward to now, and we have all these private practice coaches and all these people who help people build practices and group practices, and it's becoming much more commonplace, I think.

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Michael Fulwiler (09:04):

What were the first steps that you took to start your practice after you left your job?

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Patrick Casale (09:09):

I was building it at night while I was at my job, so I was trying to convince myself that if I got to a threshold of if I get 10 clients, then it will give me the confidence to quit my job and I'll be fine and transition seamlessly into it. And I remember when I put my notice in, it was synchronistic maybe, and maybe the universe was trying to test me, but seven of those 10 clients just disappeared. They were like, either move out of the state, just stop coming to therapy, whatever. And I was just like, oh, I just made the worst mistake of my life and I maybe need to go ask for my job back.

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Michael Fulwiler (09:45):

So at that point are do you form an LLC? It sounds like you were kind of building the practice on the side, but what about the infrastructure? Because I know for a lot of therapists I can feel really intimidating like, oh, I need to form a business entity, or I need to go get a bank account, or I have to get an EIN, all of that stuff.

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Patrick Casale (10:04):

I just added very bare bones and I've recommend anyone who's listening, the old saying of obviously it's all state dependent and licensure specific, so take it with a grain of salt. But I had a sole proprietorship. I had a DBA of doing business as I had a business bank account and didn't really have much else. I had a EHR medical record system. I was still doing paper notes a lot of the time. Payment systems were wonky. I would use IV pay sometimes or sometimes I would use simple practice and it was a mess, but I was just making it work the best I knew how to and making a lot of mistakes, which was super important and allowed me to always constantly step back, reevaluate, analyze, and then pivot and adapt.

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Michael Fulwiler (10:51):

Do you remember, what were some of those mistakes that you made looking back?

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Patrick Casale (10:55):

Oh yeah. So one that always sticks out to me is I had no cancellation policy in place at all and I didn't have any credit cards on file. So very early on had three back to back to back, no-show late cancels and couldn't charge any of them because I had no policy in place and I hadn't discussed it with anybody. And I just remember sitting in my office in the dark, so depressed, so sad to convinced myself, you clearly are not cut out to own your own business. And then thankfully, using some regulation skills and exhibiting some restraint, just convinced myself, I was like, okay, this is annoying. This really does suck. It's very frustrating, but it's so fixable. We can create the policy, have all of our clients sign it going forward, get the cards on file and start talking about the policies and procedures that so many of us are so concerned about having conversations about it really was a good pivotal moment for me to just be like, this is definitely not going to be the thing that completely sinks the ship and all of this stuff can be revised and edited and changed a million times over.

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Michael Fulwiler (12:03):

I think that's such an important point. I think a lot of therapists wait to go into private practice. They don't have everything lined up, they don't have all the forms, they don't have all the paperwork, but that's okay. You'll figure it out. Stuff happens. I remember we had Melvin Varghese from selling the couch on the show and he talked about a similar experience. He was in Pennsylvania and there was a big snow storm and he had to cancel all of his clients for the week and he lost a thousand dollars. He just sort of had this moment of, wow, I need to figure something else out to help to supplement my income in the event. And that was more of a natural disaster than cancellation policy, but that led him towards podcasting and online courses and diversifying his income. He realized, if I don't see clients, I don't make money.

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Patrick Casale (12:54):

Yep. Yeah, a hundred percent. And going to your point about therapists feeling like they need to perfect it, I mean I did a lot of that too, but a lot of my coaching was so much geared on mistakes that I had made. My website at first was terrible. I think I found some random guy online who was building a portfolio, he charged me make a hundred dollars. It was so bad, but it existed. Perfectionism is such the thief of joy because I have always kind of tapped into imperfect action of build the plane as you fly it. And I always do things ask backwards in a lot of ways. And so many of my therapy coaching clients would be like, I have to demo every single EHR under the sun to find the perfect one, but that's just preventing you from starting, right? Instead, if you just pick one, you will then force yourself to learn it as you go because you're going to get client inquiries and then you're going to have to figure it out.

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(13:50):

So for a lot of people that can feel very counterintuitive, but in reality it really is the catalyst to moving forward. And I think it's so important to get out of that perfectionism mode. So many people won't launch their websites or their psych today because it's not perfect. It never will be. And the beauty is you can change it a million times. I can't tell you how many websites I've done and redesigned and since that really bad one in 2017. So everything is just a living doc and template and it can always be edited and improved and fixed and changed.

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Michael Fulwiler (14:22):

I like to say perfectionism is the enemy of progress. And so we see that in marketing as well. You can always change it later, just ship it, get it out there and iterate.

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Patrick Casale (14:35):

Being visible is better than being non-existent. Your clients can't find you if you can't put it out into the world and they can find you even if you have a really shitty website. So

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Michael Fulwiler (14:46):

You started your private practice, you're building it up. How long did it take for you to full or what you would consider full in terms of the amount of clients that you wanted to be seen?

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Patrick Casale (14:56):

I would say it took me about four to five months, but I think it was because I had an epiphany moment after I think early on you experienced a lot of imposter syndrome and self-doubt because you might have clinical interactions that just don't go the way you want it to, and maybe it's just not a good fit ultimately, or it's just the rapport isn't there and kind of just taking everybody and anybody who calls you initially because you're panicked that you're not going to get phone calls. Once I realized that, and I changed my psych today, I remember I was going back and forth for a while from the very typical generic psych today that I audit and make fun of all the time now, which is like I'm a trauma-informed therapist and I'll walk alongside you and I use all the modalities under the sun, but then just being like, this isn't me.

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(15:44):

And if I just say something like, vulnerability is really fucking scary and it's okay for that to be the case. It's okay to be scared. It's okay to pick up the phone and make the call. And if I use words that I actually use in everyday life and then the phone just starts ringing off the hook, and it was just that moment where I was like, oh, we're in the business of selling and marketing connection. How do we connect if we can't allow ourselves to be authentic and genuine and acknowledge that we are not going to be for everybody? Not everybody who comes across my website is going to be a good fit, and that's okay. And that's why networking is so crucial. So lots of aha moments. And then once that happened, floodgates kind of open and then wait, lists happen and you get too busy and then you overschedule yourself because you're a helping professional and you're like, I can do more. And it's a good way to swing the pendulum into burnout too.

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Michael Fulwiler (16:42):

This idea of authenticity is huge. And when I think about authenticity, you really embody that. And it sounds like it's intentional, right? It's something that you think about when I observe how you show up in your Facebook group, in social media, on your podcast, on your website. You are who you are and people either love it or it turns 'em off and they don't like it, but the people who don't like it aren't your people. And I think it's much better to be authentic and be yourself and attract people who are like-minded then to not show up authentically and not be yourself. Just the fact that if you look at your website, you curse on your website and a lot of therapists would never do that, but I love that. I think that it's great. I think the clients who resonate with that, they're going to probably connect with you more in session, right? You're going to have better rapport

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Patrick Casale (17:45):

A hundred percent. I mean, even back then, just with that simple on my sec today, I get calls from young adult guys who are looking for a therapist who are like, I think you're my person because you cursed. And I'm just like, okay, well that's mind blowing to me. But that is it's reality because I've sat in therapy spaces as the client before when I'm concerned about what's coming out of my mouth and then that's a struggle. I want to be able to come to therapy and be myself as the client. So just switching that perspective around when I transitioned to group practice, I had to redo all the copy on our website. And I remember very strategically placing things like, again, similar statements like I just said on the homepage. And our web design person at the time was, you're going to turn off more conservative clients.

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(18:33):

And I said, that's okay. Those are certainly not going to be our clients. So again, I think that's why networking is crucial because people can call and say, really looking for A, B and C, and you can say, oh, Michael does that down the street and here's his contact. And it's just a really embodies abundance mindset in a lot of ways to recognize we are going to attract and repel by how we show up. And I think also, I know you wanted to talk about neurodivergence and not autistic identity. I know I am to the outsider looking in, people are always thanking me for being my authentic self and modeling and oh, you've inspired me to be my authentic self. And I'm just like, I'm not doing anything unusual though. I'm literally just being me and I don't know how else to be. And I think that is an autistic strength of just like I can't be artificial or fake. I can only show up authentically me. I just now have an understanding as to why

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Michael Fulwiler (19:33):

You have this saying that I quote all the time and my newsletter, authenticity is relatability D and authenticity doesn't come natural to a lot of people. I think it can be scary. What if I am my authentic self and I'm rejected or people don't like it or I get criticized. So there's that fear, but it sounds like you just need to push through that.

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Patrick Casale (20:02):

And let's also reframe it too, because I also think that authenticity is relatability, but I think relatability equals accessibility. So if you are relatable and you are working with clients who are parts of marginalized groups, you are creating accessibility because that means that your queer clients, your trans clients, your bipoc clients, your autistic clients are going to read your relatable, authentic statements and they're going to connect with it instantly, and then they're going to know, this person can be safe for me, I don't have to go and retell my story. I can literally just drop into the experience without shame or judgment. And I think that is a really beautiful part of humanity.

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Michael Fulwiler (20:48):

I love that. You mentioned authenticity being an autistic strength. You were diagnosed with autism as an adult at 35. Can you walk through that experience and what that was like? Yeah,

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Patrick Casale (21:05):

I was also diagnosed A DHD, but that was probably when I was 30, but it didn't answer all the questions for me. I remember getting the A DHD diagnosis and not really being surprised. I was just kind of, again, for so long, both autistic and A DHD culture and research and everything. It was all about young white boys for a long time. So when I got an A DHD diagnosis, I was kind of just like, okay, yeah, that makes sense. And I don't really think much of that, but there was something missing. I actually remember being in Hawaii at a therapist conference. I decided to go watch the Anthony Bourdain movie Roadrunner with a bunch of grief therapists. Really bad idea, by the way. They don't want to unpack this movie afterwards. But the reality was that so much of his life that he put on camera was so raw and so vulnerable, and there was so much pain.

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(22:01):

Even when he was traveling the world, you would see him do shoots or interviews and you could see it all over his face. Often my wife makes fun of me because my face doesn't lie ever. And it's just one of those situations where I was like, damn, his whole push pull of I need to be on the go, having experiences and stimulation and excitement and all the novelty, but simultaneously needing to be home in the dark with my person or my safer space and unable to really function in a lot of ways resonated so much for me. And then I remember getting back from that and just being like, damn, I'm really struggling mentally and emotionally and can't figure out what's wrong. As so many late in life, people who, or adults who have discovered their autism discovery later in life, there's always this feeling like, I just don't belong.

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(22:55):

I don't fit in. I'm on the outside looking in. I'm surrounded by people who love me, but I can't access it. And a lot of misdiagnosis comes with this experience and you just keep trying and you keep trying and you keep trying and you do all the late night deep dives and all the research and all the doctor's appointments and mental health visits and nothing ever adds up. And it's really demoralizing and defeating. And I remember shortly after being at lunch with a friend, and I don't know, I must've just been probably sitting there completely vacant and just so I don't know, fragile emotionally, and she was like, I think you need to go get assessed for autism. I think that you'll probably have a lot of answers after that happens. And I remember being a bit offended at the time because we live in an ableist society, so we experience our own internalized ableism. And I was just like, I'm not autistic. I have a master's degree. I own a business, blah, blah, blah, blah, blah. All the thoughts that were going through my head, but I sat with it for a couple of weeks and then just like, I think I need to pursue this. So wow.

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Michael Fulwiler (24:01):

It sounds like that diagnosis was almost a relief in some ways to have that named.

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Patrick Casale (24:09):

Yeah. I talk about the grief relief paradox a lot. There's grief of childhood experiences. What would've been different if I would've known if my family would've been supportive? All that stuff. There's grief, like future grief of this is not changing, this is lifelong. There's always going to be this inherent struggle. And then there's enormous amounts of relief of just so affirming and validating and just finally having that lens to view the world through where you're like everything just finally makes sense. And all of that confusion and overwhelm that has gone into this relentless searching and seeking for belonging and understanding and making sense of things is finally unlocked. And I think late in life discovery can be unbelievably, not only life altering but lifesaving in so many ways,

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Michael Fulwiler (25:08):

And you talking openly about it is lifesaving as well. If it helps someone to go talk to someone about it, someone who's listening, maybe they'll hear this and they'll really relate to it and then they'll go be assessed and maybe get some answers that they're looking for.

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Patrick Casale (25:27):

Yeah, for sure. I will say that ever since I pivoted my content from how to start a private practice to just relatable autistic A DHD content, the messages are much kinder. It's always like, thank you for helping me see myself or my loved one. Instead of like, you son of a bitch, you recommended this service and I hate it. And I'm like, Jesus Christ, it's just a free thing. So I don't miss that world as much anymore.

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Michael Fulwiler (25:57):

That's interesting. Yeah, I feel like there's much more negativity in the business coaching space. There's also a lot of bad actors and people who are disingenuine in that space as well, grifters and stuff. So

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Patrick Casale (26:13):

Both can be true. I have had all things private practice paused the Facebook group since last March, and I used to regret that because I was like, this is ultimately impacting my financial stability. I'm probably selling less retreat spots because it's not open. And there were so many members recently over the last six months. I'm so relieved every time it goes to get unpaused, I just push it back another two months. And at this point I think I should just completely shut it down because moderating a 15,000 person group is really not of interest to me ever again.

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Michael Fulwiler (26:45):

Yeah. When you think about where you want to spend your energy, right? I do want to talk about this shift in your niche and even to take a step back. So when you started your private practice coming out of and still wrestling with a oriented addiction, did you build your niche around men who struggle with gambling and addiction? I've heard you talk about your niche can be a version of yourself. Was that the case for you when you first started in private practice?

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Patrick Casale (27:16):

Yeah, for sure. I think our niche is a version of ourselves in some capacity because so many of us get into this profession to heal parts of ourself at times. So at first, when I first started, mostly focused on young adult men who were struggling with addiction and networked with a lot of halfway houses, detox centers, treatment facilities, SA iops, et cetera. And that was probably the first year of my practice was just completely filled with people who were in some sense of recovery. And then I got kind of bored of that and was no longer just wasn't doing it for me anymore. And I think our niche evolves over time as we evolved as humans. And then I started doing more attachment focus work as I did more of my own attachment focus work and dove deeper into childhood experiences. And then I would say it evolved again into high achieving entrepreneurs who never feel good enough. I can also relate to that. And then I actually have not practiced as a therapist since 2022 since my second throat surgery, but had I still been practicing to this day, I'm sure it would now evolve into neurodivergent entrepreneurs, and that would be where I would spend most of my energy.

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Michael Fulwiler (28:27):

Definitely. As someone who has been following your work and we've been connected for five years, four or five years, it's been interesting to watch that progression and I think that that's great. I think a lot of therapists that I work with in a marketing capacity, they're so concerned about niching down because they feel like they're going to be pigeonholed in their practice of, oh, I have to work with this same type of client for the rest of my career. But that's not the case. Your niche can change and evolve

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Patrick Casale (28:58):

And it likely will, even if you said today my niche is young adult men struggling with addiction, let's just use that as an example. As you went through your career and you had more clinical experience and more client interaction and more training, you're probably going to evolve even within that niche and just using a different lens or different theoretical approaches and different perspectives. So don't think that if you choose a niche today that that's the rest of your career. And I also think that if you write content really well without sounding like a walking DSM five, that one or two statements are all you need for someone else who doesn't fall into that niche who reads that statement and is like, that's me too. And I think that it really is about, again, going back to that relatability piece, much more crucial than just saying, this is my niche. I work with high achieving female entrepreneurs, but if we really break it down into what those experiences are on a daily basis, those can be applicable across the board.

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Michael Fulwiler (30:02):

And something interesting that happens too is you can appeal to someone who wants to be part of that population. So if you work with high achieving female entrepreneurs, a female who wants to be an entrepreneur could see that and like, oh, this is what I want to be. This is sort of a goal for me. This person specializes in that population. I want to work with them. Maybe I'm not yet in that population, but I'd like to be

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Patrick Casale (30:30):

For sure. And there's got to be some common threads. Most entrepreneurs take risks. They're creative, they have a lot of self-doubt. So there's going to be common threads even if you don't define yourself in that population yet or see it as of yet. So super important just to know. I think that's so crucial and it's just an evolving, evolving process.

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Michael Fulwiler (30:53):

You mentioned your second throat surgery. What happened with that? Because I remember when it was happening, for someone who's a therapist and a podcast host and a speaker who makes a living by speaking, the idea of having throat surgery must be really scary.

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Patrick Casale (31:12):

Yeah, it's amazing how sometimes we don't realize how important our voices are, and there's somatic processing behind that too. And our voice is not only just how we show up and speak, but our voice and our ability to put it out into the world. And I got diagnosed with this really rare throat condition, which impacts 0.0001% of the population, all of whom are over 65. And my doctor was always like, you're one of the lucky ones. I was like, I'm not going to see you anymore. So cool. So I had an endoscopic surgery in 2021. The issue that I have is a chronic recurring situation, so unfortunately as a 30 5-year-old at the time meant more throat surgeries for sure, but it recurred within four months and they were like, well, I guess we're going to have to do the more drastic situation now and do open throat surgeries.

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(32:09):

So my biggest fear with that was always vocal cord paralysis, which is exactly what happened. They paralyzed one of my vocal cords, so you can hear it, my voice, it's gotten a lot better, but it still has that vocal fry, and once my voice is gone for the day it's gone, I have to be very mindful and intentional of how I spend my vocal energy each day because it's like a very limited resource that I have at my disposal. And it really meant I had to completely pivot everything in my business. That meant saying goodbye to my therapy clients and coming to terms with no longer practicing as a therapist. It meant going from hosting coaching courses and four month coaching programs and doing a lot of individual coaching to completely none at all, and financially that was very scary at the time, and it is just been a thing for the last three years where I've really had to figure out how I want to show up and where I want to spend my energy reserves.

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(33:08):

And I was embarrassed about it at first. You can still read reviews on especially divergent conversations, my other where reviews are like, great podcast, Patrick's voice fucking sucks. And I'm like, Jesus, I don't even think it's that bad anymore. But it's been an interesting mental and emotional process to go through learning how to voice differently, learning how to pitch differently, endless amounts of speech therapy, and then the realization too that if I'm in a crowded loud environment especially, it's just not for me, I can't speak over this volume. It still presents its challenges, but I will say it's gotten a lot better and it's been an interesting journey for sure.

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Michael Fulwiler (33:55):

I appreciated you making the time to be here because you are busy and I appreciate it even more, knowing that you can probably only talk so much in a day. I've heard the same thing about singers. I know it's like Taylor Swift for example. It's like she does a three hour show and then she doesn't meet with fans or talk to anyone after because she has to protect her vocal chords, right? So I imagine it's a similar type experience where you just need to be aware of how much you're talking and using your voice.

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Patrick Casale (34:25):

I like to think that Taylor Swift and I are one in the same.

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Michael Fulwiler (34:28):

Yeah, it's very similar

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Patrick Casale (34:30):

Personalities, similar wealth statuses. Yeah.

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Michael Fulwiler (34:35):

Being a therapist is about helping people, not crunching numbers, but when you're running your own practice, managing finances can feel like a full-time job one you never trained for. That's where Heard comes in. Heard is the financial management platform built just for therapists. No more cobbling together spreadsheets, DIY software or expensive accountants with Heard, you get bookkeeping tax support and financial insights all in one easy to use platform. Heard was started by an accountant and a software engineer who understand the challenges you face as a business owner. Our mission is to make it incredibly easy for therapists to manage their practice as a business, build wealth and stay focused on what matters most. Their clients join thousands of therapists who trust Heard with their finances. Schedule a free consultation today at join her.com/consult. So it sounds like you were almost forced to or you had to make a decision about transitioning out of private practice. And so was that when you started to offer retreats and other types of services? Was it kind of around that same time?

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Patrick Casale (35:47):

So I kind of mentioned before that I have done most of these things pretty ass backwards in my life. And so I ended up 2020 happens, COVID happens, we're all inside, and I start all things private practice and that kind of takes off. And then a year into that I was like, damn, it's really hard to do coaching and podcasting and also see therapy clients. Then I started my group practice in 2021, and then I gave up my therapy clients in 2022. But I always wanted to do retreats before I started All Things Private Practice. Before COVID happened, I had the goal of starting a travel coaching business where I would help helpers step away and immerse themselves in culture and take more risks. I didn't really know what I wanted it to be when I pitched it at first to people that are so a travel agent.

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(36:36):

I was like, no, I don't want to do that. But I also had no idea. I remember All Things Private Practice was the popularity and the following was increasing constantly and engagement was quite good. And I just remember back in early or mid 2021 saying if I hosted a retreat in Ireland, who would come? And I had so many responses and I was like, damn, I think that means I actually have to do this now. And so I have to then deep dive the location and the resources and all the meals and the dates, and I'm like, I'm just going to slap this together and figure it out. So I ended up creating a very basic crappy sales page and figuring out all the details as I figured it out. Once I secured dates, I was just like, I'm going to put it together and I'm going to piece it together from that.

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(37:25):

But that's always where the fear comes, right? Because all of those yeses in the comment section don't necessarily translate into sales and then you book a venue and you're like, Ooh, this is horrifying. But I sold that first event out and it was a phenomenal event. I remember that the FOMO from social media literally allowed me to sell out the next year in Ireland before I even touched my feet down on American soil that year. And now since that time I just wrapped up my fourth annual Ireland retreat, which will also be my last one there. But I've hosted 20 retreats and or summit since March of 2022.

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Michael Fulwiler (38:05):

That's amazing. I imagine with these retreats, there's a lot of risk, right? You're putting down deposits. What if people don't show up? That's got to be pretty scary. But I mean, it sounds like the demand is there and the interest is there. Is it also potentially kind of a timing thing maybe coming out of COVID, people have been at home and now they're kind of wanting to get back out to the world. Do you think that plays a factor?

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Patrick Casale (38:35):

Yeah, I think it definitely plays a factor. I mean, I think people were just itching to travel and experience, but I think more importantly, people want connection. People want community and connection. And that's what I've really tried to focus in on is intentional community and connection. A lot of people would say that one of my greatest gifts is being a community connector and building relationships. And I think that's true. And I also think that because of the way my brain works, I'm able to hyperfocus on details that people would usually get frustrated or overwhelmed by. I put 110% of my energy into everything that I do, which is also a blessing and a curse, and I just try so hard to ensure that these events are worth the price of admission. I've never not sold an event out, and I know that is really unusual because I actually host events on how to build retreats, and it really saddens me when people have really good retreat ideas, but they fall flat and it's kind of demoralizing for them and understandably, but you have to have a captive audience.

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(39:37):

You can have the best retreat idea in the world, but if you're unwilling to show up on social media or you don't have any sort of following or audience, it's really hard to sell spots to anything. So I really try to emphasize that when I'm doing those trainings specifically like marketing and consistency and showing up is so damn important. And this as a marketing professional, if you were just to launch retreats today without any sort of presence that know and trust factors not established, it's really hard to purchase a spot at something on the word of someone else. You really have to trust the source, especially you mentioned some bad actors in the field. You just have to be consistent and you have to be reliable, and you have to put a good product out there because even myself could be because I closed my Facebook group down, but I would say that this year it's been harder for me to sell spots than it ever has been before. We could blame what's happening in the world right now for a lot of reasons, and I'm sure that has a lot to do with it, but it's also that the market is now much more saturated, and my events are high ticket events, typically between four to $6,000 a person, and I think they're worth the price of admission, but that doesn't mean that I don't have to constantly find innovative ways to market them and get them in front of new audience too.

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Michael Fulwiler (40:59):

Putting my Heard hat on these events are almost entirely a business expense for therapists, right? The purpose is professional development, networking. So your flights, your travel, your hotel, the cost of the retreat, all of that is a business expense that can be written off. Now, if you go early or extend your trip and you turn it into a personal trip, you need to be a little bit careful that you're not trying to write off your personal expenses. But if you're listening to this and you, this is going to air probably sometime in June, but you paid a shit ton in taxes last year and you're like, man, I really need to get this tax bill down. I need to figure out what are some business expenses that I qualify for and can kind of reinvest in my business, not just spending money to spend money, right?

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Patrick Casale (41:52):

Yeah, absolutely.

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Michael Fulwiler (41:54):

If you're someone who wants to travel anyway, it's a win-win. Yeah, it's not a free trip, but

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Patrick Casale (42:01):

It also comes with at least all of my events come with CEUs too,

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(42:05):

So it's like it's even sweeter situation. I've really tried to go off the beaten path. If you're going to come into my events, we're not going to do things in typical popular locations. Like my Ireland event is in a village called Ferns Ireland. And if you were to go over to Ireland right now and ask Irish people if they know where that is, they would either look at you like they have no idea what you're talking about or ask you why the hell would you go there? But for me, getting off the beaten path and really getting into the local culture and really supporting the local small businesses and really having this special type of experience is exactly what I was looking for. And that's exactly what I found when I did my first Ireland event. And this village has less than a thousand people.

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(42:47):

It's got a church built in the 11 hundreds a castle, built in the 11 hundreds, three pubs and one restaurant, and it's just beautiful and green and wonderful, and that's it. But I think everyone has different traveling styles, and for me, what I've seen be the most special piece is the people who come first time out of the country, first time traveling solo, first time going to an event where you're going to spend five days with 20 other humans that risk and stepping out of your comfort zone propels you, not only professionally, but personally. And I think travel is the ultimate guide on how to really move through this world, and I think that it really helps propel us into my doubt yourself, do it anyway, mentality, which is each risk builds on itself and compounds, and you strengthen that foundation so that when you want to launch that podcast, launch that course, start a group practice, you know that you have done scary stuff in the past and you can rely and anchor into that. And that for me is the most important piece of all of what I've done over the last couple of years.

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Michael Fulwiler (43:52):

You mentioned doubt yourself, do it anyway, which has become your tagline or catchphrase, one of many. Where did that come from? When did that start?

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Patrick Casale (44:03):

I don't know when I started using it, but I did trademark it. I don't remember when I started using that, but in reality, it really is the epitome of everything I've done and created because I've been filled with so much self-doubt and fear and imposter syndrome and perfectionism throughout my entire life. And I just realized that the more you step out of your comfort zone and take risks, the more you can unlock these really unbelievably cool experiences and life-changing transformative situations. I never expected to be sitting here having you read the bio that you read, and sometimes it really is about putting ourselves out there and getting started. And I think for most people, that is the hardest part is the vulnerability of trying and the fear of failure. But I always think we should talk about failure in a positive way as a data point, just a blip on the radar, something to learn, pivot and adapt from, and too many people hold themselves back from their potential because of all of those things. And you ever watch the movie Bronx Tale? There's a line where Robert De Niro is telling his son, the saddest thing in the world is wasted talent. And I think that's true because so many of your listeners and our followers in general, you have so many good ideas, but there's so much fear that coincides with getting started or getting bigger or not playing it small. And I think it's unfortunate because I've seen so many people over these last five years who just can't get out of their own way for one reason or another.

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Michael Fulwiler (45:35):

When I talk to therapists about imposter syndrome, I'll ask them, what's the worst thing that could happen? You put yourself out there, it doesn't work. People don't sign up for your course. Maybe you lose some money if you are putting on a retreat or event or something like that. But typically the worst thing that can happen is it doesn't work and the world keeps spinning and people may notice they may not, and if they did notice, they'll probably forget about it. With that said, have you put something out or have you done something, whether it was a product or a service that you were offering and it didn't work and not that it was a failure, but it was something that it didn't go how you thought it would.

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Patrick Casale (46:19):

If I'm defining like didn't work by sales, then no. Everything I've put out courses, coaching programs, retreats, everything has worked, but that doesn't mean it's not unbelievably horrifying to do it. It was unbelievably horrifying to give that TEDx. It was unbelievably horrifying to pitch a book deal to a bunch of agents and editors. It was unbelievably horrifying to start a private practice back in 2017. I've never not experienced that, but I've noticed now that if I'm starting to feel that feeling, that racing heart rate and that increasing amount of self-doubt, that I'm probably on the right track and I'm using it more as a compass now and as a guide being more willing to put things out there into the world. So I would say there are things I would do differently if I could take some things back and change certain things. I think I've rushed things early on in the past in terms of marketing or launching or not having patience for things, but ultimately I would say that the fear has never really left me. It's just I've found a new relationship with it, and it's also allowed to grow and take more risks and to have more security knowing that if I do fall flat and it doesn't work, that I will be okay. I think that's been hugely instrumental.

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Michael Fulwiler (47:41):

I love that reframe too of if something doesn't work, especially from a marketing or sales perspective, we put something out there, we launch something and no one signs up and no one buys. That's also good information. Like, okay, wasn't the thing that I needed to sell, right? There's not demand for that. There's not interest in that. So that's the data point. Okay, I've learned that now I can pivot and do something else.

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Patrick Casale (48:06):

Yeah, absolutely. Did I not give myself enough runway? Did I market it consistently? Did I show up consistently? There are so many ways that we can step back and analyze things in that way where it's like, okay, if I do this again, I'll change this, or I'll give myself more time, or I'll hire someone and delegate certain tasks that I just struggle with. So I think there's a lot to be learned from those types of experiences.

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Michael Fulwiler (48:33):

You mentioned that you recently gave a TEDx talk kind of as part of this journey of self-discovery and an autism diagnosis. I mean, that was the topic of the talk. I've heard it. It was excellent. How did you get the opportunity to give that talk? Sure. There's folks who are listening who may be interested in giving a TED Talk or TEDx talk someday.

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Patrick Casale (48:57):

Yeah, so you don't have to be a professional speaker to do a TEDx, that's for sure. So can eliminate that from your thinking if that's where your mind goes. I knew I wanted to do a TED Talk for a long time. I never got started on the application processes. The applications for each event are all individually very unique and very specific. They almost want to weed out people who are just generically throwing their name into all these events. Some of the application would be like, and why do you want to give this talk specifically in the mountains of Colorado or whatever? And I'm like, I don't fucking know. I don't really care about that. So you do have to finesse the application a bit. But I did hire a TEDx speaker coach. His name is Michael Ashford. He is the marketing director for the receptionist for iPad.

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(49:44):

He and I have been good friends for the last couple of years, and he's a wonderful speaker coach. He's really, really talented at it. He helped me with my application. He helped me really navigate some stuck points about it because he was like, you have a message as we all do, and it's just a matter of putting yourself out there because you're going to get some rejections too. So I tried a couple of events, got a couple of rejections, and then got a direct request from someone in the TEDx Manitou Springs department that was like, we'd really like you to do your talk at break free this February. And I was like, damn, that sounds like a good topic for this event or for this speech. So the same thing with the book deal. It is just you're going to have to put yourself out there and you are going to have to come to terms with rejection. And that can be really hard for people and even for myself at this stage. But I am glad that I'm able to work through that fear of rejection because none of this stuff would be possible without overcoming it.

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Michael Fulwiler (50:43):

We've talked a lot about vulnerability and authenticity, and there was this moment during your TED Talk where you forgot what you were going to say or messed up, and I think where most people would panic and freeze, you just leaned into it and I think you said, fuck, I fucked up or something, and everyone cheered and laughed, and it was honestly so cool to just witness that live. You're living what you're saying, and it almost could have been planned. I'm not saying that it was, but the fact that that came up and then you just leaned into it was what you were talking about, there couldn't have been something that would have happened that would've been more authentic. I think you turn this moment of like, wow, I just ruined this opportunity into you made it better.

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Patrick Casale (51:39):

So one, I just appreciate you saying that. And that was the general feedback. I was amazed that people were clapping for that because you're on stage. I don't ever script my talks at any event I've ever spoken at. I really do improvise it. I have a general idea of what I'm going to talk about, but I like to read the room. I like to pay attention to what's being said around me. I need to pick up on the energy, so then I will craft my talk. Even for my Italy summit that I just hosted, I didn't know what I was going to talk about until I stepped on stage, and it was wonderful. That's just how my brain typically works. And for Ted Eggs, you have to script your talk and you have to memorize it. So right before my talk, they could not get the technology to work for the live stream, and I was panicking and freaking out.

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(52:27):

I was in the green room and they were telling me the whole time, you can't get it to work. We don't think we will, but just to let you know, you have 200 people in the waiting room right now. And I'm like, stop telling me this. This is not helpful. So when I got on stage, I honestly forgot half of my script in that moment. I was just so hyper-focused on my frustration about this situation. Then I got into the flow and I forgot the line, and then I realized I forgot the line. I was like, fuck, I forgot. But I think I recovered well, and I also think I ended it in the most autistic way possible, which was basically I finished. Obviously, no one knows that you're finished. So I'm just looking around and I'm like, I don't know what to do. I'm done. So I will say that the person who organized it said in her 10 years of organizing TED Talks, it was the best one she's ever seen. So I would say that it went as good as it could.

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Michael Fulwiler (53:23):

Yeah. That's awesome. And you have a book coming out as well, you mentioned. Is it on the same topic?

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Patrick Casale (53:29):

Yeah, yeah, yeah. So like I said, everything is asked backwards. So I decided six months ago that I needed to get this book idea out of my head. I started writing one night. I turned Lord the rings on repeat on my tv, and I wrote for one straight hours. And before I know it, I have like 55,000 words written. And I was like, holy shit. So then I pitched a bunch of agents, wrote the proposal, and then I just met with five different publishers a couple of weeks ago and came to a really awesome book deal and partnership that I can't publicly state right now, and I'm really excited for it. And I asked my agent, I said, how come in these meetings, we're not telling these editors that I already have the manuscript on? He's like, because this is not how this typically works. You get the book deal, then you write the book. And I was like, well, that's news to me. I had my idea.

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Michael Fulwiler (54:20):

That's awesome. All right, we're coming to the end here. We're going to try something new this season. We'll see how it goes. We're going to wrap up these episodes with some rapid fire questions. Alright, first one. Favorite curse word.

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Patrick Casale (54:37):

It's a word that I want to trademark as well. I would go with shit weasel.

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Michael Fulwiler (54:42):

Nice. Yeah. That's surprising. I thought you were going to say fuck, but okay. Profession, if you weren't a therapist,

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Patrick Casale (54:49):

Oh man. I would really love to be at an animal sanctuary, specifically with maybe red pandas, maybe slots, maybe the combination of the two. That would be pretty amazing. Or a travel planner, one of the two.

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Michael Fulwiler (55:00):

How do you feel about therapists using AI?

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Patrick Casale (55:03):

I mean, we live in 2025, it's not going anywhere. Use it ethically. It's going to help you probably more than it's going to hurt you in a lot of ways and it's not going to replace you as a therapist.

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Michael Fulwiler (55:15):

What's your hottest or most controversial take about private practice?

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Patrick Casale (55:21):

Hottest or most controversial take? Oh my God, I want to write a book all about this. I mean, therapy is wild, y'all. Just the stuff that gets posted in some of these groups. I mean money stuff, you can be a therapist and make money. You're just going to have to be comfortable with that, and there's so much judgment in therapy spaces. It's wild people shaming each other or using the unethical or licensure board word. It's not something that we should try hard to avoid. I don't know. It's wild. I can't even think straight. That makes me mad.

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Michael Fulwiler (55:57):

No, totally, totally resonate with that. What's a class that you wish you took in graduate school but you didn't?

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Patrick Casale (56:04):

Something about starting a business. I mean, I think it should be built into every counselor social work curriculum, just even if it's an elective course on how to start a business.

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Michael Fulwiler (56:15):

Absolutely. I know you're a big movie and TV guy. Do you have a favorite therapist from a movie TV show?

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Patrick Casale (56:23):

Yes, I do. Well, I have two, three. Okay. Because shrinking is so good. I have to say that like Gabby and Paul or Harrison Ford, they're great, they're fantastic, but Dr. Sharon and Ted Lasso is also fantastic. So those,

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Michael Fulwiler (56:39):

I love that. Last question and then you're off the hot seat. What's one thing that you want therapists to take away from this conversation?

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Patrick Casale (56:48):

Doubt yourself. Do it anyway. I mean, you really have to move into this mindset of pursue the things that you're passionate about. Allow yourself to fail, allow yourself to make mistakes because you're going to, and just give yourself permission to be human.

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Michael Fulwiler (57:01):

Well said. Thank you so much, Patrick. Where can folks find you if they're interested in learning more about the work that you do?

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Patrick Casale (57:08):

Thanks, Michael. Okay, so you can go to all things practice.com, which has my podcast, all things private practice, divergent conversations, and all of my retreats that are coming up. And you can find me on Instagram, Patrick Casale. I have space in our group practice ownership retreat in Hania in Greece in September. And then I have two retreats that will be happening in March of 2026 in New Zealand, and everything else is sold out

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Michael Fulwiler (57:37):

Greece. Sounds amazing. You may see me there. Awesome.

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Patrick Casale (57:42):

It's so beautiful. It's amazing. Yeah.

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Michael Fulwiler (57:45):

We'll drop those links in the show notes so people can check that out. Thanks, Patrick, really appreciate your time. Thanks, man. Thanks for listening to this episode of Heard Business School, brought to you by Heard, the financial management platform for therapists. To get the class notes for this week's episode, go to join Heard.com/podcast. And don't forget to subscribe on YouTube, Apple, Spotify, or wherever you listen to podcasts. We'll see you in the next class.