Turning Personal Trauma into a Career in Private Practice with Dr. Bryan Harnesberger

Bryan Harnsberger (00:00):

I think you treat a person like a person, you make their world understandable. And if you aren't going to be therapeutic, always be freaking fun. Make this space feel safe for people to explore some of the hardest aspects of their world.

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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. This week I'm joined by New England native, Dr. Bryan Harnsberger, a clinical psychologist and co-founder and CEO of Wellesley Counseling & Wellness and Wellesley Neuropsychology and Assessment. In our conversation, we dive into his journey from almost dying in a car accident at 16 to becoming a psychologist, his focus on helping clients with trauma and navigating private practice ownership. We also discussed the struggles of starting a practice, managing student debt and his approach to growing a business. As you'll see, I appreciate how Bryan balances the serious work of therapy with a sense of humor. Here's my conversation with Dr. Bryan Harnsberger. Enjoy. Dr. Bryan Harnsberger. Welcome to the show.

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Bryan Harnsberger (01:16):

Thanks for having me, Mike.

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Michael Fulwiler (01:18):

Nailed it. You're a New England guy, which I'm excited to dive into. I'm from Seattle originally, but I've lived in New England for the last five years. Are you born and raised in the Boston area?

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Bryan Harnsberger (01:31):

Originally, I grew up in a small farm town in Connecticut and then went to Rhode Island for undergrad. Came up here for my master's and my PsyD, so kind of doing the whole Southern New England tour.

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Michael Fulwiler (01:45):

For folks who aren't familiar, how would you describe New England and people from New England?

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Bryan Harnsberger (01:50):

Kind but not nice. I think good fences make, so...

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Michael Fulwiler (01:55):

Where are you going with that?

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Bryan Harnsberger (01:57):

I think when introductions are done, people are really, really kind. Just that first front facing kind of interaction is always challenging. New England.

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Michael Fulwiler (02:06):

Yeah, I've found people to be very direct as well. I think it's like you go to New York City and I feel like everyone's just in a big rush and people are pretty rude, but you go to Boston and people, they'll just tell you how they feel. It's like get the fuck out of the way.

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Bryan Harnsberger (02:22):

Bill Burr, I think is kind of the spirit animal of a lot of Bostonians and New Englanders. They just, they have a shtick.

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Michael Fulwiler (02:30):

And New England is more than just Boston. That's also a lot of more rural areas and kind of countryside.

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Bryan Harnsberger (02:37):

Yeah, I mean, growing up in Connecticut, you're just kind of born into a cake tapped at both ends. You have grew up with New York Giants fans and Yankees fans and Red Sox fans, Patriot fans. It was weird. It's kind of like being on the front line.

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Michael Fulwiler (02:53):

Well, yeah, I remember Noah Kahan, the singer. I think he's from Vermont or New Hampshire. He got some heat. He said Connecticut wasn't really part of New England. So do you feel like Connecticut is part of New England?

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Bryan Harnsberger (03:05):

I think if you slash it diagonally, this part is New England. The part over here is an extension of New York.

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Michael Fulwiler (03:14):

New York, yeah. All right. Let's get into it. So you mentioned you went to Roger Williams, which is in Rhode Island for undergrad, and then you went to the Massachusetts School for Professional Psychology and then William James College for your PhD. When did you start becoming interested in psychology?

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Bryan Harnsberger (03:32):

So I've a long story. I have that. So when I was 16, I got into a really serious car accident and I had to get life started helicoptered out to the hospital. I almost died, so I didn't look left, and I got T-boned by a guy in a RAM truck hauling a ton of rock, pushed me into a tree. So I suffered pretty serious, mild traumatic brain injury, and after the haze of the hospital stay, I got back and I couldn't go right back to school because cognitively I just wasn't there. It took me a little bit of time to get back there. I remember my Spanish teacher, Senor Mezger would come over after school to help me out, but it was so hard for me to code switch from English to Spanish. I was fairly fluent and now I can barely string together a sentence, and that really was jarring for me.

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(04:23):

So my first interest into psychology was with this guy named Dr. Lovejoy, I think out of University of Hartford, and he did my neuropsych and he was able to articulate my experience, my lived experience in a way that I couldn't even articulate. So you're doing all these random tasks and then this guy is saying like, well, this explains why you're fumbling over your words or why days they don't feel kind of consecutive because of the way that your memory has been impaired and the way that your speech has been. And that really got me interested. So when I went to Roger Williams, and I chose there because I parted there before and it was fun, so it wasn't like an academic, and I really tried to crack it doing pre-med, but I couldn't get through organic chemistry too, and tried to chain together all the little amino acids.

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(05:10):

So I said, you know what? I got to stick with the PhD route. If I'm going to go in psychology, it's not going to be through the MD route. And then I started making my transition to graduating from school with my degree, getting a bachelor's in psychology during 2007. I literally just thought it was a degree for waiting tables, and there wasn't a lot of jobs during that time. So I worked at a residential facility for fire starters and sex offenders, adolescent ones, and that was really tough, really tough job. Either you're getting assaulted at work or you have to do a sweep over every once every four days. It was exhausting for 12 bucks an hour. And unfortunately, my best friend from college, he moved back to New Jersey during that time, and he died by suicide. Never informed us, never left a letter. So I found out on Facebook and then I messaged one of his friends and I had the unfortunate duty of telling everyone from Roger Williams about his passing.

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(06:20):

And I remember holding those calls and allowing people to just feel the hurt, and it's a hurt that I knew I'd never wanted anyone else to feel. I was kind of in a dead end job at the residential facility, and that's why I decided I'll throw my hat back in the ring. And two days before my birthday, I got into Mass School of Professional Psychology for their doctorate program. Ever since then, man, I get to say that I've been helping people and saving lives as often as I can every day. I do it for my buddy Andy. I have a tattoo of a Yeti on my arm because that's what his nickname back in the day.

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Michael Fulwiler (07:02):

Yeah, I love that. And so was private practice the goal when you went back to school to become a psychologist, or were you not sure at that time what you wanted to do with a degree?

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Bryan Harnsberger (07:14):

It's so funny because when you get into the school, you have all these little hopes and dreams. I remember after my head injury in senior of high school, I really wanted to create a one-stop shop, and I wanted to call it My Body thinking that wasn't going to be trademarked, got home, right? Yeah. I wanted to have a one-stop integrated care shop. Then I got into grad school and I wanted to focus in on neuropsych because that was the one thing that the sided kind of stood apart from the LMHCs and the Allies. So I thought, I'm going to look into this. I have ADHD. It's exhausting for me to write up those reports. That didn't end up being a wise decision, but luckily the internship years at MSPP allowed me opportunities just to kind of try things on for size. And the thing that I really did love, and it kind of was adjacent with Andy and his passing was college counseling.

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(08:17):

So I was originally going to go that route. I had a great internship at Bridgewater, and then I worked pre-licensed but postdoc at Suffolk University, and I liked it there, did not really care for management, but it's a different story. It helped me learn about how to treat people along the way. And then, yeah, as soon as I got my license, I just decided, you know what? I'm going to go in a private practice. It's going to be the only way that I'm going to pay off my student debt, which was considerable. It's not cheap to go for a graduate program and live in the Boston area.

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Michael Fulwiler (08:56):

I want to talk about that internship. You said that you have ADHD. When were you diagnosed with ADHD?

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Bryan Harnsberger (09:03):

That actually came out of the neuropsych report from my car accident, so that was...

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Michael Fulwiler (09:07):

Oh, so it was at that time. Okay. That makes sense.

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Bryan Harnsberger (09:09):

Yeah, they were really smart in regards to how they didn't want to put me all under the umbrella of the traumatic brain injury. They also wanted to show me what my executive function deficits were. So it was Dr. Lovejoy helped me out my way than actionable.

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Michael Fulwiler (09:25):

That's a great therapist name. Yeah.

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Bryan Harnsberger (09:28):

Yeah.

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Michael Fulwiler (09:29):

Sounds made up, but...

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Bryan Harnsberger (09:30):

It does it, I promise. Yeah. Crosscheck these references.

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Michael Fulwiler (09:35):

Right? Yeah. What's the therapist from? Ted Lasso? It's Sharon. Oh, I guess that's Sharon. I think it's Fieldstone or something. I thought it was love something. And then another, just quick question here. How did you decide between a PsyD and a PhD program, and typically what are the differences between the two?

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Bryan Harnsberger (09:54):

So for me, in between, I lasted a semester at UMass and it was very research heavy, which would've been predictably the PhD route. And first of all, the individual that I was kind of paired with for the research, it was not interesting. It was talking about doing some kind of event-related potentials for individuals with non-epileptic seizures or something of that. And it was not anything that I was interested in, but I had to fake being interested in it to kind of move my academic career along. And yeah, the problem with work that you don't like is the excuses run dry pretty fast and then you just burn yourself out. And it happened in a extraordinarily fast manner at that. So I figured I'm just going to look at PsyDs.

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Michael Fulwiler (10:45):

I see. And did you transfer schools at that point?

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Bryan Harnsberger (10:50):

I mean, not necessarily transfer. I just dropped out and cut my losses, bump up my hours at the work, and then just waited to apply for the next round. And I tried doing a tour of other programs in Texas all over, but I didn't want to venture that far out. And I had the nice connection with Boston back in the day. Yeah.

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Michael Fulwiler (11:13):

Here in this internship. And is your master's program or PhD program?

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Bryan Harnsberger (11:19):

So it was...

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Michael Fulwiler (11:20):

Where you said just the management was not?

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Bryan Harnsberger (11:23):

Oh, yeah. So I graduated and that was in between graduation and my licensure passing my exam. For my boss, it was very notes heavy kind of writing process notes for everything. It was during a time where everyone went on either medical leave or maternity leave. So I was kind of the workhorse and my boss and I have a very particular personality and I know it's not for everybody. It's one of those lessons that you learn that you either to be highly competent and very agreeable with certain bosses, and if you are not, you're going to always catch a glare or be under their radar and they're going to start looking at the procedural things that you do and wanting to create their own narratives for it.

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Michael Fulwiler (12:10):

When you say you have a particular personality, what do you mean by that?

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Bryan Harnsberger (12:13):

I like to think of myself as being pretty open and irreverent and expressive in a way where I am exercising good judgment, but I'm very playful. And some people, especially if you're looking to create a sterile professional environment, you stick out.

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Michael Fulwiler (12:32):

Yeah, I mean that's something that I observed about you just from Twitter, which is how we initially connected was like, oh, he is this Dr. Bryan. He has a pretty decent sized following on Twitter, but he's posting memes and it just doesn't take himself too seriously. And it's like, oh, that's a guy that I want to meet and connect with. Because I think so much of the field, especially psychology, I feel like is very stuffy and academic, and I think people just take themselves too seriously.

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Bryan Harnsberger (13:06):

And yeah, you got to take off the therapist hat. And the funny thing about Twitter too is the reason that I got following wasn't because of psychology. It was because I was blocked by Donald Trump. And...

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Michael Fulwiler (13:22):

How did that happen?

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Bryan Harnsberger (13:24):

Yeah, I joined a class action lawsuit and he had to unblock it, so it's the most ridiculous story. But yeah, I never really saw it as a professional based thing. I literally just was tweeting through that entire administration, which has been going on for 10 years now.

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Michael Fulwiler (13:43):

I actually didn't know that. That's funny.

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Bryan Harnsberger (13:45):

It got me to meet some of the nicest people and some of the greatest folks in regards to social justice and figuring out how I want to integrate that into our own practice. It also got me getting some negative reviews on my Google business page from individuals that are strongly or that have a certain perspective about student loans that I don't share after being publicized in an article with CNN or something like that back in the day, unfortunately, you get negative press trying to do good stuff sometimes, and yeah, it lingers.

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Michael Fulwiler (14:24):

Yeah, I feel the same way about the industry that we're in at Heard is that it's a very serious business when you're helping people to manage their money, but we don't have to take ourselves too seriously either. I think being human and having a personality, people engage with that. I think it also makes our content and our educational resources a lot more approachable for folks. If we were just to offer a super boring dry tax webinar, people wouldn't show up. But we integrate humor and we make it fun and we post memes on social media, and I think that there's something to be said about that and just in terms of making yourself more accessible, because the work that you do is inherently very serious and the work with your clients is serious and why you got into this work is serious. So that part of it's not a joke, but I think it's a balance.

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Bryan Harnsberger (15:17):

I mean, Marsha Linehan always talks about therapeutic irreverence and how important that is. And if you look at humor as a defense mechanism, it's one of the most mature defense mechanisms out there. So if you're not integrating this into your everyday life, you're really missing out on the fun and joy of things. And yeah, plays are a really big part of life. If you're not shit posting, if you're not taking things too seriously it, you're in a LinkedIn kind of toxic culture environment.

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Michael Fulwiler (15:51):

Right. Yeah. So let's talk about the move into private practice. So when you decide, okay, I want to start my own practice, what did that look like? Can you tell me about that?

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Bryan Harnsberger (16:04):

Sure. So at first I was applying, I remember because was driving down to visit my friends. We were doing kind of this staycation at my buddy's place and I had a call and I had to make a decision about canceling an interview, which is a big no-no, and it was between a college counseling setting, a really small one that wasn't going to pay well or a private practice that looks great on paper. Lo and behold, I would find out along the way that it was a little bit more challenging than I thought, but I decided to just go with the better paying option at the time, and I figured if anything, I'm just going to be able to learn about how the sausage is made. And yeah, I called in and I canceled my interview at this one college and decided to move forward into private practice.

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(16:50):

I wish I could say it was a very insightful kind of thing, but it was actually me on a whim and thank God it worked out for me. And I ended up getting this job in a group practice that had three different locations, but the pay structure was horrible and I would get paid monthly, and it was incredibly challenging to dig myself out of that early career debt. I mean, I graduated school and I couldn't rub two nickels together. I was living with four other roommates and just trying to get by. And prior to that, it gets rough when you have to go to the grocery store and you ring up and you have to start putting stuff away and saying, can you return this for me? I mean, that's really incredibly embarrassing, but that's where I was. And that was in 2017, 2018. It was a challenge.

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Michael Fulwiler (17:44):

And you have your doctorate degree at this point?

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Bryan Harnsberger (17:48):

Yeah, and I'm making 50 bucks an hour, and I thought that was pretty good because at Community Health I was making 28 bucks an hour, and I thought that was a significant step up, but it was really challenging to find ways to get clients onboarded, didn't have a very clear system on how to turn patients in. And of course, nobody tells you that when you get in the private practice, it's so easy to fill up your caseload if you work post five o'clock back in the day before telehealth, it was even more challenging and then getting credentialed at first, you're just twiddling your thumbs for the first month to two months, either getting one or two self-pay clients and then a few PPOs, but outside of that, they didn't have the incident to billing and other kind of ways to have you build a case load up incredibly quickly when you get hired into a new position. So there was a lot of challenges that I was facing that I was making note of because I didn't want this to happen if I was ever going to captain a ship myself.

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Michael Fulwiler (18:57):

So it sounds like even though you were working for a group, you were responsible for bringing in your own clients.

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Bryan Harnsberger (19:03):

That's what it felt like. I mean, they had a Google spreadsheet of first touches and they didn't really have a dedicated staff that would reach out. So it was kind of like first come, first serve. Everyone was going in soon as it was released trying to nab up clients, and I'm new. I didn't want to ruffle any feathers, so I'm just kind of trying to pick and choose the ones. It was just not a good kind of environment. So I only spent about five, six months there, and then my buddy David up in Merrimack Valley Psychological Associates opened up a practice. It was just himself at the time, it was Dave Rainen, LLC, and he's like, Hey, you want to take a chance with me? I said, sure, as long as you're really transparent with how your policies and procedures and how you find insurances for clinicians, and you kind of show me everything behind the curtain.

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(19:59):

And he was a man of his word, and he essentially helped as I kind of grew with him, we were able to build his practice. Well, he was building his practice as we were flying, and he took a lot of chances and they all worked out. So I knew that this is something I wanted to do. I worked for him for a year, year and a half, and then I saw there was an interesting post about the NBA looking to add a wellness kind of policy and division to it, and they appointed this guy Dr. William Pernell, and I think he was out of University of San Diego at the time to be the director. And I just cold emailed him and I said, Hey, I'm really interested in your policy and procedure, not expecting to get any kind of message back. But then he sent me a packet of information saying like, Hey, if you want to be an authorized clinician for people in the players association, get a private practice and fill out all these information, we're going to vet you harder than we vet senators and Supreme Court justices nowadays.

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Michael Fulwiler (21:06):

Which isn't very hard. Yeah.

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Bryan Harnsberger (21:07):

No, apparently not. But looking to see if I had any liability because of all the debt that I had, really did a deep dive into a background check with me and I knew, okay, I got to figure out how to set up a business in three or four days. Wow. Yeah, so a couple Google searches, spent a lot of time at the town hall and got an LLC, went to Santander Bank, they gave me a tax ID number, and then I was just rolling in my own practice that I did as a sole prop for a year or two.

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Michael Fulwiler (21:42):

So were you still working with the other guy at his practice?

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Bryan Harnsberger (21:45):

Yeah, so I was doing 32 client hours a week with him. And then, yeah, but I mean when you come from community health, you're booking like 40 people on the regular anyway, so it didn't really feel like it was necessarily a step in the other direction. I know it's kind of a culture shift nowadays, and I'm really glad that there's been a shift. We have it, so we want our clinicians to see 26 clients a week, a lot different than the way that it was. But yeah, I was seeing 40 something clients a week, so 32 there and then eight on one day a week, and as soon as I felt very successful doing that and I found my own biller, I just thought, okay, now it's going to be the time for me to move. And then it was around the same time that my wife passed her LMHC for her license, and she's watching me getting credentialed with everyone and saying like, okay, maybe we will set up a shared office kind of situation. And I was getting steps in Wellesley Counseling & Wellness.

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Michael Fulwiler (22:44):

Did she come into the business with you? Do you run it together then?

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Bryan Harnsberger (22:48):

Oh yeah. I mean, Emily's the lifeblood that goes into there.

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Michael Fulwiler (22:52):

She runs the business.

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Bryan Harnsberger (22:53):

More or less. I mean, strategically, I'm the one that is having the final say, fire hires policy, things like that. But the person that is there that is curating the cultural space is all Emily, and she's amazing with that. And she's also amazing on seeing ahead of the really small tasks, things that my brain doesn't catch up on. So it's a really good filter. So the things that fall through my cracks, Emily grabs it. We work really well together and couldn't be happier to be married to a person that I have a successful business with. We can always stop and grab each other.

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Michael Fulwiler (23:29):

No, that's awesome. So what happened with the NBA opportunity? Did you end up getting that?

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Bryan Harnsberger (23:35):

Yeah, yeah. I am licensed with the National Basketball Players Association, so I have folks there. I mean you outreach and you try to connect with as many people as possible. Another really cool thing too is I have a friend Paul Hanselman, and he runs set me. He did a lot of COVID testing at movie production sites in Boston and in LA in New York, and I met him at Suffolk and we were buddies and he said like, Hey, we had this mental health issue, can you come in? So that was one of the other little partnerships that we made. Another one was, I forget his name, but he's from the UCAN Foundation for unscripted castmates from reality shows. I think that's my wife kind of rubbing off on me as an artist person, really trying to find my way to connect with folks, the different arts and culture realms as possible, as well as the sports.

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Michael Fulwiler (24:32):

What was the transition like going from the other practice where you're seeing 32 clients a week to your own practice? Did clients come with you or what was that like?

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Bryan Harnsberger (24:42):

So essentially it's still kind of like I am still seeing the same folks. It's really fun being a provider and meeting with someone that was in eighth grade and having really difficult struggles academically, needing someone to advocate for them and their graduating college this year and being able to see them through that life span. I mean, I have clients that have been with me for 10 years now. I don't churn out a lot of my clients a lot. I get to celebrate a lot of life experiences with them. That's awesome.

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Michael Fulwiler (25:10):

Yeah, I resonate with that. I used to coach baseball and I coached the same group of kids from when they were 14 to when they graduated from high school. And so it's obviously a different kind of relationship, but you just get to see them grow up and it's really rewarding to be that mentor or figure in their life that has influence.

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Bryan Harnsberger (25:30):

Yeah, I mean that avuncular kind of uncle relationship where you about to be open and honest with you and they don't feel judged, it's the best. Our job is so incredibly rewarding, and if you're not learning from it still you should get out of the field. It's not for you.

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Michael Fulwiler (25:46):

So what else do you remember about those early days of starting the practice? Sounds like you explored a couple of different partnership opportunities. You had some clients come with you, which is good. How quickly did your caseload fill up? At what point did you start to think about, wow, maybe there's something here where we can expand and bring in other clinicians or was that kind of the goal from the beginning?

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Bryan Harnsberger (26:07):

My story's an incredibly lucky one. So as I signed a four year lease, the COVID restrictions hit in 2020, so we just furnished this beautiful new two room office and spent all the money that we possibly could there making a great kind of office space. And then everyone's on telehealth, and then we realized, wow, there's a lot more accessibility here. So Emily and I always had a full caseload and we thought, okay, let's try to find someone like Dave found me. Let's try to find a colleague or a close friend that may not be in the field anymore or isn't practicing full-time or has other life things going on and wants to work in a part-time kind of scenario. And that's what we did with our first two hires. There were people that we knew incredibly well that felt comfortable taking a chance, and that meant fumbling through interview processes, learning how to onboard clinicians, how to select health insurances, a whole bunch of shit you never went to school for, and you just learn, learn, learn, and you learn to become an expert in becoming an expert.

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(27:14):

If there isn't an answer for something, you have to look it up and you have to go in and you have to talk to as many people as possible to figure out those answers, and that means finding the space. It was incredibly disorganized trying to figure out those tactics and shit like that early on. When you realize something works, you're like, okay, I'm going to hold onto that. I'm going to hold onto that. I'm going to discard this. Emily and I used to sit together and we would be interviewing together and we're like, oh, this isn't a really good kind of process. It felt very mom-and-pop-esque and we wanted to find a way to professionalize it as quickly as possible. And yeah, it's just a lot of trial and error, and I think, I know it's not the most helpful advice, but for folks in the field, ones that are particularly risk averse, you can't be risk averse In order to have a successful private practice, you have to take a gamble and you have to take chances. I think the moment where it went from being a good practice to being a thriving practice happened when I understood the numbers in the bookkeeping and I could tell stories with it. And luckily, I have a mother-in-law that is my bookkeeper, and she was...

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Michael Fulwiler (28:31):

That's why you haven't signed up for Heard. Yeah.

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Bryan Harnsberger (28:34):

Yes. Well, she was VP or SVP.

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Michael Fulwiler (28:38):

If she ever retires, we're here.

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Bryan Harnsberger (28:40):

We'll connect. But yeah, I'm sorry. Her feedback is so helpful and knowing that it's my mother-in-law too, it kind of adds that additional authority that you wanted to have to listen, right? You have to listen or else I'm going to hear it from my wife or my mother-in-law, father-in-law. When she was able to show me what the numbers meant, it made me feel so much more comfortable to take risks. And of course, duh, right? One of the best ways to confront anxieties with knowledge and information, and that's what we teach our kids. So why are we so risk averse going into these things?

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Michael Fulwiler (29:18):

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(30:15):

When you say take risks, do you mean hiring and just having that overhead? What do you mean by taking risks?

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Bryan Harnsberger (30:22):

So it's like taking risks as hiring, but for me, I think the ways that I would say taking risks was when we opened up neuropsych for us, our clinicians really wanted to continue practicing neuroscience. Forget like, alright, let's figure out how to offer that and then creating a new LLC with a new tax ID so we wouldn't have to do the managed care route. Being credentialed with all these different things, having a whole nother separate place of service following the letter of the law when it comes to compliance down to a T, those were some of the risks and it hasn't been lucrative, but that's not where the value is, the values, the fact that my clinician loves to do this and we are able to actually help people that are serious need because neuropsych Gate keeps so many folks for accessible services and we're able to make this really formal kind of authoritative stance on things and help people get things that schools and other systems won't allow. So it's a very big area of my life, especially with the idea of justice. Then the other risk is adding more integrative care, either hiring expressive arts therapists that I don't really know their modalities or helping my clinicians get training in EMDR or other modalities that I'm unfamiliar with and just kind of let them cook or hiring in a prescriber and trying to learn that aspect of the job. Yeah, you got to just stay out of your toes and keep learning.

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Michael Fulwiler (32:02):

Yeah. You recently added medication management. You were telling me what has that process been like to integrate that into the business?

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Bryan Harnsberger (32:10):

So at first I was frightened because I mean it's like this whole other area and you think, oh, what I have right now isn't going to be transferable for this other position. Lo and behold, the credentialing process was more or less the same. The onboarding process was more or less the same. I just needed to figure out other little things. Where do they get their liability insurance from? What are some of the things that I need to be looking at on their CAQH that's different than us? So kind of therapy as discovery. It's just been kind of business ownership as discovery as well, and I have no idea what it's going to be like when we just started opening up his book. So I'm hoping that our onboarding process is the exact same, but right now it very much feels like we're flying by the seat of our pants here and I have faith in the process that we've already discovered, and I don't think we're going to fail. I thought I would've figured out the neuropsych stuff by now, but that's a whole different bear too. But as long as I'm able to keep working and integrating those practices as much as we can, we don't have to be the most efficient. We just need to create the most valuable for people.

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Michael Fulwiler (33:29):

Yeah, it sounds like a lot of the stuff you can figure it out. It's like you don't have to have it all figured out before you launch it and just trust that it's going to be okay. And I imagine you probably have not necessarily formal advisors, but there's probably other group practice owners that you can talk to. Is that the case?

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Bryan Harnsberger (33:51):

Yeah, I mean, we have our little sewing group. I kind of nicknamed us the Cardigan Mafia and we'll meet monthly and we will just all swap tips of like, okay, I think I had to put someone on a performance improvement plan. Has anyone done this? Or what about we're trying to figure out new insurances? Does everyone go through the health connector or do you go through Blue Cross or someone like them their own? So yeah, they feel like they're able to share those kind of thoughts and it is a little bit better than trying to get advice through Facebook groups because Facebook groups and Reddit just makes me cringe with the amount of bad advice that they give. That place kind of scares me, so I'm glad that I have some local trusted folks that I can bounce ideas off of.

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Michael Fulwiler (34:42):

Definitely with the neuropsych component, it's interesting to me because my sense is that offering psychological testing evaluations can actually be very lucrative. You can charge four or $5,000 per assessment, but it doesn't seem like that's been the case for your business.

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Bryan Harnsberger (35:01):

Well, it can, but it comes at a cost. I mean, you can talk to people that are able to churn out these reports incredibly quickly. They're really just for confirming or not confirming a diagnosis here or there. They're not going in depth to really describe a person's unique cognitive fingerprint. And for us, when we get that question, the referral question saying, okay, I'm actually struggling with these tasks or these areas, we want to paint a very clear descriptive picture, and if we're doing it through insurance, they're only going to reimburse us 1300 bucks. You can't do the hours for the advanced testings. You can't just pull whatever you want and give it to them because it all comes at a cost. So we have, it's very small and critique, but we feel like we can pull any sort of test. We have different levels of autism focused or brief ADHD assessments at lower costs to mitigate that price point because around here it's all out of pocket only, and if it is through insurance, I've never had a report sent to me that's been okay through managed care that has told the whole story that a person didn't have to pay out of pocket for it to figure out the rest.

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(36:22):

That's the reason why I had to go and create a whole new LLC for it. I wasn't going to be constrained by the restrictions of managed care.

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Michael Fulwiler (36:29):

You were saying earlier, it's not kind of work that you like to be doing anyway. As someone with ADHD, just writing and reading a bunch of reports all day probably isn't very enjoyable.

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Bryan Harnsberger (36:40):

No, no. But for individuals with that have incredible high moral compasses and that our psychologists, they love to write a good testing report because it very much shows how the systems that are here have been oppressive to these folks and how a lot of this is the frustration and the depression and the anxiety comes out from the system because people aren't able to integrate properly into it. It's like you can give people this, tell them that they need to fit in this jigsaw, but they're not the right piece. It's a real problem. But I think that the answer to the whole neuropsych thing for us at least, is I think that's just the way to go, mainly because it shows that we're not here for money, we're here for a service, and we can still support all of our clinicians and the business on its own. So I think that's something I need to integrate, but I just have so many irons in the fire right now. It's like you get so carried away with this and then you have to figure out what the five year plan actually is or the 10 year plan.

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Michael Fulwiler (37:55):

And you've grown the practice now to 30 staff, which is pretty incredible. When you think about your own values as a business owner, what are they?

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Bryan Harnsberger (38:05):

Compassion, authenticity, attunement. I think you treat a person like a person, you make their world understandable. And if you aren't going to be therapeutic, always be freaking fun. Make this space feel safe for people to explore some of the hardest aspects of their world. Luckily, therapy kind of primes you to do that, but it's so easy to be a lazy owner and forget that every single staff member has their own worlds and they're trying to hold all of this and they have their own individual wants and needs, and who am I to step in and say, are you sure that's a need and not a want? No, I got to understand what the story is behind it. So the longer that I get to be around my staff and get to know them as people, I get to understand what really truly, not just motivates them, but makes their world feel like it makes sense in what they're doing.

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(39:02):

And if I'm able to figure that out, that's not just the most gratifying feeling in the world, being able to provide a space that they can do that in, but it gives you a leg up to understand, okay, yeah, this ask is completely reasonable, especially now that I know exactly what they're coming from. Yeah, thank you for bringing that to my attention. I need to tweak a policy or a procedure here or there. I think if you are going to grow, you have to think about, okay, how many people can I have that relationship with because it is finite and I think it is 30 for us. So I always have a soft cap at 25, but I want to know, I want to know. I want to have people that I enjoy being around and that we don't have that sterile environment here and people have fun.

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Michael Fulwiler (39:55):

How do you do that? How do you build relationships with 30 people? Do you have processes in place? Do you guys do retreats? How do you build that, those relationships?

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Bryan Harnsberger (40:07):

We actually have a family dinner at The Local on Wednesday where we're just going to all go out, have lunch or have dinner and celebrate making it through most of the academic calendar and priming them up for the summer, the switch in the schedule, understanding how to bump up your utilization during those soil periods, but also other little things too. We have a WhatsApp group chat and it's just, it's formal. We'll have memes being sent in there, therapy memes, which are great. Couple Heard ones pop up from them on. We'll have that. We'll have people be asking like, Hey, I someone, does anyone know any referrals out in Minnesota? Or I'm having difficulty with calling? Is anyone free for a minute? And if you just create that space therapist not to use it, they want it. And that doesn't matter if you're working telehealth or in person, you can still have those nice neighborly chats with your coworkers. That's been huge. And on top of that, a lot of group consultations, supervisions, things like that, that's I think the bread and butter behind some of the cultural fabric.

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Michael Fulwiler (41:18):

It sounds simple, but just treating staff like human beings goes a long way. I remember when I was at the Gottman Institute, the CEO of the company would call every staff member on their birthday, and that was just a thing that he did. So he must've had it saved in his calendar, but he would call you on your birthday and he still calls me on my birthday. I haven't worked there in five years, and he still calls me. And that's, it's not a ton of time for him. He has to remember to do that. And he, I'm sure he is really busy, but it's just like a 15 minute conversation once a year makes such a huge difference. So thinking about that, what are ways that I can make my people feel supported and I see them, and it sounds like safety, creating a safe space is also great too. And you just create an environment where people want to come to work. That's not just a job that they have to put up with.

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Bryan Harnsberger (42:20):

No, and life comes with its wins and losses, and it's kind of your job to be there too for everyone and always think, I think the best piece of advice I've learned is there's never a problem at first. There's areas of support and accommodate. And if you aren't reaching out to everyone and creating that culture like, okay, this is a place that affirms, protects and supports and finds even accommodations and is very liberal with like, Hey, let's look for accommodations. You're not going to have people that fear coming into work. You're not going to have people that fear going over the numbers and saying like, okay, this is your churn rate, this is your retention rate, this is your utilization. They don't fear the numbers if you teach them what they mean and how they represent good things too. I think the whole punitive thing, we see that enough in our work.

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(43:18):

It doesn't work. So stop it and find ways to do personal touches like calling someone on their birthday or if you have just fighting a client on the roster, someone that you've never talked to before that's in your practice and reach out to them. Just be, okay, I'm the owner. Just want to see how everything's going. I just want to make sure that you're healing taken care of and supported here. It goes a long way. It goes a huge way, especially now that you have to think, okay, is this newsletter been ran through ChatGPT? Is there any human touches to this? Or we need more human touches in our work and especially in this work. God, come on.

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Michael Fulwiler (44:01):

Yes, I love that. I wasn't even thinking about that framing, but kind of in this era of automation and AI, I think it's even more important to be human, especially as a business owner. I am curious, so Wellesley is in the Boston area, which means there's a ton of highly educated people. There's a bunch of universities, there's also a bunch of hospitals and practices. How do you compete in a market that is very crowded? How do you stand out?

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Bryan Harnsberger (44:35):

You probably get this answer from everyone. If you create a space that the clinician can fully attune to the patient, take off the front end and the back end of the work, or just create the meat being the therapy as much as possible for as long as possible. And then you hire clinicians that are able to be attuned for that time, that don't have the threats of burning out, that are reliable and are well-resourced themselves psychologically, the rest just comes in. I mean, that's when you put high quality work together and then your name gets out there and every community, it still is very much word of mouth in this field. So that means a lot. What I love about it is that the word on the streets is a hell of a lot different than the words that you get on a Facebook review or a review. So when you get that kind of organic sign of approval or seal of approval, that's when you've made a dent in your neighborhood and you can really call yourself a reliable staple of the community.

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Michael Fulwiler (45:41):

And are you working with clients who are mostly in Wellesley, or do you get clients from across Massachusetts or even other states virtually?

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Bryan Harnsberger (45:49):

Yeah, so we try to meet the need where it is. So right now a big issue has been trying to find pediatric care for behavioral health. So we've been trying to hire up as many pediatric therapists as possible. We also know that's kind of like high burnout work. And because you're dealing not just with children, you're not dealing with children just with acting out behavior, you're also having to deal with the family system, the school system. So making sure that we have clinicians that are coming on with pediatric cases that also understand what role they're signing up for and how to supplement their caseload with opportunities for breaks and paying them well because this work is incredibly valuable. So we try to meet those needs. We also have a lot of folks that love working with the college age population, and they're great because they're smart and full of resources and are flexible and tend to fix themselves.

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(46:44):

So luckily you swing a cat and you'll hit a college around here in Massachusetts. So all it takes is a couple calls to figure out who their social worker is or who does referrals. And again, a human touch for us mail campaign over email campaign has been more effective. Who would've thought, I feel like you can't ignore the complete digital picture, nor can you ignore the old way. And I think you spoke to me about it, like, Hey, sometimes you just got to show up with donuts and flyers and it worked. So thanks for that Ted mug.

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Michael Fulwiler (47:21):

Duncan especially. Alright, we're getting to the end here. That actually tees me up very nicely. I'm excited for this one. I have a few rapid fire questions for you to close us out. First one is, what is your Dunkin order?

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Bryan Harnsberger (47:34):

Oh God, a tree gun, an idiot. So I drink iced coffee, black, less ice, like a psychopath.

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Michael Fulwiler (47:44):

It's a New England thing. I dunno if it's a New England thing or a Boston thing, but it's like everyone drinks iced coffee even it's 12 degrees below zero. It's freezing cold, snowing. You're going to go to Dunkin, get your iced coffee.

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Bryan Harnsberger (47:55):

And I'm not going to have it taste like an ice cream sundae either. I just want it to just be prepared and disgusting and I want as quick as possible. I'm exhausted.

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Michael Fulwiler (48:03):

Hot or cold lobster roll?

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Bryan Harnsberger (48:06):

Oh God, hot. Nothing beats butter on a delicious brioche and some really good lobster claw.

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Michael Fulwiler (48:15):

It's so good. Do you have a favorite in the area?

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Bryan Harnsberger (48:18):

Yeah, so I would have to say that my favorite is it's in Chatham. Max and Chatham.

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Michael Fulwiler (48:25):

That's Cape Cod.

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Bryan Harnsberger (48:26):

Yeah, it's Cape Cod. But around here I would say, oh God, who made a really good one? Island Creek Oyster in Fenway. They have a really good one.

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Michael Fulwiler (48:34):

Good. Yeah, I've had Even Tide. Have you had Even Tide?

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Bryan Harnsberger (48:36):

No.

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Michael Fulwiler (48:36):

They're good too. Yeah, there's one in Portland, Maine, but I think they have one in Boston too. So any New England folks, definitely go check those out. What does success mean to you as a business owner?

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Bryan Harnsberger (48:47):

Oh God, I'm a people pleaser at heart. It means that I'm able to see everyone's point of view, even if I don't agree with it, and people still have faith in me, even if I am disagreeing with them and that we're going to make a really good decision and it's going to work out. Sometimes that means buckling up for a few months or a year. And if someone is able to have that faith in me, I feel like it's successful. The fact that they're able to put their life in my hands for that short amount of time, or not short in a lot of cases. So I think that is success for me.

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Michael Fulwiler (49:21):

As a business owner, what's the best compliment that you can give to someone?

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Bryan Harnsberger (49:25):

It's the third party compliments. I think one of the best ways I compliment my staff is when I'm able to make a direct referral for them. Because I can sing their praises. I can tell you exactly what they do really well and it doesn't feel like sooner or later they're going to hear the client or the person say, oh, Bryan spoke very highly of you. It means a little bit more when it comes from a third party versus if I tell my employees, I'm so proud of the way that you handled this case. Yeah, that's great. But I think those, that third party affirmations, one of the best things that you could do for being a leader.

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Michael Fulwiler (50:04):

Love that. And then finally, what's one thing that you want therapists to take away from this conversation?

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Bryan Harnsberger (50:10):

Loosen up. See what you can do with your own worries and anxieties. See what they're trying to teach you, see what they're trying to hide from you. And you should appraise yourself a little bit better when it comes into having faith in yourself. Because if you made it past the licensure, you have jumped through several different hurdles. As long as you continue to hold near and dear your ethical obligations, everything else just falls in place. So please just trust yourself a little bit more.

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Michael Fulwiler (50:42):

Love it. Bryan, thank you so much. This has been awesome. Where can folks connect with you if they're interested in learning more about what you do or referring clients to you or maybe even applying for a job?

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Bryan Harnsberger (50:54):

Yeah, just check out our website, www.wellesleycw.com. And if not, feel free to reach out to me on a LinkedIn. Twitter, not so much anymore. Bluesky, not the other ones. They're personal.

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Michael Fulwiler (51:11):

Catch you on LinkedIn.

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Bryan Harnsberger (51:12):

Yeah, exactly.

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Michael Fulwiler (51:13):

Alright, thanks Bryan.

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Bryan Harnsberger (51:15):

Yeah, no problem.

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Michael Fulwiler (51:16):

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 joinheard.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.