What Therapists Need to Know About AI and Privacy with Candice Thompson

Candice Thompson (00:00):

There's a tagline somewhere, some professor who had said, AI won't replace therapy, but therapists that don't use AI are going to be weeded out of the industry. And I just think, how silly! My job is about my interpersonal skills, my ability to analyze, my ability to hold space. It's not about my ability to ChatGPT or use it for notes. That's just the craziest thing that I've ever heard, that I need a robot to do my job well or I'm going to lose my career.

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Michael Fulwiler (00:29):

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 Candice Thompson, a licensed marriage and family therapist based in Silicon Valley. Surprisingly, given her location, Candice describes herself as tech cautious, so I wanted to bring her on the show to unpack her views on tech, ethics and privacy. In our conversation, we discuss what she's seen working with clients in Silicon Valley and how it's shaped her perspective. If you're a therapist who's concerned about the impact of venture capital or AI on the therapy field, this episode is for you. Here's my conversation with Candice Thompson. Enjoy. Candice Thompson, welcome to the show.

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Candice Thompson (01:25):

Thank you so much for having me.

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Michael Fulwiler (01:27):

Well, excited to chat. I know that you have some strong opinions about tech and...

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Candice Thompson (01:35):

Many things.

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Michael Fulwiler (01:36):

Tech and mental health, so excited to get into that. Before we talk about that, you had shared with me that you initially wanted to become a lawyer, so when did that change for you to becoming a therapist?

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Candice Thompson (01:49):

Yeah, that's right. So my journey in high school, I did speech and debate, which is called Forensics, and I think California maybe most of the US. So I always thought I was going to be a lawyer and that was my track starting college, and then I started seeing a therapist on campus who was getting her hours. She was a grad student and I just totally fell in love with her. She provided such an incredible container for me, and I was in a season of life where I was just figuring out my identity. I was maybe 19 at the time, I would feel like come in really preppy one day with a collared polo shirt, and then I had a faux hawk for a while and a skateboard and then a lip ring. I mean, I was just really exploring myself and she was so generous with this is developmentally appropriate, and so she for me created something I'd never experienced before and I thought, oh, I want to be that for people. And took my first psych course and absolutely fell in love with it and switched my major and jumped into therapy from there. And I went through licensure and grad school as fast as you possibly could. I went straight from graduating into grad school and did my hours really quickly. Had two jobs a lot of the time, passed my boards the first time. So yeah, I've been practicing now for 16 years. I mean, that includes my pre-licensed hours.

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Michael Fulwiler (03:16):

It's amazing the impact that a therapist can have on us and that can completely change the trajectory of our career. So I'm really glad that you had that experience. You mentioned you went right to grad school, which was it at USC? What was that experience like?

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Candice Thompson (03:33):

I really enjoyed USC, so their model was exposing us to, I mean, a lot of therapy school, you're processing your own stuff, but also they exposed us so well to so much different content and ways of living so that we wouldn't be shocked in a room. They were very good at ethics and law. Some of the things I talk about on LinkedIn too with coaching or how people market themselves, I feel really privileged. That stuff was a part of my training of here's how you need to sign an email. This is if you're pre-licensed, you need to have your supervisor's name and licensed on all of your content. So I feel really like they prepared me very well.

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Michael Fulwiler (04:20):

That's great. Then after graduation, you said you got your hours quickly. Did you work at an agency after grad school or a group practice?

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Candice Thompson (04:26):

I did. I did a lot of nonprofit work for a long time. Part of my story is throughout my career, people kept telling me therapists don't make money, like supervisors. And I actually had a therapist at the time. I had just graduated, I had moved back to the Bay area and my therapist was like, oh, you're probably going to have to get a restaurant job because therapists can't get paid for their hours. And I don't know, maybe just my personality, I might be a little competitive. My mindset was like, nope, that's not possible. I can't, I have to make money. I didn't have parents or anything backing me at the time. I wasn't married. So yeah, I always found agency work. I've always found something that paid and ability to make it work. And then after I got licensed and literally, so I was working like 40 client hours a week, sometimes I had two opportunities at one time so I can get as many hours as possible. And then I took the boards and then I was licensed. I had an agency job and then opened a private practice and slowly ramped that up. So I started off one Saturday a week and then a Saturday and an evening and slowly built it up until it felt financially safe to let go of the agency job and stepped fully into private practice.

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Michael Fulwiler (05:47):

The fact that you would have a master's degree and feel like you had to get a restaurant job just to get by, I mean, that's wild. That's the case and it was still the case.

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Candice Thompson (06:00):

Absolutely, and that's a huge part of my messaging as well is therapists should know their worth and their value. I didn't know then what some of the things I know now, if I could have done it over, I would've tried to get into a private practice. I wouldn't have gotten that route. But it felt like the only thing, and I do think that's where therapists really sell themselves short after their license is here you are for years, you've been working for free or very little, and then you have an agency like BetterHelp come along that's like, I'll give you $40 an hour, and people are like, 40 sounds amazing. But of course if you do $40 an hour, you need 40 clients a week to make that work and the burnout is high and it's not sustainable.

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Michael Fulwiler (06:43):

Yeah, that's $40 an hour as an independent contractor. So 30% off the top is going to taxes.

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Candice Thompson (06:51):

Exactly. And you're paying for your space that you're taking it in, the technology, the internet, your phone. Yes. So you are having your own business at the time, but making very little, and I think therapists cut themselves short when we forget how much education we have at that point. What's your license? My first post I went viral was that our education and time getting licensed is equal to that of a dentist, if not more. And so no one expects a dentist to be making pennies or to not be able to own a home, and so no one should be expecting that of therapists.

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Michael Fulwiler (07:31):

Yeah, there's this narrative that I see on social media about how therapy is so expensive and therapists charge too much and therapists are greedy and therapists should be working for discounted fees or rates, but they're not saying the same things about their doctors or their dentists.

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Candice Thompson (07:49):

No, but your oncologist or surgeon or a lawyer, do we divorce lawyers pay up the wazoo? And I think there is conversations to be had around accessibility. I think a lot of the responsibility lies within the insurance companies, and certainly there are nonprofits that can help, but yeah, I agree to put that burden solely on the practitioner is not sustainable.

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Michael Fulwiler (08:18):

I totally agree and I'm very aligned with you on that. We talked about that at length on this show. I want to come back to you starting your practice. So you mentioned you started on the side. What did that look like from a business formation perspective? Did you go out and did you form an LLC? Did you open a bank account? What were the steps that you took to actually start to see clients on your own?

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Candice Thompson (08:40):

Yeah, so first at the time I think I just picked therapist brains and the internet was not what it is today. Honestly. I think now you could probably find a YouTube or a Reddit that walks you through the process, but I would just ask therapists what they did. So I think the first step was going to my bank, opening up a bank account, applying with the IRS, getting the NPI. I just had the list of things opening, starting a website. I had had the office space. So that was the first thing is an opportunity opened up it's organization that has affiliated therapists, which I really like the model because it's your own private practice. You pay for the space, but you get referrals through them as well. So it's a nice alternative to group practice. So yeah, I had that already and opened up my Psychology Today. And it's interesting because only in the last year and a half that I've seen myself as an entrepreneur, I felt like at the time I was just doing the steps I needed to do and no business training and just seeing what's around me and matching that.

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Michael Fulwiler (09:51):

When did that shift for you to actually seeing yourself as an entrepreneur and business owner? What led to that change?

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Candice Thompson (09:59):

It's in the last year and a half. It was LinkedIn. I mean, it's just a funny thing. So I have a small child and when she started going to school full time, I just had more capacity. I knew I wanted to do it more with my career. I wanted to teach. So I sat down with a therapist that's five, 10 years ahead of me and picked her brain about some of the things that she was doing, and she had associates and she was like, oh, you should get a LinkedIn. And I did that. And I think really what it was was starting to see coaches who were marketing themselves, charging a lot of money, getting all these speaking engagements at Apple and Google. I'm in the Silicon Valley, and I would go on their LinkedIn because a great thing there is you have people's basic resume, right?

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(10:49):

What's their education? What's their experience? You have people with communication degrees who came off a corporate job, opened up shop, and it honestly just emboldened me like, oh, I can learn by just viewing. I think that's been my whole business career is seeing what other people do and trying to match it and say, oh, I have all this experience. I can offer those same services with much more qualifications. And so it became kind of a game for me where everything that I felt jealous about, I just said like, oh, I'm going to do that this year. And I did, and it was really fun, love, and I think I keep doing that.

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Michael Fulwiler (11:28):

I love that. Instead of getting mad about it or complaining about it, you just do it yourself or do it better, right?

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Candice Thompson (11:34):

Yeah, exactly.

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Michael Fulwiler (11:37):

What is your perspective on coaching and the relationship between therapy and coaching? It's something I've seen you talk about on LinkedIn.

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Candice Thompson (11:44):

Yeah, I think that it's interesting because coaching wasn't really an industry up until maybe COVID really heightened that track. My issue with coaching is when it steps into the scope of psychotherapy, and actually how I learned about this was around that time that I'm describing. I started LinkedIn. I started working with a coach for the first time ever because I just wanted to get unstuck with some things in my life and I'd done lots of psychotherapy through the years, but I wanted to try this. And the coach felt exactly like a therapist and I started calling it, I'm going to therapy. And then I realized there's something wrong about this. She didn't have a license. So I started doing some of the research of like, is this legal? And came across articles of, no, that's practicing without a license, which I should know that because if I let my license lapse and I don't do my CEUs and pay my fees, then I would be, there's a fine that's certainly available to me if I keep my shop open and practice psychotherapy without a therapy license.

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(12:50):

And so I realized, yeah, it's a felony charge for practicing without the right credentials. And so that's where I get really upset is find... I think career coaches, there's certain things that you want to help people move forward and there's something really concrete and specific. A coach might be great for that, but right now I don't think there's a lot of good education because it's an unregulated field of where that line is. So you see trauma-informed coaching and neurobiology coaching and DBT, CBT coaching. It's like those are psychotherapy terms and that the whole what makes it illegal, I'm not a lawyer, this is just the information I have learned, is that if someone assumes, just like I did with my coach, if someone assumes you're in a therapy relationship, that is enough to be considered a therapist and practicing without a license and being at risk of a criminal charge.

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Michael Fulwiler (13:48):

The counterargument that I've seen to that is that if someone has a master's degree but just they don't have a license, is the license actually just gatekeeping people? And for a lot of people it might not be accessible. Getting supervision is expensive and is it keeping people out of being able to help people? And so in that way coaching is more accessible. What's your...?

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Candice Thompson (14:13):

Yeah, shouldn't there be lots of opportunities for gatekeeping before someone could be a therapist and hold that vulnerability? There should be. I've gone through grad school, I've seen some people that should not be therapists at conferences or... You want there to be gatekeepers, and that's also what I was taught, right? Grad school is a gatekeeper. Your supervisor is a gatekeeper. The licensure is a gatekeeper. The BBS or your governing board in your state is a gatekeeper, and that protects the consumer and it's supposed to protect the industry. So some people don't pass their licensure for the first time. Within the licensure, you need to understand the current laws and ethics and what to do if someone's at risk of suicide, what to do if someone's at risk of harm. If you don't have that training, you should not be putting yourselves in that position. You could do a lot more harm than good. So I do really see it as healthcare, the same way I want my doctor to have all of the training and all the gatekeeping so they don't prescribe me something that's going to end up hurting me.

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Michael Fulwiler (15:19):

You wouldn't want someone performing surgery on you or your kid who's not a board-certified surgeon. You didn't pass an exam. And so I understand that it's holding therapy to the same standard of quality as other healthcare and even other just professions that require licensure.

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Candice Thompson (15:42):

And it is just as dangerous. It's maybe not as life and death as a surgeon, but the childhood traumas that people come in with, the horrific stories, to open that up, you risk someone's psyche. You risk their mental stability. You can't put people at risk of harming themselves. So it's not innocent. And I think that's what I hear is like, oh, well you're not a surgeon. People don't know the kind of stuff that therapists hear, and that's not for someone just walking down the street to sit down and hear of someone's complex trauma and to sit there with a blank face or provide empathy to not react in a way that it affects you and to be there solely to help that person repair. That is an art form. And I think we're stepping away from that right now with the mental health tech and the coaching industry. It's like, oh, mental health is a crisis. There's a money grab here that's happening and there's not a reverence to what actually happens in a therapeutic setting.

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Michael Fulwiler (16:48):

What about therapists who are licensed, who are interested in offering coaching services? Do you see that as also problematic?

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Candice Thompson (16:56):

I know that the ethics around that or you're supposed to have different forms, you're supposed to have the person understand that you're not serving as a therapist in that role, you're serving as a coach. Therapists can provide coaching, so the safest thing to do is to be someone's therapist and you can do behavioral plans and actionable steps with them. That's certainly underneath the scope of therapy, but you can't enter into that relationship as a coach and then slip into therapy. That's a dual relationship. Therapists should know this stuff. And so that's where I get so vocal on LinkedIn is when people fight back, it's like, yeah, you got to go. It's not me. I'm not creating the laws. I'm just trying to follow them. And there should be voices out there letting consumers and other clinicians know this is actually what the lie is. People should go check that out.

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Michael Fulwiler (17:44):

And I think when it comes to coaching, it seems clear that there needs to be some sort of governing body that's overseeing what's happening. And I saw recently, I think it's in the state of Utah, they're introducing a license for coaches. And so I think the more regulation, hopefully the more harm reduction, otherwise it does feel kind of like the Wild West, especially now with access to telehealth that you can be a coach and you can work with anyone.

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Candice Thompson (18:15):

Yes, certainly. I imagine that at some point there'll be a lot more lawsuits and that there will be some regulation or just in the in between of that. So it's an interesting time to be a therapist, and I think that's what I appreciate entering the field when I did is when I entered the field, there was no telehealth. We completed our notes on a piece of paper. I still do. I wrote all of my schedule on a planner. I still do. I have a locked box where my notes remain. We used to accept cash and check, but that's how things used to be. And it's changed a lot.

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Michael Fulwiler (18:57):

But you've described yourself to me as tech cautious and I'm wondering what's beneath that.

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Candice Thompson (19:04):

Yes, I'm happy for technology to be a tool. We're using technology now to have this conversation that is fantastic, that there's an internet, that there's a video that we've got these fancy microphones. But I think that there becomes a point that people aren't thinking about what's in the best interest of the client or the consumer. So I just saw something on LinkedIn last night where someone said, in this generation, nobody cares about if their data is breached. Privacy is not something people care about, and I didn't engage with it. That person is not a mental health professional. But I thought how negligent for product or a provider to have that kind of, oh, well, it doesn't matter. They don't care if their most private thoughts can get leaked into the internet. That's dangerous. And I know as a therapist, it's my responsibility to protect someone's privacy and I'm liable. So if my notes are online and that data gets breached or I use a recording for my sessions for easier AI notes and that data gets breached, that's on my license and that's very dangerous to the trust and relationship between my client. So what's happening in tech is I don't think people are thinking like a therapist. They're thinking like a company, and that's really dangerous because this is a sacred field.

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Michael Fulwiler (20:25):

Definitely I could see from an advertising perspective that I actually don't mind that Instagram knows about my online search behavior because they'll serve me ads that are relevant to me. Like, oh, I've learned about products or services based on ads that were relevant to me and that's great. I'd rather have ads that are relevant than not relevant. But when it comes to my therapy session notes and data, if I'm doing therapy online through a tech company and that tech company is feeding that data to Facebook to then target me ads for depression medication or something like that, then that's now not okay.

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Candice Thompson (21:08):

And I don't think that's ethical, I mean that's where I would love. I think licensing boards don't have the manpower right now to get ahead of all this. As therapists, we are supposed to protect that information. We're not supposed to use any of that information for our own good or anyone else's good. So that opportunity in of itself I think is a breach of the relationship. So that's part of some of my interest right now is to just say some of that stuff online. And I've been getting more into mental health consulting for startups and the health tech space because this stuff is drilled in you in grad school. And then to prepare for the licensure, that is a hard test. The hardest test, I think the pass rate is like 40%. It's a hard test because you have to get the exact, it's like one of those tests where every answer is right, but you have to get the exact right ethical thing in that moment. And without this stuff drilled into your mind, people don't know what they don't know. So like, oh yeah, mental health is important here. This will help therapists, and I've done some of this consulting and to see some of the things on the back end that's just not aligned with what therapists should be about.

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Michael Fulwiler (22:21):

What are the types of things that you're consulting with companies about and how have you been able to get those opportunities?

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Candice Thompson (22:28):

Yeah, a lot of that has been through LinkedIn. So I've helped people with EHRs, I've helped people with, there's all sorts apps people want to create right now. It seems like one of the buzzes is continuous care, which is also so fascinating to me is like I know as a human being, I've done certain things like that before. I don't want to be on my phone more than I am. I don't want to click a survey that doesn't increase my ability to walk outside or to take five deep breaths. So I've done a lot of consulting on apps like that and some AI stuff. It's all very interesting to me and I just hope, at least with what I'm saying on LinkedIn, the therapists seem to be really attracted to. So I don't think I'm the only one out there. Therapy before this current generation was very old school. We are the last ones to adopt technology. I think that's why the owner of the affiliation I was a part of for a long, long time, he until COVID did not even have email and he would write notes and put them in our box to communicate with us. I mean old school. And there's something about that's just so pure and I think there's just this hip tech moving fast that's not always in alignment with the heart of therapy, and I don't want that to get lost because it's a really beautiful thing.

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Michael Fulwiler (23:54):

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Candice Thompson (24:58):

Yeah, good question. So when I had an associate, I got my first EHR. I don't use it. My associate uses it. I will use it for its credit card option, which has been convenient for my clients. I use Google Meet for video calls. I mean, I try to go as scrappy as possible. Also that's free, so that brings down some of my costs, especially since I have office space in person. So there's a lot of these additional costs too that companies need to keep in mind unless something's bundled. We're paying for Psychology Today and other networking services and our accountants and our payrolls and any lawyer fees and covering our liability insurance and our Licensers and our CEUs and our internet and our phones. There's so much. And so to slap on a continuous care and AI nodes and EHR and a credit card service, that's a lot.

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Michael Fulwiler (25:54):

Definitely. And I think the privacy concern aside, I think the other opportunity with software and technology is to streamline some of these processes that historically were done manually. So we talk about insurance billing and submitting claims, having online platform available to do that or with Heard for example, streamlining your bookkeeping and your taxes and all of that. I'm curious for you, as someone who prefers to do things a more traditional way, do you feel like you are spending more time on those things or is that the time that's being spent on the admin type work? Not really that big of an impact.

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Candice Thompson (26:39):

It's not for me, a big impact and I've been doing this a long time, so I take notes during session and that's pretty easy. Maybe I have to spend a minute on notes afterwards, but that's a really simple process. I've got a great accounting system down that I create an Excel spreadsheet every quarter before I do quarterly taxes. I put everything in there. It's pretty easy. So I personally haven't been as bogged down by that extra work, and my heart is never to shame. If there's a product that works for someone, go for it. And this is a thing that works for me. I just don't want people to get lost. So if what products you're using helps you do your job well and you're being true to your clients, that's the most important thing. It's when we let technology be the driver and they have companies like BetterHelp that are like, I just think they have the upside down ideas of what therapy is that could really change our whole industry and affect people's mental health in a time when people need us the most.

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Michael Fulwiler (27:50):

Definitely. That's so interesting to me that you're also in Silicon Valley, so you're in the hub of tech. And so how do you think that's impacted your relationship with technology and tech companies?

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Candice Thompson (28:05):

I have a lot of tech clients, and if you don't know this already, a lot of tech founders or CEOs don't allow their kids to use their own products, YouTube or social media. And so I think that's part of it is like, oh, I know what's behind some of this stuff. I've had the conversations with some of these founders and I see the holes and that makes me even more distrustful of some of the products that come out and people are moving fast. I know VCs, so I think understanding the language makes me more skeptical when someone's saying, here's the marketing tagline, this will make things faster for you. I'm seeing behind who wrote that, who benefits from that? Who created that? What's the intention? What's the motivation? Who is funding it? So I think that helps me to stay above water with some of these things.

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Michael Fulwiler (29:01):

How do you think therapists can be part of the solution?

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Candice Thompson (29:04):

Yeah, always. I think if therapists realize we are the main product right now, what everyone wants to sell is therapy or a therapeutic relief. If you are licensed, then you can sit in the comfort of, I've got the antidote that a lot of people need right now. And so blocking out the noise, realizing these companies cannot survive without us buying those products or joining their big platforms. And so I think being really discerning, choosing to use products and companies that you actually believe in, and I think writing out of the noise would be my hope. These companies aren't creating therapists, they're just using us, it feels like in a lot of sense. So if we say, no, thank you, then those companies don't get to survive.

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Michael Fulwiler (29:53):

Are there companies that you like or think they're doing things the right way?

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Candice Thompson (29:58):

Yeah, so full disclosure, I do have one sponsorship with Spring Health, and that's a sponsorship that I got on my own. I feel very proud of that business opportunity because my husband has Spring and his therapist is absolutely fantastic. So in a season that I needed a few more clients, I started looking into all of the companies. I mean, I even had conversations with BetterHelp. I was just curious, how much do they pay? What are they like? And so in that process, spring quoted me higher than any other platform by 15%. It felt pretty significant and it works with me. It's not one of those, Alma, I didn't like that you paid into it because I feel like they're already taking a cut off the top and the numbers were okay, but then at the end, oh, and it's a subscription fee of $125 a month. I thought that's crazy. So that was an easy pass. That would've been my second choice. But Spring has worked really well. You take as many clients as you need. The people that I've met on LinkedIn who work for them are clinical and I really enjoy them. And so that is the one company that I have endorsed so far. I know it's still tech. They're parts of them that I wish I had control over that I could speak to different products and make it different.

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Michael Fulwiler (31:21):

Yeah, I've seen them talk about AI as well and how they're thinking about AI and measuring outcomes and things like that. But yeah, Spring Health is one of the larger EAP-based companies that's out there, and I've heard good things of the platform businesses. My sense is the EAPs, like Spring Health, Modern Health, they have the best rates.

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Candice Thompson (31:44):

Which is something yes, and I think, so part of that, and I don't really know the backend yet, I really want to make a post on an informed part of this information, but I think the reason for that is because they have multiple funding sources because you have the company itself, my husband's company pays for that service. They bill insurance and there's a portion of it that my husband pays for. So it's like eight sessions were free and then it's maybe $50 from there. I think for some people like $25. So it's accessible and affordable for the client, but because you have more than one pot, almost just insurance, they bill the insurance and Alma takes a cut from the insurance. Then you get what's left over and you're paying a subscription fee, where with Spring, they're bringing to the table more money that they got from that session, and so then they can give more to you.

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Michael Fulwiler (32:35):

I want to talk a little bit more about LinkedIn. So we've had therapists on the show who've built a following on YouTube or on Instagram, but LinkedIn we haven't really ventured into yet. And I know you're kind of early in your LinkedIn journey it sounds like, but can you talk about LinkedIn and the kinds of relationships you've been able to have and what's worked and what hasn't worked for you on the platform in terms of posts that get engagement?

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Candice Thompson (33:03):

Yes, I love LinkedIn. I really do. It's new for me, but it's been engaging very quickly. So my first viral posts happen maybe eight months ago and I've had six or seven since then. For me, it was just saying the stuff I've always felt and I didn't expect to have that kind of reaction or start getting a following where I'm a therapist. The last thing I ever thought about was sponsorships and any kind of platform. That's just not how I work. Literally the day before, oh, maybe it's a couple days before my first post ever went viral. I had posted a video which 200 people maybe have ever seen. It's on my LinkedIn, you can find it where I talked about digital discernment and why I don't post very much on social media, just my own ethics behind that. And I'm like, of course the universe is like, are you still going to follow that as you get all this engagement?

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(33:57):

Yeah, that was never my intention. However, so how it's worked is I say the things that are really important to me, the things that come to mind or that I just witness in the world, conversations that I have with other therapists or news that I hear with some of these big companies, and there seems to be a lot of engagement that's happened from that. Some tips that I have that I've learned is less is more. So I know some big names can post every day and get thousands of comments. I notice that if I post more than once a week, I get less engagement. So I try to just post once a week, but I engage regularly on other people's content. So I really like it. And I think part of that's just my own identity too, as therapists, no one sees what you do and I'm a mom, and so it was like LinkedIn is with this place. I'm like, hi, I'm a professional and the world engages with you as a professional. It's been so fun. I've gotten speaking engagements from that and these consultation opportunities and I've met a lot of great individuals and I'm pretty genuine when it comes to LinkedIn. So even with us, we had a chat months and months ago. The people I engage with the most I try to actually get to know because yeah, we're all fighting the good fight together.

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Michael Fulwiler (35:12):

Yeah, there's two things there that I want to highlight. One is engaging with other people's content. So it's called social media for a reason. It's not just broadcast media. So social is about interaction between people. And so that's a piece of advice I give to therapists who are interested in trying to build an audience on social is, yes, you do need to be posting content that's relevant and helpful and engaging, but also it's about engaging with other people's content and building relationships. And the more that you comment on other people's posts, the more that they're going to engage with you. And I've seen that it's like if I engage with other people, then they start engaging back or they start sharing my stuff and then that just helps to get it out more. But then also taking those relationships from online to offline and even though it's still online, but off of social media, whether it's LinkedIn or Instagram and just setting up a call to chat.

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(36:12):

And yeah, I think we connected and that I think just makes it feel a lot more real and a lot more human that there's a person behind this account because I think so much of social media can be so toxic. That's one thing that I have liked about LinkedIn is it feels a little bit more positive. I think you still get comment sections that turn negative or people get in fights, but I used to be more active on Twitter, and I noticed over the last year or so, it just becoming a lot more negative and toxic. And so I've noticed myself engaging more on LinkedIn. And so I think there's this perception that LinkedIn is kind of this cringey place where it's like people are posting lessons that they've learned or it's just for job posts and stuff. But I think for therapists, especially if you're interested in tech and just learning more about tech and getting opportunities in tech, I think it can be a great place. And I think connecting with other therapists like yourself.

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Candice Thompson (37:13):

Yeah, I've found tons of inspiration from it and really have enjoyed the platform quite a bit. And it almost feels like there's a bit of a cohort. There's a handful of people I see all the time. I feel like they're my friends even though I've never met them in person. I mean within reason. Obviously I know it's a different type of relationship, but there's certain people I've reached out to and I've gotten negative comments and said, Hey, this just happened. How do you deal with this? And it's nice to be able to develop that over time. And part of my ethic around engagement is I'm not trying to fight with anyone. So I try to be really kind and polite, even if people disagree, if it's a heated disagreement, I always follow up with a direct message as well to kind of keep the peace.

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(37:58):

And there have been a few times I had someone once say that I was in it just for the money. And what about diversity? And it hurt me so much because it's like people don't know your story. I put myself through college. I'm not a white male, I'm a multi-race female. I am diversity. I am equity. I am the person that you should be fighting for and for my success is part of the story. And so sometimes people say things that really get under your skin, and there's a big name right now on LinkedIn who he always gets hundreds of comments and he just posted that he's stepping down because of some negativity for a while. And I don't think people realize how painful some of those comments can be.

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Michael Fulwiler (38:41):

Absolutely. I mean, that's the dark side of social media. We've talked about it on the show. We had Jeff Gunther on the show. TherapyJeff on TikTok and Instagram if you've seen him. And he said, actually going viral is really terrible because it's like when you post something on social media, typically the people who follow you, they're positive, these are your friends, your contacts. And then once it gets beyond that circle, then you start to have people who are engaging and trolling your posts and they're negative. And then that starts to get a little bit weird and it's like people think, oh, I want to go viral. I want to have this big audience. But there's this other side of it actually where there's a lot of negativity and it can be very toxic as well. And so I think it's very important. I've had my own experiences with that, more so on Twitter, but where it can really impact you. And so I think it's important just to check in with yourself about how you're using social media, how it's impacting you.

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Candice Thompson (39:36):

Yeah, absolutely. It's a real part of it. I've reached out to Megan Cornish before too, just like, how do you handle this? And so it's nice to have other people who have kind of built a following who've been through it, but all I could do is control what I put out there. I know that myself, it's very opinionated. I also feel confident that the things I post are in alignment with what the laws actually and the ethics are. So I feel confident in some of that boldness. And at certain point, if it post gets too big, I can't, I'm not going to read all the comments. I just can't. I've got a business and a family, and so if something has a hundred comments, unless you tag at Candice to that comment, it's just going to get lost. And so that helps too. It's just like there's stuff I don't know that's probably up there.

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Michael Fulwiler (40:24):

You have heard that talking to therapists who are on Instagram specifically, they've come on the show and said they'll post something and they'll engage with comments for the first 15 to 20 minutes and then they'll never look at it again.

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Candice Thompson (40:35):

Right? Yeah, that's smart.

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Michael Fulwiler (40:37):

They don't care because they know that they'll just get sucked in and it's hard to pull yourself.

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Candice Thompson (40:42):

And I think people start having conversations with each other. So that's given me permission too. It's not all just a conversation with me, it's opening up dialogue. The only note I'll say I also want to add about social media is there's so many people out there that want to be experts. And I think in any field, in any stage of life, there's developmental stages and it really rubs me the wrong way. When people come right out of the gate and they're like, I'm an expert. I've been studying therapy for 20 years, I've been practicing for 16 years. It's only in the last year and a half I've felt bold to say, okay, I really feel like I can be public facing in some of these things because I've seen a lot. I know a lot, but that's why I really encourage digital discernment. People that come out there and they're like, I have this presence and I'm good at marketing, but yeah, maybe I just have my degree, maybe I don't at all. And I think that's where it can get dangerous because you just don't know until you've been through it. And any field, you make some mistakes and you learn along the way and you strengthen. And I think that developmental process is really important to go through first before you position yourself as the expert.

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Michael Fulwiler (41:52):

I totally agree. I've been working as a marketing professional for 15 years in this industry, and I wouldn't call myself a marketing expert. And part of that is because everything just changes so fast. Marketing 15 years ago is not the same as it is today, and it feels like all the time things are evolving. And now with AI, especially AI is completely changing how people search online. People are now searching using ChatGPT or an AI tool instead of going to Google, which has a huge impact on SEO and how we think about content. And so I'm curious, as you think about the future and where things are headed and how fast things are changing, what do you hope for the future of the intersection between mental health and therapy and technology?

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Candice Thompson (42:47):

Right now, I just hope that it slows down and the people that are proponents of it the most are selling something. And that's very interesting to me. And LinkedIn I think is such a great place to see the background of business. And so the names that are like, everyone's doing this. There's a tagline somewhere, some professor who had said, AI won't replace therapy, but therapists that don't use AI are going to be weeded out of the industry. And I just think, how silly! My job is about my interpersonal skills, my ability to analyze my ability to hold space. It's not about my ability to ChatGPT or use it for notes. That's just the craziest thing that I've ever heard that I need a robot to do my job well or I'm going to lose my career. So I just hope that we slow down and that the boards really need to step up and put out some notes on their positions.

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(43:43):

That's what I would love to see. And I'm a part of a clinical committee here in the Silicon Valley, and we've talked about as an body of clinicians to come out and say something's about digital discernment and how dangerous some of these things are. So I think that needs to happen more, is that bigger bodies, maybe universities can come out and say, Hey, this isn't in the best interest of our clients. Having AI friends is not in the best interest of humanity, period. I don't care if people are using it. I'm not going to be the one to say that. That's a good thing. People smoke cigarettes. I'm not going to say that that's healthy for your lungs. People might still do it and they might buy it and you can market it, but I hope therapists can just stay true to what they believe in and not let these messages force them to doing things that make them feel uncomfortable.

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Michael Fulwiler (44:34):

Yeah, it's an interesting dichotomy here, right of it is moving fast and if we can try to resist it, but it's going to happen anyway. So we should try to be part of the solution and hopefully inform some of this technology. But the same time, it feels like we need to also slow down and hit the brakes a bit. I read something recently that when it comes to software, you program software and it follows rules and it does what you tell it to AI. That's not how AI works, especially generative AI, which it really trains itself. And there's actually AI leaders and experts who have come out and said, we actually don't understand how AI works, and it'll make decisions sometimes that we don't know why it made that decision. Or if you've used ChatGPT, it'll make stuff up sometimes and they don't know why that works. And that to me is very concerning, especially when it comes to someone using AI as a therapist. It's going to make something up. And that's not to say that a human therapist wouldn't say something that's harmful, so human therapists aren't perfect either, but I do think that we should be raising the alarm bells here and saying, hold on, just because we can do something doesn't mean that we should. Maybe we just need to hit the brakes here.

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Candice Thompson (45:55):

I think about the classic narcissist. The narcissist is going to use the AI and say, someone wronged me, this thing happened. And the AI is going to believe them. They have no discernible skills to say, you are a narcissist. That's not how it happened. Therapists have to hold that knowledge and say in their heads, this person has a personality disorder. I'm going to slowly work with that, but I'm not going to just believe whatever they say, I'm not going to make them feel like a victim or feed into their pathology. And AI doesn't have that ability. So I'm a skeptic at heart, just in life. I feel like it's a good quality. And so I think about something like Theranos, I would've been the person, this doesn't make sense. This is going to fail. And I think there's something here too of this is moving too fast.

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(46:41):

It's very flashy, it's the new thing, but there's a lot of potential harm, and I think I'm just going to sit back and see what happens. I don't think that it has a huge role in my day-to-day business at all. I can live my life without it. Just like with my life with taking cash and check and doing paper notes for a really long time and other people are going to make different choices, but I'm curious to see the fallout. There will be fallout, there will be lawsuits. We've already seen, I forgot the name of that one I posted on it months and months back, but it was a healthcare AI and a clinician went on to talk about an eating disorder to test it and see what it would do. The bot started saying things about counting calories and it ended up being pulled. Tessa, is that the name of it?

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Michael Fulwiler (47:30):

Yeah, I think it was eating. I remember reading about this. It was an eating disorder hotline that they replaced with an AI chatbot, and then the chatbot was saying things that were harmful to people, and so they ended up rolling it back. But that was kind of in the spirit of efficiency. We don't need to have human beings be texting or be answering the phones when we can just have a chatbot do it. But then the chatbot was saying things that we're not okay.

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Candice Thompson (48:00):

I don't know about you, but when I call customer service and they want to chat, I'm always speak to a representative. So we've all had those experiences or online, I've talked to customer service bots and I'm like, that's not even what I asked for. I need this specific thing. I just want a human. And so I can't imagine that you're depressed and you get all these funky answers or you're so vulnerable, you can't even discern that it's a funky thing.

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Michael Fulwiler (48:27):

Yeah, I appreciate perspective. I think there's an appropriate level of cynicism or skepticism when it comes to this stuff that whether you're listening and you agree with it or not, I think it's something at least to think about.

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Candice Thompson (48:42):

Yeah, that's right. And certainly people agree with it. My posts on AI get very little engagement in comparison, and I've taken from that, oh, people are onboard, and I might be on the fringe with this. One time my husband texted me and it was just a very different text, and I said, did you just use ChatGPT? I'm sorry about that. And I'm like, don't ever ChatGPT me a text message again. If you know me at all. That is the last thing that I ever want. So that is unique to me. But I think that humans, I hope that as humanity at some point, more people take a radical stance on we need less screens, more just life. I love the Opal app. I get their ads, I follow them on Instagram, and as soon as I see one of their ads, I'm always offline because it's just so compelling of like, this is your life. This is how many days you get, this is a drug that you're on, and it's helpful to redirect. And we need more of that, not more buying into having our eyes more on a screen for longer.

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Michael Fulwiler (49:48):

Yeah. I appreciate this conversation. We're coming to the end here. So I have a few rapid fire questions to close this out. You ready?

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Candice Thompson (49:57):

Yes.

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Michael Fulwiler (49:58):

What is the most challenging part of being a therapist to you?

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Candice Thompson (50:02):

Sitting down all day.

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Michael Fulwiler (50:06):

What's one thing that you think therapists need to hear right now?

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Candice Thompson (50:12):

That they are valuable, well-trained and worth charging, A reasonable market rate that gives you a comfortable enough lifestyle, one that you expect a dentist to have.

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Michael Fulwiler (50:24):

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

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Candice Thompson (50:28):

That we get to drive what happens next in the industry and that people can make tools and products, but we get to choose if we're going to use them and how we advocate for what therapy and mental health looks like. And in the end, I do think that will win.

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Michael Fulwiler (50:46):

Candice, thank you so much. You've given me a lot to think about. Definitely going to sit with this conversation. I hope our listeners do as well. For folks who want to connect with you, especially on LinkedIn, how can they do that?

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Candice Thompson (50:56):

Yes, please find me on LinkedIn. I think my handle is something like Candice Thompson, LMFT. I also have a personal website. That's also my full name.

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Michael Fulwiler (51:06):

Great. Thank you so much.

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Candice Thompson (51:07):

Thank you. Bye.

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Michael Fulwiler (51:10):

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.