We recently connected with Lindsay Millspaugh and have shared our conversation below.
Lindsay, appreciate you joining us today. Setting up an independent practice is a daunting endeavor. Can you talk to us about what it was like for you – what were some of the main steps, challenges, etc.
When I graduated from USC in 2017 with my masters in social work degree I knew that I wanted to be in private practice, however, I wasn’t sure where to begin. I found an agency in Las Vegas, Nevada (where I was living at the time), and I loved their model of helping newly-graduated college master’s-level therapists build their own private practice. They provided a support system that would supply insurance-based clients to me, and they would bill insurance for services, so that I could focus on clinical care.
When the Covid-19 pandemic hit the globe in 2020 I was just about to finish my pre-licensure hours, and gain my full independent licensure to practice therapy on my own. I had lived in Nevada for 4.5 years at that time, found the love of my life, and we had been counting the days of moving out of Las Vegas. My fiancee, Chris, lost his retail job as the store he worked for decided to close due to the pandemic. I lived in Colorado my entire life before Las Vegas, and we decided we wanted to move back as we had plans to start a family in the future.
I asked the company I was working for, as they already had 3 branches in Nevada, if they would consider opening a branch in Colorado with me as the lead. Initially they were on board, and excited with the idea. I turned down a couple of job offers hoping for something larger with this new plan. The owner came back to us a week later saying that none of the other owners were as interested in opening up in another state, and he encouraged us, that if we really wanted to, we should do it ourselves.
We were terrified. I knew nothing about the business side of what we were doing, how to bill insurance, how to pay ourselves, and what all we would need in order to be successful. My previous boss said he would give us support and help us to get started. We came up with a name, and on May 26th, 2020, Chris and I decided to open Higher Sights Counseling LLC in the state of Colorado and take the leap together.
We initially started working with a company who said they would help us learn how to work with insurance in Colorado, and we quickly found that between them, and my previous boss, neither were even close to the support and help we hoped they would be. I found myself doing research, combing through insurance manuals, building spreadsheets, calling insurance companies, and Googling constantly. I couldn’t help the feeling of intense dread and anxiety about how little I knew, and just how much I knew that there was even more I wasn’t even AWARE that I didn’t know. I would spend 16-20 hours a day on my computer, compiling documentation, building templates for our systems, making intake paperwork, building a website… it felt like there was always a million more steps ahead that needed to be tackled. All while building the business, I had to make money to pay our bills. Chris wasn’t working as he was helping build the business, so I had to meet with clients.
I was seeing 7 clients everyday for 5 days a week, working all evenings, and all day on the weekends. Over time I started to find that the business was, well, working! It was a lot of learning, scary mistakes, issues, and seemingly something new everyday. However, I was meeting with clients, we were able to pay our bills, and everyday the phone would ring more and more with clients in need of therapy services. We quickly started to see that in the pandemic clients were struggling to find a therapist and were desperate, even willing to pay cash when they could not afford it, to get some help. I told Chris that we needed to start hiring more therapists. That we needed to help these clients, and I could no longer work 16-20 hour days. He was nervous about hiring and training new providers when we still felt we didn’t know enough, but he also felt strongly for the desperate clients in need. In January of 2021 we hired our first two pre-licensed therapists. As of today, we have 57 therapists on our staff, and a medication management provider, and 5 employees on our administrative team.
How we got from A to B is no easy answer. What I can say is that looking back my excessive work and desperation was not as necessary as I felt it was. It would have been okay to get away, take more breaks, and try to not anticipate what I didn’t know would be coming. I should have put my relationship first, and relied on us as a team instead of believing that I had to fix the issue and make this work for the both of us. I would tell anyone who is starting a practice to pay the money for advice even though you feel you cannot spend a dime. Build a community of people around you who have been there already, and know that you will not know anything unless you try. Do not be afraid to start hiring and delegating because as a business owner you need to remember your only focus cannot be the person bringing the money in, or you will never grow.
I have had my foot on the gas pedal, ready to learn and figure out issues as they come, because I knew I could never predict them. If you try to be overly cautious, only move forward when you think you know what is coming, you won’t get anywhere. If you want to run a business, be cautious and mindful, but know that you are capable of dealing with what comes your way.
Great, appreciate you sharing that with us. Before we ask you to share more of your insights, can you take a moment to introduce yourself and how you got to where you are today to our readers.
The commonly-known origin of psychotherapists is that we all got into this profession because we have felt suffering, and we wanted to prevent our experience from happening to others. When I was 14 my sister offered me a book to read. It was called ‘Reviving Ophelia’ and it was about a psychiatrist who wrote stories about her adolescent female clients who were suffering from eating disorders, self-harm, the loss of a parent, and other similar concerns. I knew then that this was my passion. This is what I wanted to dedicate myself to. I was lucky enough to know from a young age where I wanted to put my energy, and I was also lucky enough that this path was already carved out and accepted by society to help guide me. I graduated high school, immediately went to a 4-year university (CU Boulder) that had a great psychology program, found out the flexibility and benefits of being a social worker, and then graduated from USC with a Masters in social work. I got my LSW license to practice under a licensed supervisor at a private practice, and I finished my required hours before the 2-year requirement timeline. I received my full LCSW license 1 day after the 2-year mark (I wasn’t wasting any time).
Laughably enough as a social worker, not a Marriage and Family Therapist, I found couples counseling to be my truest passion when I started practicing. I believe that suffering inside of a relationship with the person you love, and you are closest to, is one of the most painful experiences we have. I wanted to help couples find their way to a safe place with one another, even within conflict, because I learned it was possible. My goal as a therapist became not only teaching, but proving to my clients that there is love, and an even stronger and safer bond, after damage in a relationship.
I would say that although I love my work as a therapist, what I am the most proud of is who I showed up as when it came to being a business owner. I always went through life with great grades, being ‘successful’ in enough of what I needed to, but only doing what I HAD to do to get by and have an easy life.
As a business owner I became no longer only responsible for myself. I am accountable for my employees, staff of mental health providers, and our clients, and therefore, a piece of my community. It is up to me to learn what is ethical, legal, and responsible as a business owner. It is my job to ensure we are providing the best possible place to work, the best care for our clients, and the best way to make sure our team can walk away feeling proud of what they are a part of. That they can trust that we have their best interest, and mental health in mind, as employers, and clients. We incorporate a daily practice of learning to be flexible, open, opportunistic, trusting, supportive, and always willing to grow (and recognize) areas that need to be strengthened. This role has been the most challenging experience of my life, but I have found that I am capable, that I also make mistakes, but am dedicated to the work. I also know that I could not be here, or have made any of this, without my finacee, Chris.
Are there any books, videos or other content that you feel have meaningfully impacted your thinking?
There is a book titled ‘Making Money is Killing Your Business,’ by Chuck Blakeman that changed my life. I recommend this book to every friend of mine who owns a business, because we all seem to be stuck in the same cycle that this book describes. The primary premise is that as a business owner you establish a business in order to acquire a value, or a goal, that you have. One of the greatest examples (and one that I align with the most) is that I built my business to have ‘freedom’. Freedom to me means building a great company that allows me to not have to work, or ‘produce,’ all day everyday in order to have a paycheck. I plan on having 2 children in my future, and I want to be there for them in their pivotal years. As a therapist who can only make money by meeting face-to-face with clients for hours a day, I did not feel I would have the time I wanted to also be a mother in the way I dreamt of.
This book specifically describes the issue that business owners find themselves in, which is that when starting a company we get stuck in focusing on the ‘urgent’ day-to-day work that brings the money in, and keeps us trapped from hiring and delegating tasks to others so we can meet our goals. This book has taught me how to make the time to develop systems in order to be able to step back, provide job opportunities, delegate, and grow the business without being the only person bringing in income. It taught me that I can stop running on the daily treadmill of over-working to keep the business afloat.
We often hear about learning lessons – but just as important is unlearning lessons. Have you ever had to unlearn a lesson?
I have always been a ‘lone wolf’ when it comes to anything I do in life. I hated group projects, every sport I did I preferred to be a lead or independent, and I loved being in a therapy private practice because I was able to work independently. Being a business owner I have had to deeply unlearn that my way is *the* way, learn to delegate, and learn to have patience and openness to alternatives.
I was always in competitive sports growing up, and pulled myself through college and graduate school with little support from others, always happy to do it all on my own. I always felt by doing it alone I could achieve quicker. I didn’t need to wait for others. Throughout college and graduate school I also created my own business teaching pole dance fitness (a sport where you can be completely independent), and made a name for myself in competitions, social media, and paid my bills traveling to different parts of the world, teaching workshops and private lessons. Again, all on my own.
Opening up a business with a heavily opinionated partner, having an administrative team with different ways of working and learning, hiring therapists from different backgrounds who are all running their own practice, has been a drastic change for me. Needing to practice teamwork became my new normal. A very painful at times, new normal. I struggle the most when I feel passionate and strongly about a decision, to then find someone else has a differing opinion, and personally not agreeing. It takes time, and effort, not to want to continue anyway, or disregard the concerns or opinions of others. To focus on taking into account their opinions and making sure they feel what they say matters, and trying to come to a solution when you are nowhere close to agreeing, doesn’t often end as well as one would hope. This is a daily journey that can always use progress.
In a team, you need to practice a great deal of communication, spend more time and effort documenting systems and procedures to minimize confusion, and regularly having to discuss and check in with one another to make sure everyone is on the same page. It is a daily practice and mindful work that is difficult for me to perform after a lifetime of doing things my own way and feeling it was always successful, (and much quicker). Learning to slow down, have patience, and stay open is an internal battle that has gotten easier, but there is a great deal more work to do. When every day feels like there is never enough time, and decisions and communication all take more time, it can be hard to want to follow this path. Ultimately it has always led to more positive results, moral, and teamwork in the end. We would not be where we are, have grown as quickly as we have, or have been as efficient and successful, without the daily effort and feedback of the entire group. I may be frustrated at times when it comes to working in a team, but the results would be impossible on my own. Thank you, especially, Chris, for knowing and working on this struggle with me!
Contact Info:
- Website: https://www.highersightscounseling.com/
- Instagram: https://www.instagram.com/highersightscounseling/?hl=en
- Facebook: https://www.facebook.com/HigherSightsCounseling/
- Yelp: https://www.yelp.com/biz/higher-sights-counseling-lakewood
- Other: My therapist instagram: https://www.instagram.com/lindsaymillspaughlcsw/?hl=en
Image Credits
Brindi Tremblay Light and Pole