The Private Practice Success Podcast

60. Salutogenesis: In Treatment & In Business

• Gerda Muller • Episode 60

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In Episode 60, Gerda explores a powerful concept that can transform both your clinical work and your business: Salutogenesis - the science (and art) of moving from 'dis-ease' to 'health-ease and how understanding and applying Salutogenesis can double your potential client base. 

Gerda breaks down what Salutogenesis is, why it matters, and how it applies far beyond the therapy room. You’ll hear why it’s simply not enough to just help clients reach an 'absence of symptoms'  and how aiming for true wellbeing creates better outcomes, stronger retention, and a more sustainable, fulfilling business. 


In this Episode, you will learn (among others):

  • How applying this framework can reduce clinician burnout, improve client retention, and make your business more sustainable.
  • How to prevent 'flight to health' (when clients exit therapy too soon) and instead facilitate lasting change, not just symptom relief.
  • The untapped opportunity in prevention and how to ethically expand your impact (and your market) beyond those in crisis.


Who This Episode Is For:

  • Clinicians and practice owners who want to do more than just treat symptoms and are ready to lead clients (and themselves) toward real, sustainable wellbeing.
  • Allied health professionals interested in prevention, positive psychology, and building a business that stands out for all the right reasons.
  • Practice owners who want a new lens for growth, sustainability, and personal fulfilment.


Tune in for a thought-provoking, hope-filled conversation that will challenge the way you think about therapy, business, and your own potential and help you build a practice you can’t stop smiling about :)

Want more info on The Ultimate Admin Training Course?

Email Gerda at gerdam@private-practice-success.com and she’ll send you all the details. 

Connect with Private Practice Success & Gerda here:

Well, hello there amazing private practice owner. My name is Gerda Muller, and you are listening to the Private Practice Success Podcast, and this is episode number 60. 

Today we're going to talk about a really interesting topic, and that is Salutogenesis. I always need to say that slowly because otherwise I just slip over the word, and we're going to talk about Salutogenesis: In Treatment & In Business. So tell me, have you heard about this concept before? Yes or no? I first heard about Salutogenesis back in the early 2000’s, which makes me feel really old right now when I think of it. But I heard it as part of my Health Psychology Unit whilst doing my first year of my master's degree.  I clearly remember that I absolutely loved Health Psychology. I don't know about you, but when I think back of my recollection to Masters, it's actually funny looking back now because I remember for example; sitting in my neuropsychology unit learning all about the brain - you know, Broca’s area, Wernicke’s area and learning how everything works together and the functions, and I was fascinated. I thought, “I want to become a neuropsychologist one day because this is fascinating - doing these assessments, and writing these reports. It's so interesting.” 

Then we went on to play therapy, and we learned about directed and undirected play therapy, Filial therapy, and I went, “Oh my goodness, this is amazing. I want to become a child psychologist, because of the work that we can do, and the impact we can have is just life changing. I want to do that. I'm going to be a child psych.”  You're starting to notice a trend here. And then my university was really big on assessments, and I learned all about assessments and I went, ‘I'm going to be an assessing psych, that's all I'm going to do. Maybe even work in forensics because that's where you do a lot of assessments, and is very independent, you can be re objective.’ And then I landed in the Health Psychology unit and I absolutely loved it. I went, “Oh my goodness. It's people coming in, and they have these health issues - stroke, heart disease, cancer, all of these things - and they are struggling with their mental health and I can make such an amazing impact by supporting them through that. I'm going to go work at a hospital one day and I'm going to be a health psychologist.” 

Like I said, it's funny for me looking back. It's like every new unit I wanted to do something different. But now as a seasoned, let me say, use that word, seasoned, not old - seasoned, and experienced psychologist, I look back and go, I think that is how it should be. I think that is probably the purpose of your master's degree. To give you a feel of all these various areas that you can work in, in order for you to make a really good decision about what you want to do when you leave university. And again, looking back, I feel like I've made the perfect choice being in private practice, because the beauty of private practice is that we can help all those clients. We can do neuropsych work, we can do health psychology work, we can work with kids, we can work in the forensic space, we can do assessments, and that's just once again, why I love private practice. Why would people not work in private practice where you've got so much scope. you can go as broad as you want and you can go as niche as you want.

I just love private practice, but I think you know that already, right? So thank you for going down that little rabbit hole with me. I've got very fond memories of my masters' time, while also really challenging memories because you need to work freaking hard to get through Masters. But all in all, it was such an amazing experience for me as part of my career.  Anyway, I heard and learned about Salutogenesis as part of my health psychology unit, and I want to talk to you about this today. As I said, it applies both in treatment because that's obviously where I learned about it in its application, but I also want you to go with me as we put this filter through our business, because this is a private practice success, mainly business podcast, so it would be a miss of us not to look at it from both of those perspectives,

What is Salutogenesis?

Salutogenesis was first coined by Aaron Antonovsky, I believe it was in the 1970s, and I'm going to try my best to explain it to you. I normally explain it to clinicians at my practice, because this is one of the first concepts I would always teach my clinical team members during their clinical supervision, and I would normally be writing this down on a piece of paper or on a whiteboard that we have in our consult rooms. So I want you to imagine a clear piece of paper in front of you, and we are drawing a straight line from the left-hand side to the right-hand side, so we've got this line which is going to represent a continuum on the left-hand side. I want you to imagine - or maybe if you are writing this down if you're sitting at your desk - on the left-hand side, there's the word dis-ease, or disease, and then all the way to the right, there's the word health-ease, or healthy. So it's a basic continuum that goes from disease to healthy. Or being in a state of dis-ease to health-ease. I also want you to make a mark in the middle of that line, and the middle of that line really marks the absence of mental health symptoms. And I want you to think about the clients that normally books in to come and see you or your team of clinicians. I would say that for the majority of psychology practices, the majority of clients that come and make an appointment are falling on the left-hand side of our piece of paper. So they're falling between disease or dis-ease and the middle point of an absence of symptoms.  

The Medicare system is also set up to support that. You need to have a mental health diagnosis in order to access treatment in order to claim Medicare rebates, for example, to see your psychologist,  So there has to be a presence of symptoms and a diagnosis, so the majority of people come and see us during that period. And then it's our job as psychologists, for example, me being a psychologist, to work with them and to meet them wherever they come in along that line and go, ‘Okay, let's benchmark. This is where you're at. These are the symptoms, and what are your treatment goals? And now we're going to work with you firstly towards the absence of symptoms.’ But unfortunately, that is where a lot of people stop. Because what tends to happen, ‘Ah, I've done my 10 sessions that I get Medicare rebates for, so now I'm going to stop coming.’ And very often clients think like that because the clinicians think like that. They go, ‘Oh, you've come to the end of your sessions, thank you and goodbye.’ That I think is irresponsible, and I actually think it's unethical work as a psychologist to do that. I believe it's unethical because I believe in Salutogenesis. I understand the concept, and I can see the benefit that it has on the lives of the clients that we see at my practice. 

Because I see our job as helping professionals, yes, to meet people where they're at, and to take them from a place of disease, to use that yucky word, so let's say dis-ease, and to work with them towards a place where they can go, ‘Yeah, look, my scores on the DAS has gone from severe, maybe moderate or extremely severe, even to the normal range. Because there's never going to be an absence of symptoms, let me say that as well, right? Anxiety, depression, and stress - it's normal human emotions. If you don't have it, then we've got a problem Houston. So when I say that the middle point is an absence of symptoms, I'm talking about the absence of symptoms that stop people from living their life - from going to work, looking after their kids being normal humans - that's what I mean with that. But that's only part of our job. There is this whole right-hand side of this line and this piece of paper of this continuum where we have responsibility to be working in. Where we need to tell clients, ‘Yes, you've done amazingly well. This is where we've gotten to, but this is how I can help you next.’ Because the purpose of life is not just to get rid of my depression and my anxiety and stuff. The purpose of life is to live a meaningful life. To live a life where you feel like you have a purpose. That you are contributing, that you are happy. That you are content in little pockets of moments. Yes, life can be hard. But your life needs to be meaningful and you deserve a meaningful life. And as a psychologist, I'm here to help you with that as well.

So needless to say, as a psychologist, I've got a very strong belief that clients that walk into my therapy room, that they are much, much more than just the symptoms and the diagnosis that they bring with them. Yes, it's my job to help them with that, that's first and foremost why they are coming to see me, because they're obviously really, really struggling, even suffering with what it is that they're going through. But that's just part of my job. And I also know that that's this chapter and season that they're in, and I know that there is so much more potential for them. So I see it absolutely as my job and my moral responsibility to show people that they're not broken. That we are going to work together to get you to a place of an absence of symptoms like I've just defined, which means you can have a normal life. But you know what? That you can have more. You can have that stuff that you see and hear other people having. I'm not talking about these well curated lives on Instagram that we all know are super fake. I'm talking about having meaning and having purpose, and I can help. And I will always put my hand up and I'll communicate that to them. Obviously, it's their choice, if they say yes or no, but as long as I know that I've advocated for their right to have it, then I know I have done my job, and that passes my - can I sleep at night test.

So I do hope that I've given you. A good idea of what Salutogenesis is. I've done the best I can, given that this is only the spoken word. Obviously you are welcome to go and read up on this topic. I do believe from memory that Antonovsky actually has a book that he published called Health Stress and Coping, and it was published towards the end of the 1970s, so it's a bit old. But I'm pretty sure it's still very valuable. You can just do a bit of a Google search. I'm sure you'll get some articles on the topic as well. So let's put this through our clinical filter.

The Clinical Application of Salutogenesis

What is the clinical application of this idea? Let's say I've convinced you and you've gone, ‘I think this is a really cool idea, Gerda, I want to know more. How do we apply this clinically?’ Because I most certainly do, and as I said, I teach this to all the clinicians that I have supervised ever. So I'm going to touch on three important things. I'm sure it has way more ripple effects than only those three.

Flight to Health

The first thing is that it prevents flight to health. One of the important conversations I would have with a client, generally in session two, when I am feeding back to them the results of their depression, anxiety, stress scale that I would've completed in session one. I already have the flight to health conversation with them, because I know therapy works. If you follow evidence-based best practice interventions, people will get better. Yes, it's sooner and faster for certain people depending on what's happening in their world. But I know that there's going to be movement.  I also know that for a lot of clients come session six, they will see really great improvement on their DAS scores. And what often happens, people go, ‘Oh, that's amazing. My scores have gone down. It's maybe even in the normal range.’ And they are so happy that they are no longer broken - in their minds -  that they just want to exit AKA graduate from therapy. It's like, ‘I'm all good. I've done it. I've done the work. Let's celebrate. I'm good to go. I don't need to come back.’ But what we know is that the nature of therapy, getting that support, having somebody that actually listens to you, makes you feel heard, understood, and validated, that can often lead to very fast symptom improvement. But if we then take that support away, all of a sudden, then things come crashing down. So that fast movement between, let's say session one and six, that's referred to as ‘flight to health.’ And if you then as a psychologist, a helping professional say, ‘Yeah, good. We want to validate you've done well and we are going to discharge you after session six.’ What you are actually doing nine out of 10 times is setting that client up for failure. Okay? 

And I'm referring to bread and butter work. There's always exceptions, people, I'm generalising here, right? But our bread and butter, depression, anxiety, stress, clients that come through our doors - they're going to have improvement. But even if they get to the normal range of their scores, there's going to be some type of relapse if what you do is just remove those support barriers. So in my point of view, that is very unethical to do, because you know it's going to happen, which is why I already talk to clients about it in session two, because I want them to know if - and probably it will - your symptoms improve that there's still going to be more work to do. So we want to stop flight to health occurring because we know that there will be a crash after it, and we want to prevent that clinically, we want to prevent that. Because sometimes that actually worsens what it is that they're dealing with because they feel like failures. They would go, I've tried, I've, and maybe they might even go, oh, psychology doesn't work because I went for six sessions. I did all this work. And look, I'm back at square one. We don't want that. We want people to have a good experience with the mental health system, with private practice. But that means that we need to educate them on stuff like flight to health, hence that conversation is so important. And because I understand Salutogenesis, I can frame it within the flight to health understanding as well in order to prevent that from occurring.

Prevention

That then segues nicely into the second point here, in that it is really good for relapse prevention in the first instance, right, because that's what we are doing. If we want to be mindful of flight to health, that also means that the next step is relapse prevention. We want to stop that from happening. But even more so, we want to offer prevention anyway. So you don't have to wait, client, out there in the street. You don't have to wait until you've reached rock bottom. Prevention is actually the best medicine, but unfortunately you don't get Medicare rebates for prevention, and that's the part that I alluded to earlier, that the system, especially the Medicare system, is set up in a way that you need to reach rock bottom - in this instance, rock bottom being, need to meet all criteria to get a full diagnosis, to get a mental health care plan in order for you to get rebates - we don't want that. So clinically, it allows clinicians also to look at the role that they can play in the prevention of very severe mental health presentations, which is an important part of the work that we need to do as well.

You Deserve More

And then thirdly, it really communicates to clients that you deserve more. You deserve more than just the absence of symptoms. You deserve that meaningful, purposeful, functional life - however you describe that, and sometimes that's the hardest part for clients, depending on their childhood,and  their life circumstances. They don't know what that could be for them because they never thought that that was possible. So that is an important job for us as a clinician to help them put words to that, for them to be able to, to even acknowledge and allow themselves to think that there's something more. That life could be better, that they deserve better. That is so, so super important. And that to me also, again, links to the fact that we need to reduce the stigma around mental health as well. Because if you think about it, if people have mental health disorders - you know, put that through the filter, depending on your allied health discipline -  if they don't take action on what is happening for them in their world, they will never get better. They will stay on this left-hand side of the continuum. That's not life. Nobody should stay there because they're too scared or they're scared of being shamed or judged. So if we can start to talk about mental health in this instance, through the filter of Salutogenesis - for example, on your social media, on your Instagram page, on your website - from a clinical perspective to go, ‘You know what? We help people on this side of the continuum as well. We can actually help you with prevention. We can actually just be there to talk to you.’ That's really going to help reduce that stigma that still exists. I know it's getting better. I think every year it's getting better, especially with platforms such as TikTok, for example, there's a lot more people talking openly about mental health concerns. But we still have a shit ton of work to do, and Salutogenesis is an important part of that work.

The Business Application

So if we were to look at the business side of private practice through the filter of Salutogenesis, what does this mean for your business? I'm going to touch on three important points here, again, I'm sure there's more than just three.

Enhanced Client Retention

First point, if you have a clinical team that understands the concept and the clinical impact of Salutogenesis, then that will have a direct positive impact on the client retention within your business. In other words, instead of clients just coming for six appointments, they might come for 10. Instead of somebody coming for 10 appointments, they might come for 18. Because we now understand that our job as clinicians is not only to go from this dis-ease to the middle of this continuum, but our job is also to then take on phase two, of helping the client to get to health-ease - that meaningful, purposeful life that it is that they want.  And why is that good for your business? Because client retention from a financial perspective is much cheaper than new client acquisition, because it costs your business money to acquire a new client. So instead, let's do our jobs well, okay. Let's do our jobs well, and make sure the client gets to where they need to be, and that's going to help with that client retention.

An Expanded Market

The second point for the business is that Salutogenesis expands your market. Because I'm thinking right now maybe what a lot of you are doing is marketing towards people that's going to enter your business on the left hand side of our piece of paper, anywhere between dis-ease and the midpoint of no symptoms. Or no symptomology sufficient to meet diagnostic criteria. That's where all your marketing is going, right?  But now if you look at this through the Salutogenesis filter, you now have this whole other market that you can tap into. Your market has now literally doubled from a business perspective. Now, of course, if you want to tap into this expanding market, people that do not have a mental health diagnosis, but they are not at the right-hand side of health-ease, they are somewhere in between. If you want to tap into that market, you need to be mindful of where that market is. What language do I need to use, how do I talk to them? How do I tell them that we are here? But that's a whole expanded market that you now have.

So if you're currently looking at your freaking diaries, and it's like month after month after month of open appointments, maybe it's time for you to go, ‘Let's look at this market,’ because there's a shit ton of people sitting in there. And I can tell you, and I've said this before, a hundred times before, I feel like I know as a psychologist I can take any person off the street, anybody with no mental health issues, even the person that tells me my life is perfect Gerda. I know for a fact I can take them. Into the therapy room and I can do at least six sessions with them where they will get value from it. Because guess what? You. me, everybody, we don't know what we don't know, and there's always a freaking next level. So it's really about going, how do I help those people? How do I find them? How do I talk to them? Because they also deserve help. Now, I know there's some of you that's thinking, ‘But what about the people that's struggling Gerda.? What about the people that have, you know, all these other mental health conditions? Well, I'm not saying don't talk to them. But you also need to look at where your practice is located? What type of practice do you have? Which market is right for your practice? And yes, it feels good to help people with very severe symptomology. I know I worked in that space for a very long time, and it makes the work that you do very salient, because you can see how their lives change. But I can tell you once you've started to work on the other side, you can see it as well. The joy, the happiness, the contentment, feels just as good. So this is just my invitation to you to say, is that a market that maybe I want to venture into? Because it's there for you if you choose to also look at that.

Enhanced Sustainability

And then the third point here, a very, very important point when it comes to business, is that applying the Salutogenesis to your business enhances sustainability of your business. Why? Because there's two really important sustainability aspects here. First, in terms of sustainability in clients, I've just spoken about client retention. But also sustainability in terms of your clinicians. Because as a clinician myself, I know that having a new client come in takes a lot of mental work for me. I don't mind new clients, I love new clients, but mentally there's a lot more work that happens. Because you need to do an assessment, you need to do a case formulation where you apply everything you know to this person and how you can best help them, and then you need to put together a treatment plan. Now, if your clinicians are only doing 3, 4, 5, 6, 7, whatever their retention numbers are per client, that means let's just say six on average, let's say your retention numbers at your practice is six per clinician, and I would encourage you to know what those numbers are for a whole of practice and individual clinicians. But let's say it's six. That means that after every six sessions with a specific client, they've got a new client on their caseload. So the number of new clients they have is going to be at a certain level.  

Now imagine if instead of just taking people from dis-ease to that midpoint, which is from session one to six, and then you go, hang on, let's talk to them, maybe they want another four or five sessions, maybe even another six. That means that clients now stay for twice as long with us, which means that there's less new client assessment, case formulation, treatment planning that needs to happen. So from a burnout prevention perspective with clinicians, it really helps with that sustainability. And I can tell you that if a clinician's able to help somebody from a state of dis-ease all the way to health-ease, you know, how freaking good that feels to them. I know because I've been there. It feels amazing. And the chances of those people relapsing becomes less because you've done your relapse prevention. Those people have had a great experience with your business. They are probably also people that will refer friends and family to your practice. But coming back to sustainability for our clinicians,  it's reduced the risk of burnout. And the other thing as well, If you start to tap into the second market that I spoke about earlier, that also allows your clinicians to have a bit more balance in their caseloads. Because again, from a burnout prevention perspective, if all your work is on the dis-ease side of this continuum, you might have a lot of at-risk clients, people with a lot of severe symptomology. So wouldn't it be nice for clinicians to also have clients that come in with presentations that don't require that level of intervention.  I've had many of those over the years.

Prime example, somebody working in corporate saying ‘I've come to a fork in the road of my career. I either stay with my current company or I've been offered this other job. What should I do? How do I make this decision objectively?’ We can have a conversation, I can help them with that. Another example that I've actually had surprisingly a lot of times over the years, so I'm certainly not breaching confidentiality, but doctors and medical students coming to see me saying that ‘I've got this option between these two specialties. Both have been offered to me. I don't know which one to choose. How do I decide because I'm going to make this huge commitment in terms of time and money and energy, and I need to make the right choice. How do I decide?’ I love that, and I feel like it's such a privilege that I can help and facilitate a decision like that for someone. Having clients that come into the business, into the therapy room, and who are entering on the right side of the continuum again, supports sustainability from a clinician perspective that maybe it's not a very dark session. Like I'm a trauma psychologist, a lot of sessions can get really painful and dark. So it's always good to be able to have other types of clients where you can go, this is a really light session. This is a really energising session. And yes, trauma work is energizing at a different level, but you know what I'm saying here, right? So it brings diversity into the caseload. And always you want to give clinicians options. Maybe some people go, oh, you want to do trauma? That's perfectly fine as well. But I'm talking here as a general rule, being able to have a caseload for your clinical team that is more balanced. That every client is not a high-risk client, and when you start tapping into that market, the market working towards the health-ease from that midpoint, then you are introducing more variety and more sustainability into that caseload for your clinical team.

You as the Business Owner  

Now that we've spent some time looking at Salutogenesis in its clinical application, as well as its application and importance to your business, I want to invite you now to look at a third application, and that is how this applies to you - the practice owner, responsible for the clinical application and the business application. Let's look at you, and maybe you can guess where I'm going with this. Because right now your business, and your experience of your business is sitting somewhere on this exact same continuum. A continuum from dis-ease or disease to health-ease or healthy. So, ask yourself this, what is your business like right now? Consider things such as what your client numbers like? Are your diaries full or not? Are you confident about filling your diaries week after week after week? What's your team capacity like? Do you have a shortage of clinicians. Or maybe you don't have a shortage, but they're not really productive or efficient. So there's a capacity issue. Consider your systems. How efficient are your systems at your business right now?  What is your cash flow like? Is it a positive or negative cash flow? Is it cash flow that keeps you up at night, or is it a cash flow that you are really confident about?  And also fifth and very importantly, what is your profit like? Are you just scraping into the black year after year and you're going, well, at least it wasn't a loss. Are you just hovering around the 5 to 10%, or do you actually have a good profit margin sitting at around 20, 25, 30%. 

Based on those growth drivers I've just mentioned, being clients, team systems, cashflow and profit, how close is your business potentially to the dis-ease part of this continuum? Or maybe it's actually very close to the health-ease part of the continuum. And this is for you to reflect on. There's no judgment here. But I think it's really important for you to also go, this applies here as well. Where is my business? And me as the human being in charge of it, taking on all the risk and responsibility, what is my experience of it? Do I feel like I'm in dis-ease when it comes to my business? Or do I feel like I'm in health-ease? Whatever your experience is, it's probably an accurate reflection of where your business is at. So I want you to know that there is a continuum. I also want you to know that if you're currently on the dis-ease part of the continuum on the left-hand side of our page where we've been drawing this, I want you to know that there is this whole other part of health-ease, which is available to you. Just like the clinical clients. Just like your clinician team deserves to also be in and operate within the health ease part of the continuum. So do you.

I know it's possible because that's where I'm sitting with my business. I've got a self-running practice. You would've heard me talk about that. I live six and a half, seven hours on a bad traffic day, all the way from my practice. My practice runs in my absence. So when I think about The Psych Professionals, there's a lot of health-ease going on there. It makes me happy. I feel content about it. I feel confident about it, and that's an amazing place to sit at. But also know this, that I know what it feels like to be in dis-ease because I've been there, done that, got the t-shirt, never want to go back there. And that's why this has become my life's mission to help practice owners like you move from dis-ease in your business to health-ease. I'm hoping that this is going to instill some hope for you, because I think it's particularly with, with us allied health professionals - and I see this a lot with psychologists as well, because I'm a psychologist, I find most of the practice owners , that reach out to work with me are psychology practice owners - they are very self-critical about how well they're doing or how badly they think they're doing. And they often think that they must be the only ones who are struggling in business. Surely nobody else is struggling. Even when people reach out and talk to me about joining the Private Practice Success Academy, they often ask like, ‘Am I too far gone Gerda, can you actually help? Is it going to be safe for me to speak up in The Academy Facebook group on some of the group sessions, where I am going to be the only one whose business is really shit? Because I do not want to be embarrassed.’ And I always say, ‘Nope, you're going to be in the right room.’ Yes, in The Academy there are people who are across that continuum, but you know what, there's a lot of people in there that when they joined, they were in dis-ease, and they're no longer there. They're on the other side of the spectrum now. 

There's always a way forward, and I think that's important to know that way forward, something better is available for each and every one of you. Now that I think of that, because I'm thinking of people that've been in The Academy, 2, 3, 4, we even have somebody that's now been in 5 years, she was one of the first people to join, she's still there today because we've been running for five years. Those are the people that see really big results. For me as a business coach, what I do see when I look at the trends within our membership, for example, a lot of people do come in in the dis-ease part, because I think I'm known for being a problem solver as a business coach. I'm known for being able to look underneath the hood as they say of your business and going, ‘Oh, I can see what's wrong here. I know how to fix this, these are the strategies, here's the tools, and the resources. I give all of that to you. I hold your hand as you implement it. So I am good at helping people grow from this ease to that midpoint. But I find what often happens for a lot of practice owners, they go, ‘Okay, I, I think I've now invested enough time, money, and energy into me as the business owner. I'm going to exit myself from The Academy or whatever other mastermind they're in, and I'm now going to do the rest of it alone.’

I've made a decision over the holidays that I need to be more vocal as well about this, because I always respect somebody's decision when they say, no, I'm good to go because I'll go - you are an  adult, you're a business owner, I'm not going to tell you what to do. But then I'm going, why is it so easy for me to advocate for my clinical clients about this, but I'm not doing this with my business coaching clients, and I've been reflecting on this over the holidays. Because it's like I know, yes, it's amazing - to use this phrase, we fix your business, you know what I mean with that - we've made all this progress, we've implemented these strategies, you can see things are getting better and things have turned around. This is actually a vital stage. Maybe there's been some business flight to health, right? It's exactly the same thing, these are universal concepts. When flight to health happens in your business and you take away those supports, because things are going well - business is never straightforward - when the next big thing happens, you are without support. And just imagine if you are listening to this and you're going, ‘I'm a business owner and I'm not in dis-ease, I'm actually maybe in the middle somewhere, Gerda.’ But just imagine what you can do when things are actually going well in your business, when it's already impactful, there are good systems in place and you've done a lot of those foundational pieces,  to have a coach, a mentor or consultant standing next to you, having your back. Empowering you to think bigger, to scale, to implement with ease. To be supported when things go wrong, or when you need to make a big decision - because that's often where things start to go hairy. 

When practice owners are faced with really big decisions - and these are my helping professionals and especially the females amongst us, and that's the majority of people I work with - we make a lot of heart driven decisions, and that's often where things start to go wrong. And I'm not saying you can't be hard driven. You most certainly can, but you need to balance it with logic - with the numbers, with the data, with an assessment of what the scenario is. What does this mean? If I say yes to this, what does it mean, if I say no to this? And having somebody to bounce that off really ensures that you stay on that upward trajectory of business growth. A lot of practice owners tell me, ‘But I don't want a big practice Gerda.’ And, part of me always thinks it's because they think they shouldn't have it, because then I'm going to be a tall poppy, or that looks and sounds greedy if I say I want a big practice. But you know what, what is big anyway? Define big for me. In our world of small business, a level five practice is eight clinicians, that's a head count, that's not even full-time equivalent, it's a four-room practice. You can have a profitable, sustainable, four room practice that supports your life, that looks after your clinicians, and that serves the clients in your community. That is a big practice. So when people say, but I don't want a big practice. I think they're thinking of five locations, a hundred clinicians - yeah, that sounds like something that's way too much work for me most of the time as well, but it's most certainly doable, I can tell you that I've got two practices myself. I mentor, coach, and consult with practices that have multiple locations, that have 20, 30 clinicians. So, you can have whatever you want. I'm thinking that's what I want to really emphasize here. Because a lot of times we've got so many I can'ts in our head, even if it is unconscious. Because at the end of the day, you can have whatever you want.

So the question that I want to leave you with today is the following, irrespective of where your business is on our continuum that we've discussed, think about this, what do you really want from your business, from your practice? If you could tell yourself what that is, and you could actually say it out loud, and I'm going to encourage you to say it out loud, maybe write it down first, whatever works for you, but I want you to think, what would that be? But, what would it be if nobody heard me saying it, or if nobody saw me writing this? In other words, nobody's there to judge you. Nobody's there to tell you ‘Oh geez, that's a bit big. Oh, that's a bit scary. Oh, hmm. That's a bit over the top.’ Nobody's there to judge you, and you are also not judging yourself. So you first need to silence that little voice in your head that's telling you can't because you've got young kids, or you can't because you've got other family responsibilities, or you can't because of whatever the reason is. Tell that little voice to shut the hell up. What would your vision then be? And there's no, it's too little or it's too big. It can be whatever you want. Just be honest with yourself. You owe yourself that level of honesty. Once you know what that is, just sit with that. Just sit with it. Let it process. Be mindful of how it feels in your body. Does it feel scary? Does it feel good? Does it feel intimidating? Whatever it feels like, whatever it is, know that it's perfectly fine. At the end of the day, you get to decide what you do with your life. You get to decide what you do with your business. But I never want you to dull the dream that is within you, and I'm always here to tell you that you can have your version of the ultimate private practice, because you get to define what that looks like. That is where I'm going to leave our discussion for today.

Thank you so very much for tuning in. And as always, remember that I am here to help you build a practice you can't stop smiling about. 😊

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Gerda Muller

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