The Human Behind the Healer with Anna Steele, LCSW

Content Warning: This episode of Therapists Unchained features a deeply honest and vulnerable conversation regarding severe depression, systemic burnout, and suicidal ideation among mental health professionals.

In this episode of Therapists Unchained, host Sivie Suckerman sits down with Anna Steele, LCSW, a licensed clinical social worker who runs a solo private practice in Vail, Arizona. Anna shares her courageous professional evolution from the grinding gears of public mental health to true clinical autonomy, while laying bare the profound personal cost of an industry that frequently denies the humanity of its healers. They speak about navigating profound struggles while working under high-stress institutional systems. She and host Sivie Suckerman discuss the unique challenges, isolation, and barriers that clinicians face when seeking support for their own mental health.

If you or someone you know is struggling or in crisis, please know you are not alone and help is available:

National Suicide and Crisis Lifeline: Call or text 988 (available 24/7, free, and confidential).
Crisis Text Line: Text HOME to 741741 to connect with a crisis counselor.
Local Resources: Reach out to your local crisis clinic or emergency services.

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Anna Steele, LCSW

I have worked as a mental health professional since 2000. In 2009 I earned my Master’s of Social Work (MSW) from Arizona State University (ASU), and I have worked as a therapist ever since. I have worked as a therapist in public mental health in several settings. These have included residential treatment, community crisis services, and juvenile detention. While working in public mental health I became trained in Eye Movement Desensitization Reprocessing (EMDR).

In 2016 I decided to go into private practice, and I opened Vail Counseling PLLC. The experience in public mental health and my training in EMDR was very valuable in private practice. At the same time I started working with people who wanted even deeper answers and healing than traditional psychotherapies and even EMDR could provide.

In 2021 I was introduced to Intensive Short Term Dynamic Psychotherapy (ISTDP). This treatment intervention taught me how to fully experience all emotions in order to find the deep changing answers that my clients and I were looking for. While learning about ISTDP I also realized that attachment theory helps provide deep healing answers, and so I have taken the time to study and thoroughly understand attachment.

In 2024 I took an intensive training on couples therapy called PACT (Psychobiological Approach to Couple Therapy). PACT has helped richen my understanding of attachment. It has also taught me skills that help deepen relationships and improve attachment.

A principle that I have lived and worked by since the beginning of my career is to be willing to do anything I ask a client to do. As I have learned different therapies I have also done them myself. I support those I work with by being trained and experienced in various skills of psychotherapy, and by being able to understand through my own personal experience. If you are searching for answers that will create meaningful change in your life I look forward to the opportunity to use my experience and training to support you in this journey.

Vail Counseling

This episode was produced and edited by Sivie Suckerman, MA, LMHC, ACS

Transcript

SPEAKER_03 0:08

Hi, everybody. My name is Divi Superman, and this is Therapist Unchained, a podcast hoping to educate, empower, and inspire mental health clinicians across the country, navigating the systems that we're facing in this ever-evolving mental health landscape. And today I have a clinical social worker named Anna Steele, who runs a solo private practice in Vale, Arizona. She got out of public mental health in around 2016, so about 10 years ago, and has been working for herself since then, which she says has felt very empowering and healing. Anna also focuses a lot on complex trauma in the work that she does. So welcome, Anna. I'm really glad that you're here. I wanted to speak a little bit about how this episode might feel a little bit different from other episodes that we've had. That Anna reached out to me and sent me a lovely email talking about really, I think, at the core of what this whole podcast is about, which is that therapists, clinicians are human beings first. We're all human beings. And we're therapists second. And how do all of these systems, how does the work compound and affect us as human beings? And that was really the core of what Anna was communicating to me when she reached out, which really struck me. So, Anna, first of all, I just want to acknowledge the vulnerability of sending that email to me that something that I was doing here felt like it had the space to have this conversation. And I'm really glad that it felt like it had the space to have this conversation. I want to welcome you. Is there anything I missed in your intro that you want folks to know?

SPEAKER_00 2:00

No, that's like a concise summary. So yeah, thank you.

SPEAKER_03 2:04

So I'm curious, you reached out to me speaking about some of your own mental health struggles while doing this work. I like to start with folks just kind of providing that trajectory of how they got to where they are now. And within your trajectory is where a lot of this stuff kind of bubbled up. So I think it's a great lead-in to talking about what it means to be a human being and a therapist and how that can impact people in this work.

SPEAKER_00 2:35

Yeah, I can kind of give you a trajectory. I was thinking about that. I started in 2000. I was finishing up my bachelor's in history, and I realized I don't really like history. So I got into this field, and my first job in this field was residential substance abuse, and it was an amazing program, and I fell in love with this work. I learned that you can have boundaries, I learned that you can say no, and it was absolutely life-changing for me. And I realized this is what I wanted to pursue and do, you know, and and it was a really good program while I worked for it. It was back in Ohio. Things always change, and um also my husband, it was my husband to be at the time. Um, we decided to move to Arizona, and so, you know, life changes, and we moved to Arizona, and I get a job in public mental health working outpatient. I end up finding a little niche with people who are HIV positive and who have substance abuse issues. And I work with them. The organization that I worked for at the time paid for tuition reimbursement. So I got my master's degree. I went back and got my master's. I worked uh for them for over five years. Once I got my master's and I could become a therapist, which I, you know, I mean, like I'd come in entry level and worked my way up. And I was like, oh my God, I get to be a therapist. I'm so freaking excited. And I went back to my roots of what I loved, uh residential substance abuse treatment. And I got a job in a program, and it was great. I loved it. It doesn't pay well, but I loved it. It was, it's God, that's where my heart is in this work. And then in less than a year of getting that job, I got pregnant. I'd been trying to get pregnant for five years, had to use IVF to get pregnant, ended up with twins, and it ended up being a high-risk pregnancy, and I was hospitalized at five months.

SPEAKER_03 4:41

Oh, wow.

SPEAKER_00 4:42

Because I was hadn't worked there for a year, they were able to lay me off. FMLA did not protect me. And I don't know if that has changed, but at the time it didn't protect me.

SPEAKER_03 4:55

I still think it doesn't, honestly.

SPEAKER_00 4:57

Yeah. So they laid me off. I could have fought it, but my husband was working for the same company at the time. And I didn't want to jeopardize his job because that was our income and insurance. So had the had our kids, got back into working, tried to go back and work for the same company, but I couldn't get into the same program. It just wasn't a great fit. I had started looking elsewhere. There was a company, a locally owned company in Tucson that ran the crisis services, and they had a great reputation. Southern Arizona Mental Health Corporation is what it stood for. Everyone knew them as SAMHAC. They had such a great reputation, they had built-in clinical supervision for people working towards their independent license. But the 2008 uh recession started to really hit hard, and uh states were pulling back grants, and then also big national um companies came in, and so the grants that SamHack got were were being reduced and being given to this other national company, and I could just see like it was changing and not as good. So I looked elsewhere for a job and found a it's a it's another local residential substance abuse program that had a really great reputation and they were trying to start up a new adolescence program. I don't I don't know why. I mean, I have my guesses as to why they completely flopped with their new program, but it was a complete disaster. And I ended up laid off from there because they lost funding because it was such a disaster. And then from there, I needed a job. I had kids, I had to get a job, and so I went back working PRN at SamHec for a little bit, and through connections, I found a job at juvenile detention in mental health. And I will say Pima County's juvenile detention, I actually really like the way they run their program and their juvenile detention is very positive-based, rewards-based. Like compared to a lot of juvenile detentions, I do like it. Um, but they contracted with a for-profit agency for their mental health and medical services. And so I didn't actually work for the county, I worked for this private for-profit company that contracted with the county. And I still remember like getting fully onboarded and kind of really fully being a uh uh employee and walking down the hall like on one of my first days, and just having this sense of like, oh my god, is this like the biggest mistake I've made ever? And I was like, I don't know, I just gotta move forward because it was the best pay that I could progressively getting more pay, having to support a family. Sure. All of that.

SPEAKER_03 8:17

And so But I'm curious though, what what were you picking up that you had that like where your kind of stomach sank?

SPEAKER_00 8:24

I don't I, you know, like the institutional hallway walking down. Uh, you know, it's hard for me to like put my finger on exactly what it was.

SPEAKER_03 8:34

Like, is this what comes to mind for me because I'm remembering when I was in grad school, I came really close to working in a jail situation for my internship. And I remember when I went to the interview going, is this where I want to be every day? Like, is this the environment that I want to walk into every day? And that's what I was thinking when you were talking about that.

SPEAKER_00 8:56

Yeah. Yeah. It was uh, yeah. And you know, the kid, the kids, um, I found that working with adolescents isn't hugely different than working with adults who have substance abuse issues, because a lot of adults with substance abuse issues are kind of emotionally arrested at earlier ages. So I found that like working with the kids, like it's the work I've always done and always loved. And they're not easy, but but I'm trained. Like that's what I'm trained in how to do. It was it was this ad administration, it was working in the administration where they were just constantly messing with my schedule, wanting wanting to try to change my schedule, wanting to um not approve time off, wanting to change my pay, but anything else paid significantly less. And I had a mortgage and kids to provide for. And so I couldn't, so I had to figure out it was probably about six months in, I would, I realized I had to figure something out. And nobody, I I'd gotten my degree in 2009, and this is several late several years later. You're supposed to be able to get your clinical supervision within about two years, and then be able to get your independent license. Like nobody I worked for was providing me with clinical supervision. So I realized in order to get that next level of license to where I could then start creating opportunities for myself, I had to go pay for my supervision myself. And so I did. I signed up on the side without telling the person really in charge of the program. I didn't tell her what I was doing at all. I like I did it on the weekends, in the evenings, and I went to work for her and and through her paying her, and I was I'm I was willing to pay her, like I wasn't making any money on under her, but I was paying her for the supervision and I needed the supervision. And she wasn't living the high life herself either. She was scraping by as somebody else in this business, also. So I mean, I couldn't fault. I I I really wasn't upset with her. I I knew it wasn't a model that like really worked, but I could I just had to do it long enough to get my supervision from her. So I couldn't.

SPEAKER_03 11:18

Yeah, I mean, I private I privately supervise folks in in Seattle who have their own practices as an associate. And I mean, if anyone, like the site you were at were the ones that you know, we should be frustrated with that they didn't provide that for you.

unknown 11:34

Yeah.

SPEAKER_00 11:34

Yeah, absolutely. So I did. I I got all I got the supervision I needed, I got the license, and then I built my own private practice, and it was scary as hell. I mean, this is 2015, 2016, and I'm putting everything in place. She gave me supervision and then she also supported me in connecting me with stuff. So that we have an email listserv here in Southern Arizona where we have hundreds of people on it and um therapists in the area. It's a great referral system. Uh, through that, I could ask who is a good biller. And so I got connected to a local, uh, small local business that does billing, you know, and so I I figured out what I can do myself and what I don't have the brain for. Um, I don't have the brain for billing or taxes, and I need help with that. But I can do my own scheduling, I can sign up for most insurances, you know, so uh all of that stuff. I can do that. And it was super scary, but staying where I was was horrible. Like, um, I guess what I reached out to you, and what I'm kind of glossing over and skipping over is like how bad it got. It was probably two or three years that I was working for this company, knowing that I was working to get my license and trying to manage it. And it was such a dark time in my life. Work was not a great place. I would there were things at home that were very difficult at this time. So difficult, or so home was not a great place. So I felt like I had nowhere that was good. At some point, I realized I was having fantasies about suicide. And I had I had worked crisis, like I done crisis assessments with people. So essentially, while like the tears are streaming while I'm driving in the car, because that just seemed to happen a lot at that time. I realized what's going on in my head, and I like stop myself and I'm like, what are you doing? And I have a conversation with myself that I would never have with another person. Um, this is not how I would do in a crisis assessment with anyone else.

SPEAKER_03 13:51

But I asked Yeah, well, you have a different relationship with yourself than you do with other people, so that makes sense.

SPEAKER_00 13:58

Yeah. So I ask myself, I'm like, are you gonna do it or not? And so then I think it through. I think through all of the details, and I think about this and I think about that, and I'm like, oh, I don't really give a shit about that. Like, oh fuck them. I don't really care. I was so angry and so hopeless and so dark. But then I came to my kids and I was like, shit, I fought so hard to bring them into this world, and I can't abandon them like that. And so I realized suicide isn't an option for me. And so I said, Okay, if suicide isn't an option, then stop, be done, like quit fantasizing. And so when the fantasies would come up again, I would just be like, Stop, knock it off. Like, we're not doing that, that's not an option. And I survived that way for probably a good five years.

SPEAKER_03 14:56

Wow. Five years, that's a long time to honestly be in survival mode like that. Yes, and beholding and witnessing. I mean, this to me is the core of it. Like we are tasked with sitting and holding space and witnessing people in their darkest moments. Yes. And the expectation placed on us while we are being chronically underpaid and disrespected and not supported. This is what really drew me to the email that you sent me is what you're talking about here, which is that the systems that we're in deny our humanity for some of us to the point of having SI.

SPEAKER_02 15:43

Yes.

SPEAKER_03 15:43

And it's not something that therapists, and this is what I was just like so incredibly like impressed with you for, because you sent me an email just really laying this like with such vulnerability. And it's not something that as therapists we tend to talk about, which is our own mental health.

SPEAKER_01 16:02

Right.

SPEAKER_03 16:03

Because there's this facade that I think that we are that we feel like we need to put on, that somehow we have it all together. Yeah, you know, and I don't want to show weakness. I don't want to people to think I'm incompetent. Right. And yet we are in these systems that just continuously beat us down, which is where where you were in where you were working at that time and feeling trapped. Yeah. And I think giving therapists a space like to speak to this is really, really important because this is to me what this is all about. Like, if we don't take care of ourselves, we can't be martyrs to the system. Yeah, we just can't. Yes. And so I I just really wanted to acknowledge the vulnerability that you're bringing to this in naming this because it's not something that therapists openly talk about very often.

SPEAKER_00 16:59

I did not tell one single person for probably around five years. Yeah, somewhere around five years. I did not tell one single person. I didn't write about it, nothing. I kept it to myself because I didn't want to have my income that I was fighting so hard for. I didn't want it to be jeopardized by somebody telling me that I couldn't do the work that and like that was the first time that I was able to create hope and optimism for myself, is when I was able to get my independent license and start to create my own business and realize that I don't have to be trapped by public mental health and other people who start up businesses. I don't, I'm not trapped into having to be their employee. I can start my own business and be my own boss and I can create my own options for myself. And that was like the first hope that I started to have again. It was my clients who inspired me to do therapy myself. Because I everything that I did with my clients, I I therapized myself with. He said, Um, if you're not willing to do what you asked somebody else to do, you're a hypocrite. And he was just direct and blunt like that. And so I was like, Well, shit, if I want my clients to keep making appointments with me, then I need to go really do therapy myself. And so I I did. I felt I took a little bit of time to find somebody. I paid out of pocket because you know, the really good therapists don't take insurance. And so I was like, I don't care. I I need somebody good who is competent and good at what they do. And so I found I found the person who um I thought would be good. Took me about three sessions. I think it was the third session that I finally told him how dark my thoughts really were. And he helped me realize that I was absolutely scared to death of him being incompetent. And this was the moment, this was the make or break moment of is he gonna be competent or incompetent. And he was competent. Thank God. Right? I didn't end up hospitalized against my will. Um, because working in crisis, I saw people, I saw a therapist be competent and incompetent in doing crisis work. And so he was the first person I told, and he handled it well, and he did a really good job. And then from there, slowly I began to see that I could talk about it and work through it. And with time, I've opened up and talked more. When insurance, we used to be able to bill for an over an hour, and then uh two or three years ago, it was on a January 1st date, they got rid of the CPT code and we could no longer bill past 60 minutes. And it was a backdoor way to cut reimbursement rates because if we did a 90-minute session, the last 30 minutes paid more than the first 60 minutes. And wow. Yeah. And so when they did that, and I realized, I mean, that's how I was getting insurance to pay me what I deserve to get paid. But when they did that and I couldn't do that anymore, and it really cut what my income was gonna be, I was like, oh my God, like I I tried to make insurance work for like another six months, and I'm like, this is not working. This I can't do it at this pay rate. And so I had I'm like, okay, I gotta move away from accepting insurance and I gotta move towards being able to do self pay. I decided to write articles, and I don't know how to write articles except at a gut level truth. You know, like I don't I I mean, I I read other articles that are really good, really well written by other therapists, but like they don't share anything. About themselves, and I'm like, it's good material, but I don't know how to write that kind of stuff. Like, I just know how to write from my gut. And so that first article that I wrote was about my experience with depression, suicidal thoughts, and therapy. And I was publishing it in a local, we have a little local newspaper here, here in Vale, the Vale Voice comes out once a month. And so people were going to find out about it. So I just needed to like there were a select few people that I had told at that point. But at this point, essentially, I'm kind of going public with it. So people who know me, I tell them ahead of time so they don't read about it and learn about it in an article in the local newspaper. That's really where I started talking more about my own experience. And then my really good friend who was working for the crisis center that is currently in Tucson. One day she told me that her coworker had committed suicide. And I'm like, damn, like I'm not the only one. And that's what I also found when I started talking about it, also, is that I'm not the only one who has these thoughts. And I don't like I go back and forth. I'm like, man, do just like actually the majority of people have these thoughts and we just don't talk about it because it's not safe to talk about. Or are they actually like not, is it not the majority of us, but still the majority of us who do have these thoughts don't talk about it because it's dangerous to talk about. Um, because it's, I mean, it's the one thing that you can get hospitalized against your will for. There's three things you can get hospitalized against your will for. And this is one of them.

SPEAKER_03 23:51

And then on top of that, being a clinician yourself, yes, right? Like there's image management. There's, I want, I don't want people to think that I can't do the job. I I need this job. I need to, I need to maintain that people know that see that I'm competent. And you know, who wants to go to see a therapist who's struggling with her own mental health? And I mean, there's so much looped into it and in being in this work as far as the pressures put on us to kind of in a lot of ways, like forsake our own humanity in order to just like be able to like keep showing up every day.

SPEAKER_00 24:32

Yeah.

SPEAKER_03 24:33

And that's the part that really struck me in when you reached out to me is like, you know, we we sit with people, we have a really hard job. It's like you've said, it's we're not adequately paid. There's an expectation that we do a lot of work for free. Then, you know, on top of that, you look at like financial stress that people are under, especially in the economy that we're in right now. Yeah. And what's that, what that's doing to people. And then you mentioned like stuff at your home was was stressful, which all of us, I mean, I've been in situations when I was at a former workplace where my whole life was falling apart.

SPEAKER_00 25:19

Yeah.

SPEAKER_03 25:20

And I was clinical director of like a 50 clinician practice, going, okay, well, I, and I was seeing clients, and it's like, all right, just keep going. There, there was no, this work really doesn't allow the space to take care of yourself and to honor yourself because we're fee for service. Well, I mean, you were working like in a salaried position at the time too. I'm assuming it was salaried, but but there's still this pressure to continue to perform, to meet expectations, and there's this lack of I think acknowledgement that we're human beings. Yes. I mean, it just feels like a weird thing to say, but yeah, and and we are affected by the systems that we're in. Yeah. We're affected by them.

SPEAKER_00 26:13

Absolutely. I think it's most common, like I kind of hear it implied when people talk about going to a couple's therapist, and they're like, you know, well, are is the couple's therapist I'm going to divorced themselves?

SPEAKER_03 26:29

Right.

SPEAKER_00 26:30

Right? Like, oh god, do I want to go to a therapist who's like can't couldn't even keep their own marriage together? And like we're human beings and we have our own struggles. And knowing, like, in the therapy room, that it's about the client, it's not me. They're the one paying to be there. And at the same time, like, I need to show up genuinely. And for me to put on a pretense, I I just I just can't put on a pretense. So at some point I gave up putting on the pretense that I'm better than, or I got my shit together, or like, I don't know, somewhere in this process, I was like, Yeah, that mask came down, so let's not try and revive it. I'm struggling on this journey, and this is what I've discovered, and I would love to walk on this journey with you, also, and share with you everything I have learned, not just like well, both in a personal way and also on a skill level as a therapist. Like, I've I've one done my own work, and then two, I've gone to trainings and learned how to be skillful with it as a therapist, and I will use all of that to help somebody else on their journey. But I'm but I'm gonna be real and honest. Like, I I can't fake it anymore, so I I give up trying to fake it.

SPEAKER_03 27:57

That resonates. I'm I'm the same way. I yeah, I can't. I always blame menopause though, that I just can't do it anymore. I like my sorry, I'm gonna say the thing. I I yeah, and the pretending gets tired. Yes. And I just think about you. I mean, it it kind of exemplifies like the whole like name of the podcast, Therapist Unchained. Is I would someone once coined the term for me of like gold handcuffs because you were like in this position where it's like I've I'm getting paid better than I would get paid anywhere else, and I've got health insurance and all of these things. And it's like these gold handcuffs that you feel like, oh my God, what how am I gonna be able, am I gonna be able to leave? Is it even possible or am I stuck here? And should I shouldn't I just be grateful that I've got this great job, even though I'm miserable? Yeah. And then to take the chains off and dive into, all right, how do I create the life that I want where I'm not beholden to systems that are not serving me? Yes, where I have autonomy. And and I know you've spoken with me, you haven't really named this yet in the podcast, but you've we've talked about like imposter syndrome and just that sort of confidence in going out on your own. And I'm curious how you were able to move through that to kind of, I mean, it may have just gotten to a point where you were like, all right, like something's gotta give. I, I, I have like self-preservation. I have to, I have to figure this shit out. But what were you able to do to move through that fear to create something that was that was yours and that was giving you what you needed to be able to continue to do this work? Because I think a lot of people listening feel trapped in different ways.

SPEAKER_00 29:55

Yeah.

SPEAKER_03 29:56

In whatever work they're in, whether it's, you know, working in community mental health, whether it's like working with headway because they're like, I don't know how to do this myself, and I feel trapped now because I'm with all these platforms and and I have no support and I don't know what to do. And I'm like the next step feels so scary. And uh, I guess I'll just stay here because that feels safe. And I at least I know how this operates. Like, how were you able to move through all of that?

SPEAKER_00 30:23

You know, I think what it came down to is that what the situation I was in stopped feeling like it had any kind of safety to it. So I'm not safe. I don't feel safe. Nothing about my situation feels safe or good. And there's this speck of hope that like maybe this will be better. And so I was terrified and anxious. I, you know, I barely slept, I didn't sleep much, you know, working 40 hours a week and then coming home and signing contracts with insurance companies and you know, doing their web research. I remember one night, I loved the I love zombie TV shows and movies. So I don't I don't know why. But The Walking Dead was on, and I really wanted to watch the next episode, but I stopped and I was like, okay, I can either, you know, on my deathbed be like, I watched every episode of The Walking Dead, or I can say I started up my own business and really gave it gave it a shot. And so I stopped watching The Walking Dead. I I don't think I've watched another episode of The Walking Dead since then, and I said, I'm going to put my time and energy into building my own business. And I remember one insurance that I was getting paneled with, and I'd sent them a late email, and then I was up early on another morning, and she's talking to me on the phone, and I got her phone call, and she put it all together, and she's like, Time difference and this, and you were up at this, and that and she's like, Do you sleep? I'm like, and like, I'm just not gonna answer that. So I like I I was already terrified. This was absolutely terrifying. I was shaking, I was scared to death, but killing myself wasn't an option, and I didn't know any other option. So do it. Let like I like just staying in the same situation, letting people continue to harm me and hurt me, like I couldn't take it anymore. I couldn't let them keep doing that to me anymore. And so I had to find somewhere to, and it was a risk, and I was like, I don't know if I'm gonna make it or not. And you know, I guess like once I started having the first successes, you know, like I got paneled with some of the first insurance companies. And back in in 2016, like it wasn't hard. Like some of these, like you just filled out an online application that was like maybe a page long, and then you got paneled and contracted, and it was really quite easy and straightforward with most of them. And so then once I had some of those initial successes, and then I filled up so quick because I signed up for every insurance I could because I had to get out of juvenile detention. So I signed up for everything I could within less than six months. I was my my schedule was completely booked.

SPEAKER_03 33:34

Um it was a different time back then for sure.

SPEAKER_00 33:37

Yes.

SPEAKER_03 33:38

Because I started my initial my solo practice, I think, in 2014. Yeah. And I had a wait list within six months.

SPEAKER_00 33:45

Yes.

SPEAKER_03 33:45

It just isn't like that anymore. Yeah.

SPEAKER_00 33:48

It can be. You got to fix your Google profile. Okay. At the end.

SPEAKER_03 33:53

We're doing okay at the group, but I know I think with not I'm just hearing not me particularly, but yeah, uh, but I think what I'm hearing more and more is just because the algorithms are really favoring these platforms.

SPEAKER_00 34:05

No, people that that's what I keep hearing, and that's what I keep hearing, and I was believing that. And then I read it, and then I read an article that said, if you're not showing up on Google searches, these are the number one, like the top five things you can do. The number one thing is fix your Google profile because AI changed how Google searches work. So I spent like a month fixing my Google profile, and I'm getting calls again and I'm I'm booked again.

SPEAKER_03 34:33

That's great.

SPEAKER_00 34:34

Yes. So yeah, I wanted to say that.

SPEAKER_03 34:38

No, I appreciate that.

SPEAKER_00 34:39

Yeah, fix your Google, not you, but like if you're on trip.

SPEAKER_03 34:42

The world out there.

SPEAKER_00 34:43

Yeah. If you're not getting phone calls, check your Google profile. And people search for you, they may search for therapists in your area, but they may also search for you by your name. There was a Google profile under my name that I wasn't aware of.

SPEAKER_03 34:56

Well, that's where I'm lucked out. I'm the only Civy Sucreman in the whole world. So I'm like, I that I feel like is a big bonus for me to have the name that I have.

SPEAKER_00 35:06

So yeah, no. But sorry, that was a tangent, but I thought it was important.

SPEAKER_03 35:12

But you just pushed through. I mean, you were recognizing the fear, and I think it just it it it what I'm hearing is that there was just a tipping point for you where something had to give and you chose yourself.

SPEAKER_00 35:26

Yes. And um myself and my kids. And then I had successes, and I saw my schedule fill up like that once I could accept insurance. And then I got to the point where I had all these phone calls and people leaving like heartbreaking stories on my voicemail, and I couldn't, I had no room. I like I had like I I couldn't like skip my lunch break and like fit them in during lunch or like I had nothing. I had no room for anybody, and and so I saw the need. I mean, one, I've worked in crisis work, so I've I saw like when it gets to that kind of crisis need, and then I saw in my own community like how desperate people are, and that like I can't see everybody. And so then when insurances started fucking with me, I was like, what the, what that, like, what are you on, people? Like that you think that people don't want me, like you try and come at me and send me an email that says, Oh yeah, we've looked at the uh you the market in your area and it's oversaturated with therapists, or this is the pay. I'm like, are you like what are you on that you like? This is so not based in reality and on the ground of that, like people are overwhelming therapy. If you accept insurance, you are completely overwhelmed. If you don't accept in insurance, people are still willing to pay for you for your services. If you are half decent at your job as a therapist, people are willing to pay out of pocket because people are hurting out there and they want good services. And if you care about giving good services, I don't care. Like, yeah, I just got to the point where like I had enough successes. I saw how much people wanted my services. And when insurance started coming at me with their bullshit, I was like, this is bullshit that is not founded in any sense of reality at all. And then I push back. And there was one EAP that it only worked with one EAP.

SPEAKER_03 37:42

Oh God, they're the worst EAPs. I'm like, no, I I'm not gonna, I'm not gonna take 60 bucks a session for your EAP. Yeah, I'm not gonna do it.

SPEAKER_00 37:49

So they asked me, but they were desperate. And so they asked me what my reimbursement rate was. Now I know what they were asking me, they were asking me what my contracted reimbursement rate was, and I was like, oh hell no. And so I said, Well, my fee is $150 an hour, and that's non-negotiable.

SPEAKER_03 38:06

And get a girl, get a girl, right?

SPEAKER_00 38:10

So I I didn't I didn't need their referrals at that time, and they were desperately coming at me. So I'm like, this is what I charge. And if you can pay it, pay it. If not, like quit wasting my time and your time. And they're like, we'll pay it. And I'm like, really? Are you freaking it was it was one EAP. No EA, no other EAP has done it. But uh, but I was like, okay. And then I had a um Medicare Advantage program contact me that was new coming into Arizona. They were in California before and they came into Arizona and they were setting up their network and they called me. And I'm like, well, the issue is your reimbursement rate. And they're like, well, what if we can raise it? I'm like, but you can't, but you can't, you won't. Like, I don't know. I was so skeptical. And they're like, no, we will tell us what you want. And I think they looked up my website and what my fee was, and they're like, 150 bucks. I'm like, yeah. And they're like, well, let me talk to our team and let me see if we can get you that. I'm like, yeah, sure. I'll see if I hear back from you. They did. They called me back and I was like, okay, all right. Like, so when we're confident, when we know that pe that we provide good services and people want what we have, then like you cut through the bullshit. And now I mean my heart breaks because I really fought to be able to accept insurance for as long as I could. But like when I couldn't keep up with the schedule and what it would take to have as many people as I needed to pay my bills and keep up with all the notes, and I I couldn't do it. I was like, damn it, I can't keep taking insurance anymore. And that was it's it's not like from a business perspective, this is the smart business decision to make. And from a clinical therapist perspective, it was it's it's heartbreaking to know that there are people in need, and like the most vulnerable, the people in the most need can't afford me. And that's heartbreaking.

SPEAKER_03 40:06

But you didn't you didn't build the system, exactly? You didn't build, and like the through line too is that finding your voice and not martyring yourself within these systems, not sacrificing your own life for the work, it feels like that that first move that you made kind of propelled and helped you grow that sense of like self-advocacy, yeah, and um getting more comfortable using your voice as an advocate for yourself. We're really good at advocating for our clients. Yes, but your own growth in going through like you know, significant mental health struggles and suicidal ideation to breaking free of those chains, and then even through the fear finding and building on that voice to the point of like, well, take it or leave it. This is what this is what I cost. And then making the bigger choice of like, all right, I'm weighing this out, and it makes me very sad that a lot of people won't be able to utilize my services because they can't afford me. And I have to take care of myself if I want to have any sustainability or longevity in this work.

SPEAKER_00 41:31

Yeah.

SPEAKER_03 41:32

I think that's incredible. And it's an incredible story.

SPEAKER_00 41:36

Yeah, that's a a piece of this that I had reached out to you about like you talk about people being isolated. And like on one hand, like breaking out of anybody else's control was such an important thing for me. So signing up with somebody else else, signing up with one of these venture capitalist platforms, like I looked at their contracts because they, you know, you can get a higher reimbursement rate. So I I looked at it, but I looked at the contract that I had to sign, and I was like, oh hell no, I'm I'm not signing that. Like on one hand, like there is a sense of isolation. Uh, you know, like during COVID, all of that, like there definitely is a sense of isolation, but at the same time, like not being under anybody else's control is so freeing and so powerful to me. I'm I'm not willing to sacrifice that for anything. I will I will be in isolation, I will be alone, except that I'm not, because I have an amazing local biller who like they're amazing. And if I'm like dumbfounded by something, I can call them up and they can help me. I have um here in Southern Arizona, we have an email listserv that hundreds of people are on and hundreds of therapists are on it. And if you have a question or a dilemma or a need for a referral, you can send it out on this email listserv.

SPEAKER_03 43:12

So, like even though it can be isolating, like there's you can build your own infrastructure for yourself so that you don't feel isolated is kind of what I'm hearing.

SPEAKER_00 43:22

Yeah. And I mean, honestly, Civia, I've heard you talk about like the uh group practice that you're trying to, and I'm like, damn, I wish like, but like I don't know. I've like I have met really great people who I loved working, you know, that first program that I worked in that like made me fall in love with this work. Like I loved working. Uh George was the supervisor. I loved working for him. So I mean, there are people who I'm like, oh, I would work for like that, would be a great place to work. But um, but yeah, I just got to the place where I working for myself and not being under anybody else's control and being Able to do it the way I want. And then also, like, most recently, I've really decided not to accept any more new insurance clients because I was kind of doing a mix. And so then, like, I got a phone call, and somebody was clearly upset that you know they had found me on their insurance panel. And I'm like, I'm sorry, I'm not actually taking anybody new with insurance. And he was clearly upset. And like that was such a hard phone call to say that to somebody. But that was my decision. Like nobody told me I had to make that decision. And so those really hard decisions that like have to be made. Like it's really good that nobody else is telling me that like I'm telling myself. Because if it was somebody else telling me, I'd just get mad.

SPEAKER_03 44:49

Yeah. And that sense of autonomy. And yeah, like as a group practice owner, I always come back to I want to create a place that I actually want to work at, work in, you know, like, and so that's what I try to create. And I recognize that people have different reasons and different leadership styles. And I'm actually currently working on building a leadership academy for group practice owners to kind of shift some of like the exploitation that we see. Because I don't think that it's always coming from, I mean, I think that sometimes people are just greedy. And this is, I'm actually saying this because it's a little bit of a segue into one of your areas of specialty that I want to talk about, but that, you know, people can be greedy or um just not be in it for the right reasons. But I think mostly it's that we're not trained in how to run businesses, the what it means to supervise clinicians, how to even like vet what kind of clinicians you want, or how to know what kind of energy you want in your practice and how to hire and like all of this stuff, and like what the mission, vision, values of your organization is, and just all these components that I don't think that we talk enough about. And, you know, when you're talking about this kind of wanting to stay outs outside of where you've seen exploitation and just like not being treated well, it's interesting because that aligns with one of your interests of like sociopathy and what we know about people in leadership roles tend to lean more. There's a higher prevalence of folks with, you know, either sociopathy or psychopathy. They're not actual diagnoses. They're correct, right? They're um, I can't think of the word that I want, but uh they used to be in the DSM.

SPEAKER_00 46:48

They used to be diagnoses, but they Oh, did they? Yes, they were taken out and replaced with antisocial personality disorder.

SPEAKER_03 46:55

Oh, I didn't know that they were ever in there. Oh, that's interesting.

SPEAKER_00 46:58

You know, like you're making me like realize that I don't actually know for sure. I I like I'm pretty sure I read it, but I would actually have to verify for sure. But I'm I think they were in there and they were taken out, and they thought antisocial personality disorder replaced it. But the thing is, APD really focuses on criminal behavior. Um, and sociopathy and psychopathy are traits that somebody has.

SPEAKER_03 47:29

Yeah, their personality styles.

SPEAKER_00 47:31

Yeah. And yeah, in doing complex trauma, I mean, one kind of working through my own stuff, and then people I I sat down and I'm like, who is really attracted to me? Who finds me and sticks with me as far as like in my working clients? And it was adult children of emotionally unsafe parents. Um, sometimes teenagers too. I've I've had a couple teenagers, but yeah, adults who have emotionally unsafe parents. And I quite I I came up with the term emotionally unsafe parents because it hasn't been come up with before, and because I don't want to uh the the narcissistic diagnosis kind of drives me a little bit crazy. Um, because I'm like, everyone's not a freaking narcissist. And and then as I really started to realize who was attracted to me and try to lean into that um and develop that a little bit more and explore that, that is where I was like, okay, so everyone's not a narcissist, but what the hell is this? And that's where I was like, that's where I went back in time, like back to some other stuff and found some other stuff around sociopathy and psychopathy. And I'm like, that's what this is. Like, there's a meanness, there's a maliciousness to this that needs to be named and talked about.

SPEAKER_03 48:56

Um and I remember in our pre-interview, what really struck me, which I think is like the kind of thread holding this together, is how much we have normalized like sociopathic traits in systems, right? When we're looking at leadership at the corporate level, nonprofit, public health systems, that there's this normalization of these, we'll just say sociopathic behaviors, like, you know, having to like have restricted emotion, disregard for employee well-being, that martyrdom culture. Yes. And that these systems often are prioritizing, you know, efficient business models over the humanity of their clinicians or even clients sometimes. Yes.

SPEAKER_00 49:45

Yeah. Yeah. Um, like I was able to, I know there's like different definitions, and I mean the common thing that people talk about is there's no clear definition of a psychopath, but you know it when you see it. Um, and so, but like my mind needs some uh structure. So I came up with four things that I'm like, okay, if somebody has these four traits, they're either a sociopath or psychopath, depends on how intense these traits are for them. The first one is restricted emotion, which isn't a lack of people think it means a lack of intensity of emotion, which that isn't true. The theory is that psychopaths are born with three emotions anger, disgust, and jealousy. And that's it. The the most extreme version of this is that's it.

SPEAKER_03 50:38

And I also heard they have much like as far as brain goes, their limbic system development and their amygdala just doesn't their amygdala doesn't really fire much.

SPEAKER_00 50:50

Yeah, which is where fear, like fear, like yeah, so that holds no, they don't have anxiety. They do have anxiety.

SPEAKER_03 50:56

Oh, do they?

SPEAKER_00 50:57

Yes, they're actually highly anxious people usually.

SPEAKER_03 51:00

Oh, okay. That's interesting.

SPEAKER_00 51:01

Yes, it is fascinating. But yeah, so like anger, jealousy, and disgust, they can be explosive with those. But affection, love, grief, guilt, those they just don't fear, they just don't feel any of those. So it's restricted emotion. It's not a lack of intensity, it's it's a lack of how many emotions they're able to experience.

SPEAKER_03 51:25

And I just think I have to say, yeah, based on like the settings you were in and where you felt like you were being crushed, yeah, this direction that you've taken. Yeah, it is just really fascinating to me. And it it feels like part of your own evolution in honoring your experience there to be able to step back and kind of name. I don't know. I just feel like there's there is this connection there. And so I just wanted to say that because it it speaks to our own evolution as therapists and how we can bring our own experience into the work that we do and how our own humanity can show up sometimes in ways that people may not realize with the time we have left, which you were already starting to do, but I want to just kind of couch it in this as far as the work you are doing now, because I know that this is work that you're heavily engaged with, and we'll have like links to all your stuff in the show notes. But here's a little opportunity for you to shine in this area and to kind of talk about, I think you do groups for people who have have come from unsafe attachment systems, to use my my language that I would put around it, or you know, this sort of interest in sociopathy, psychopathy, or if you want to say factor one and factor two psychopathy, or there people talk about it in a lot of different ways, but yeah, how this now has informed your work.

SPEAKER_00 52:50

It's been a journey, and like many of my clients have gone on this journey with me, and I've like in it together, like like trying to discover together with them, like what is this, and then be able to like see it when it happens, to be able to see it when we come across somebody who has restricted emotion, who is self-absorbed, who is deceitful and lies, and who is malicious. If somebody has all four of those characteristics, like that is somebody to be careful of. Like they can be very hurtful. Now, Patrick Gagney wrote a book called Sociopath and Memoir.

SPEAKER_03 53:31

I've I've seen interviews with her, and I started, I started, well, I'll put read in quotation marks because I listened to it on Audible, but I started to listen to her book on Audible. She's interesting, her story is interesting.

SPEAKER_00 53:43

It is, and so she brings in a perspective of that sociopathy is a disorder that should be recognized as a disorder so people can get help for it. And so I want to leave, I want to make sure.

SPEAKER_03 53:53

Doesn't she also consider it like neurodivergence? I feel like I've heard her use that language around it as well.

SPEAKER_00 54:00

She has. And I would like to leave space around that, like there are nonviolent sociopaths who are amongst us who function very successfully, and but yet they know they struggle and they're not happy. They're highly anxious people, usually. And and I want to leave space that like to where this could be considered a disorder where they could get help for it. And there have and there are also many of us who have been very hurt by them, also. So I want to acknowledge both is that if we don't acknowledge this as a disorder and start to recognize it, we just continue to be hurt by it and gaslit that there's something wrong with me that I'm hurt, rather than that, no, this is sociopathic traits and behaviors, and somebody's coming at me. You know, these systems, like I think the most idealistic business model that I've yeah, I I've never taken a business class in my life. You know, I'm I'm a therapist, but yet I run a business. So, you know, in my in my understanding of business, like the most perfect business model is pretty freaking sociopathic, honestly.

SPEAKER_03 55:10

Well, perfect for who.

SPEAKER_00 55:11

Right. Yeah. Right? Yeah, no, that, yeah. So uh, so yeah, like figuring out how to bring the human, figuring out how to identify that this exists and this is a thing, and let people get help and treatment for it, and then let the rest of us recognize it so we can put up boundaries and say, okay, we're not going to tolerate that behavior. We're not gonna let people come at us like that and do this to us anymore. Like you can't, like insurance companies. When Pima County, Tucson decided to move from kind of a local crisis, a company, local company that provided crisis services to this big national company. And you have this big national company coming in that's really they're what they're worried about most is their profits and their bottom line. But we're talking about crisis work. I mean, yes, you have to run a viable business, but that is not the main priority of a crisis, of a crisis company, you know, company that that deals with crisis in our community. Like your bottom line, your profits should not like should not be more important than providing adequate good crisis services. And so, yeah, getting like bringing the humanity back in, starting to recognize like this is sociopathic, like being non-emotional. But a common phrase that many people in our society all over use is well, if I could just not be emotional about this and just be logical about it, well, then you would be sociopathic. Like we don't need to, we don't need our emotions to be out of control and lead us into bad behavior. We need to learn how to be skillful with our emotions.

SPEAKER_03 57:00

But also learn to listen to what's coming up because that's informative. Yes. That should be informing us. And I think that there's uh, and I hate that argument because I think logic includes recognizing the emotional responses and the impacts on people. And stripping that out doesn't make you more logical, it just makes you tone-deaf and disconnected to reality. Yes. In my opinion, that's that's me though. But I I just love how you have, it feels to me like you have taken what was a really hard experience where you were in these systems that were crushing you. Yeah. And in that despair, you found a way to to like lift yourself out of that and consistently build upon what you were learning and finding more and more of a voice and claiming your autonomy in all of these ways. And then also where one of your major niches niches is, and I know you do groups and stuff, and we'll have all the information about the work that Anna does in the show notes, but that you have used, I feel like your experiences to to create a really authentic niche for yourself that is really, it just feels really honest for you and like a real clear, natural progression. And it shows to me also the trust that you've built up in yourself to follow that and to like trust that trajectory for yourself based on all this stuff that like kind of led you there. And I think that's really why I wanted to highlight your story because you're normalizing the humanity that we bring to this work and how that informs it can inform our work. It doesn't mean that we have bad boundaries, just because we might be invested in something that relates to our own experiences in this. But like the strength that you had and the, you know, I'll say it again. The when I first got your email, I was like, it hit me so hard, Anna, that I'm like, this is what I'm doing this for. Yeah. Like the fact that you re reached out to basically a stranger, I mean, parasocial relationships are one thing, but like people know my voice. Yes. But that you were vulnerable enough to put this out there to be on a podcast to talk about it, even though I know how like nervous people can get about being on a podcast, all of this. But the the strength that you had in doing that and in telling your story and showing your humanity, and also just seeing how it's informed your work, like that feels that has to just feel like you know that you're exactly where you're supposed to be right now. That's what that's what I feel like when I hear that.

SPEAKER_00 59:50

Yes, yeah, yeah. So when insurances try and like, you know, pull their bullshit, I'm like, what are you like seriously? What the hell? Like you are you even like have you ever searched for mental health services? Yeah, no, it's uh I am right where I I am right where I want to be and a good place for me. Absolutely. Like this, I had a thought and I lost it.

SPEAKER_03 1:00:16

It's okay if people don't realize my cat has been walking in circles where I'm trying to record, and she slipped and fell on the floor off of my my dining room table. So that was that was what just happened. If you heard a crash, that was one of my cats who can't get to my lap right now and is very upset about it.

SPEAKER_00 1:00:32

But um, yeah, yeah. That was the tribe, that was the trajectory of what you were saying, is that yeah, finding myself and f oh, I know what the thought that I had is I love helping clients. Like, I love this work. And in speaking out, I realized that I would also love to bring attention to the likeliness that there are many therapists who have suicidal thoughts and never talk about them because we've seen the mental health systems, the crisis systems from the inside out, and we're like, oh hell no, I ain't never gonna, I'm never gonna say any, I'm never gonna speak up myself.

SPEAKER_03 1:01:14

Well, we know, we know how things play out, so we're gonna be less likely to want to engage because we know how the systems work.

SPEAKER_00 1:01:20

Yeah. And my friend did a quick Google search of suicide rates amongst therapists. She found one article, and it was suicide rates amongst psychologists. And it was psychologists have a higher suicide rate than the average population.

SPEAKER_03 1:01:37

Yeah, and we don't talk about it.

SPEAKER_00 1:01:39

No, no, we don't, yeah. Like we talk uh and and and we should talk about veterans' suicide rates. Yeah. Absolutely.

SPEAKER_03 1:01:47

I mean, it's it's never the trauma Olympics, right? Like who has it worse? It's it's just about this is a place specifically in this field where we're sitting with folks every day, and then we have to, we have to feel like we can't even acknowledge what's going on with us because it may impact our work, our ability to practice. Yeah. It could, it could impact our our ability to network with other colleagues. Are we gonna be judged for it? What are people gonna think? Are people gonna think I'm incompetent? All of this. And that that whole mentality is that being trapped in these systems that doesn't serve the field, it doesn't serve us. And it should also make people think about the expectations. Whether you're a group practice owner or you run a big organization, are you taking into account what these expectations that you have for clinicians working for you about their own humanity? I get it. None of us make enough money, and and I get it, but something's gotta give.

SPEAKER_00 1:02:50

Yes.

SPEAKER_03 1:02:50

I mean, something really has to give in this.

SPEAKER_00 1:02:54

Yeah. Well, I'm I mean, it is giving. Like there's people aren't able to find therapists that they can afford. And because um, I I've heard you say like it's there's not a lack of mental health providers. I agree with you on that, because yeah, if somebody can self-pay, there's tons of therapists available for anyone who can self-pay. But it's affordability because therapists can't afford to accept what insurance is reimburse, and and clients can't afford to pay what we charge. Well, not all, not all clients can afford. There's plenty of people who can't afford us, and that sucks. Yeah, so it's an it's an affordability issue.

SPEAKER_03 1:03:38

I agree, I absolutely agree. And I just want to thank you so much for putting yourself out there to talk about such a vulnerable topic and sort of expose yourself in this way, because I think that it will hopefully, I know that you're not the only one. Right. And my hope is that other clinicians listening to this, if they've been hiding their own like overwhelm or even SI depression, whatever it is, yeah, that hearing you talk about your journey through this will number one make them feel less alone or like there's like, you know, there's some outlier because I don't believe that they are. Right. And I hope that your story also empowers them that they can find a path out of whatever trap that they feel like they're in that is part of the pressure keeping them in the state that they're in. That there is, there are people out there like, take our hand, we can help you get out of that. And that there's no shame as a therapist in struggling with your own mental health. I mean, if we're being honest, most of us came to this field for a reason, folks. Yep. I mean, if we're being uh honest, yes. In fact, one someone I used to supervise said to me once, oh my gosh, because my sister's also a therapist. And this person was like, Oh my gosh, I could only imagine what your family's like if both of you ended up as therapists, which I thought was funny. I love my family, no, no judgment, but anyway, I thought that was funny. So, any like final words before we sign off for the day?

SPEAKER_00 1:05:14

Yeah, I think we hit like the major things of just talking about the humanity of this work and wanting to put that out there and hope to reach others and let them know they're not alone. And yeah.

SPEAKER_03 1:05:27

Well, thank you. Thank you so much for speaking out. I think a lot of people would shy away from doing this. And so I think you stepping forward is taking a lead in bringing this to the forefront. And I hope that it has reached people that needed to hear it, and I'm sure that it will. So thank you so much, Anna, for reaching out and for willing your willingness to be vulnerable on the podcast. I also want to thank all of my listeners. Obviously, if you are struggling yourself, please reach out to your local crisis clinic, call 988, get the support that you need. We often are really focused on our clients and we can't forget that we need to take care of ourselves. So utilize your local resources and call 988 if you need additional support. Thank you so much for listening and sharing and liking and all of those things. The support really helps this podcast get into people's podcast platforms, gets more subscribers, gets the word out on what we're doing here. So please continue to share this with colleagues in your network. Thanks for listening. Again, my name is Civy Suckerman, and this is Therapist Unchained.