Building a Therapy Practice for Black Women with Dr. Ayanna Abrams

Dr. Ayanna Abrams [00:00:00]:

Black people do take care of their health. Black people do go to therapy. Black people can do self pay or private pay. Black people will pay for therapy. They will send their children to therapy.

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Michael Fulwiler [00:00:12]:

This is Heard Business School, where we sit down with private practice owners and industry experts to learn about the business of therapy together. I'm your host, Michael Fulwiler.

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Michael Fulwiler [00:00:28]:

Serving historically underserved communities is a profound passion that shapes not just how therapists practice, but also how they run their businesses today. My guest is Doctor Ayanna Abrams, a psychologist based in Atlanta with extensive clinical and research experience working with black people across the diaspora. As the daughter of parents who emigrated from the Caribbean to the US, she spent a lifetime navigating issues of cultural difference, transition and identity. I had the opportunity to get to know doctor Abrams through a program I offered during the pandemic called consulting for therapists and have been following her work since. In our conversation, Doctor Abrams shares the lessons she learned from starting her private practice, including the challenges she faced as a black female therapist and how she overcame them. We discussed the importance of networking and building relationships, which played a key role in her business success. Doctor Abrams also talks about her involvement in the community and co founding of not so strong, a mental health platform for black women. She provides insights on the common misconceptions therapists have about private practice and shares practical advice on balancing clinical work with other professional engagements like training, consultations and presentations.

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Michael Fulwiler [00:01:42]:

Here's my conversation with Doctor Ayanna Abrams. Enjoy.

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Michael Fulwiler [00:01:48]:

Doctor Ayanna Abrams, welcome to the show.

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Dr. Ayanna Abrams [00:01:51]:

Thank you. Thank you. Thank you for having me. I am excited to chat.

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Michael Fulwiler [00:01:54]:

So glad you're here. You are actually a former student of mine, which is how we know each other.

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Dr. Ayanna Abrams [00:02:01]:

Time has flown and it has not.

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Michael Fulwiler [00:02:05]:

Yeah. So during the pandemic, I was doing a lot of marketing consulting with mental health companies, and therapists were reaching out to me, asking me how I was working as a consultant and how I was working with these mental health companies. And so I did a few one on one coaching calls with therapists that seemed to be helpful. So, you know, I figured there was an opportunity here. So I partnered with my friend Vic Dougal, who, you know, and we put together this program called consulting for therapists that you were part of. So I got to, to work with you for a few months through that program, which was really fun.

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Dr. Ayanna Abrams [00:02:46]:

Gosh, I can't believe that was, what, 202-12-0221 in the year at least three years ago. At least three years. Yeah. One thing Mike gonna do, he gonna put together an opportunity.

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Michael Fulwiler [00:02:59]:

Yeah. I wanna talk about consulting and the non clinical work that you do. But before we get into all of that, I would love to talk about your background as a therapist. Your parents, they emigrated from the Caribbean. Could you start by talking about how that has impacted your career and your journey as a therapist, particularly your education and the population that you work with in your practice?

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Dr. Ayanna Abrams [00:03:30]:

So my parents are from Guyana, which is a caribbean country, but it's in South America. I'm more landlocked than not. And they moved to the US when I was born. Nothing. I was raised in New Jersey, and it's interesting, being raised by caribbean immigrants, in some ways thrust me into the career because I found myself really interested in differences between people. Right. So I'm this caribbean household, but I was raised in this, like, Jewish Italian. Right.

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Dr. Ayanna Abrams [00:04:01]:

Kind of area of New Jersey. So it was vastly, my gosh, vastly different. I'm, like, straddling two cultures all the time. I'm this way outside. I'm this, you know, young black american girl, but I'm not, because inside we eat different foods. My parents have an accent. They have really, really different rules, and a lot of my friends have. So it's just me kind of navigating all of that.

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Dr. Ayanna Abrams [00:04:24]:

And I think that was my initial interest in differences between people because I felt different and kind of really split. And, you know, they always say that most therapists, not all therapists, are some type of wounded healer. So I'd also say that in some ways, things that were happening in my life were kind of. My family probably also thrust me into wanting to help people, but also because my parents are caribbean immigrants, they didn't believe in therapy. So it actually wasn't helpful for me to go into this particular field. They wanted me to be a doctor, but I'm essentially the wrong kind of doctor. Right. The doctor that they mean is a medical doctor.

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Dr. Ayanna Abrams [00:05:02]:

They want you to be a doctor, they want you to be lawyer, or they want you to go into the military. Those are my, like, three options per se. And I didn't want to be a medical doctor. So, like, psychology and all stuff kind of really wasn't on my mind until I took a class in high school. My senior year, I took a psychology class, and we watched. Gosh, I used to know. I used to remember. This is my, like, college application story movie with Hailey Jo Osmond and not 6th Sense.

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Michael Fulwiler [00:05:30]:

Yeah.

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Dr. Ayanna Abrams [00:05:31]:

With, like, him and Kevin Space, Kevin Spady and Helen Hunt. Gosh. But he is this little boy, and his mom is like, he's in the school, he's dating, all this kind of stuff, and just things happen in the movie, and it has this really, really sad ending. So I remember wanting to work with families and wanting to help kids, like, emotionally and help parents emotionally. So that kind of thrust me into being a. I knew I was going to be a psychology major when I went to college, and then I ended up doubling, double majoring in african american studies, which further serves who I am and kind of where I am today. But I remember that storyline kind of paired with what I knew about my family. I didn't know anything about mental health per se, but just, like, wanting to help people and really, really being interested in differences between people and, like, why people are so different and how that's affecting people, all of that kind of came together towards psychology and then taking psychology classes, you know, your 101s, all the regular, whichever kind of stuff.

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Dr. Ayanna Abrams [00:06:34]:

But I think because I paired that with being an african american studies major really sealed the deal for me in terms of, like, who I wanted to work with. I mean, it was people who looked like me. It was people who had similar experiences, but also people who looked like me, who had different experiences. And that was a lot of what I was doing in terms of my classes, in terms of my research in undergrad, in terms of, like, community work in undergrad as well. And that then set the stage for grad school. But I had support of my parents because I was advancing my education, but not because they cared about what I was doing, like, understood or, like, respected psychology. No lie. I could.

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Dr. Ayanna Abrams [00:07:21]:

You could call my dad now and ask him what I do, and he knows that I'm a psychologist, but he'll throw in a joke that I'm just getting paid to be somebody's friend. Like, he does not, like, respect psychology until somebody has a problem. And then he calls me, like, well, can you work with them? They need a psychologist. I'm just like, oh, so now I'm the one. Like, now I'm the one in the two. So it's been that kind of, kind of paradox with receiving their support. But again, their support is much more because immigrant families and, like, american education, right. Is a big thing that they strive for and they kind of come here for.

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Dr. Ayanna Abrams [00:08:03]:

But like I said, it isn't the right profession. My parents would be, my family would be much more proud if I was a surgeon or a pediatrician or something like that, so. Or some type of scientist.

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Michael Fulwiler [00:08:16]:

Right. Was private practice always the goal when you were in grad school, is that the path that you were on.

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Dr. Ayanna Abrams [00:08:25]:

So I went to undergrad at Syracuse University, and they are a. It's research, right? So a lot of what they were talking to us about and kind of training us towards was academia and teaching and, like, PhD, which is not the degree that I have. So I actually really didn't get a lot of. A lot if, like, any support towards clinical work from professors, from the minimal mentors that I had there in my psychology department, one, because they weren't clinical, and two, because of the population I was interested in. I was also at a very white university, so that was a complete wash. I had to really, like, just hone that in for myself and just, like, really kind of keep myself going with that. Until grad school, private practice didn't become a thing in my mind until internship of my degree. So, like, four years of schooling, and then we do internship, and then we do postdoc.

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Dr. Ayanna Abrams [00:09:20]:

On internship, we used to have some speakers come in and talk about what they're doing. So whether they're in a college counseling center or whether they're in private practice, whether they run an agency. So that was, like, my first, like, education around it, separate from, like, what you see on tv. It's like, oh, I know that there are therapists who are, like, in the office doing therapy, but I don't really know it in terms of the business sense of it. And then when I was on postdoc, that's the time where you're sitting for licensure, getting all your ducks in a row to kind of move on to your next position. And I was in college, mental health. That was kind of all I knew for the last few years. And I had applied to positions at different university counseling centers, and either they weren't hiring.

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Dr. Ayanna Abrams [00:10:06]:

There's a whole bunch of other drama. I revoked an application from one because there was just drama, and I was just like, and my current site wasn't hiring for staff. So I remember about two month and a half, maybe two months before my postdoc ended in 2012. My supervisor was just like, you need to prepare to be open for business. And I said, who's business? Whatever are you? What do you mean business? That was the first time I liked business. And she was just like, well, you know, you're coming up on the end of postdoc. You're not doing another year of postdoc. I think you need to consider private practice.

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Dr. Ayanna Abrams [00:10:42]:

And I was like, I don't even. I see it again. She was in private practice. Few of the staff where I was training had, like, part time private practices, but not anything that we had any kind of training in. We had somebody come in and talk about being in private practice, but that wasn't teaching us how to be in private practice.

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Michael Fulwiler [00:11:00]:

Yeah. There's no business classes in your program?

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Dr. Ayanna Abrams [00:11:04]:

Not at all. We were trained to work for agencies. We were trained to be in academia. We were trained to do research. And she. So that was more than. That was then what we focused on for the next, like, six weeks and kind of wrapping up my training was, she's like, you need to find office space, you need to figure out some fees, and you need to start meeting with different colleagues who are out around Atlanta to start getting referrals. So that's what I spent.

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Dr. Ayanna Abrams [00:11:29]:

The latter part of my postdoc that last month was reaching out to clinicians who we like tend to refer to already. So I knew their names. Clinicians who we tend to refer to already to just try to see them for coffee. I wasn't paying for it yet. They were nice enough to pay for some of my coffee.

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Michael Fulwiler [00:11:45]:

You didn't have a job? Yeah.

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Dr. Ayanna Abrams [00:11:47]:

Yes. It turned into me offering coffee, but I couldn't do that at first. And the picking your brain kind of stuff about, hey, you're connected with Emory. You trained at Emory. I'm coming out really soon. Like, please teach me how. And they were very, very welcoming, very generous. And the day after postdoc ended, I was open for business.

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Dr. Ayanna Abrams [00:12:09]:

And that was it. I wasn't open for good business or big business. I was open for business and trial by fire. I am still open. Twelve years later, you're still here. Yeah. Wouldn't recommend doing it that way, but I am still here. Yeah.

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Michael Fulwiler [00:12:28]:

Well, it sounds like it was out of necessity. We've talked to therapists on the show who they build up a part time practice on the side, and once it gets to a certain point, they're able to go full time. But for you, it sounds like it just is what you needed to do, because it was the only option. You mentioned you went out and got an office space, which now you probably wouldn't need to do. Right. Because you can operate virtually, met with referral sources and networked. You mentioned, like, figuring out your fees, how did you navigate how much to charge and how to collect money and how to manage your finances?

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Dr. Ayanna Abrams [00:13:05]:

You are taking all the way back, if at all. Right. So what was really helpful? So one of the people who I met with was a former postdoc at Emory who had come to talk to us about private practice, and she had office space right across from Emory's upperclassmen housing. So very convenient. I was very familiar with the area because that's all I knew of Atlanta, was Emory surroundings. And I remember reaching out to her, and she said that I was just kind of talking about where I was, where I was at, and kind of what was going on. And she was just like, I have office space. And she was like, and because I do want to help you out, it's a whirlwind kind of that kind of time period.

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Dr. Ayanna Abrams [00:13:44]:

She said that you can rent office space in between. So I think someone else had the office, but I would be in there when they weren't because I didn't have a big caseload. She's like, you can rent office space, and I'll charge you $15 an hour, and I will only charge you 15 if your client shows up. So you have no show or cancellation. Don't worry about charging me. And, like, that was unheard of because all the other places that I started looking for office space would say, you got to block out this time. You got to do 3 hours at a time. It's, you know, 60 /hour like, you would.

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Dr. Ayanna Abrams [00:14:15]:

You would be losing money. Until I, like, made clients, and I never lost money in this arrangement, and that was the point. So when I left postdoc, I think two clients, I think I had three clients who came with me. They couldn't come at the same frequency that I was seeing them at the counseling center. So I think two of them were, they were coming, like, by week, every other week or something like that. And I made up a fee. And the math that I was doing with my mind was like. And so the suite that I was in was next to this.

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Dr. Ayanna Abrams [00:14:47]:

She owned us. She owned a suite of offices. So there was five therapists in there who were just paying her rent. So I remember looking at the math and saying, well, I can't charge what she charges because she has been doing this for longer. She's better than me. She is. She's. And I wasn't licensed either.

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Dr. Ayanna Abrams [00:15:07]:

So depending on the state, you can do that. This state, I was allowed to do that. And she also said that she would be my supervisor. So I had taken two of my exams. So in Georgia, you have to take the HRP, jurisprudence, and then the oral exams. A lot of other states don't have the three parts. Georgia's ridiculous. I had taken the E.

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Dr. Ayanna Abrams [00:15:27]:

P. And my jurisprudence, but I was scheduled to take my oral in, like, September, and this was Auguste. So she's like, I'll supervise you. I'll sign off on your notes for whoever you see. And, yeah, so I knew that my fee was going to be less than her fee. And I was also. My therapist was a psychologist, so I was like, it's got to be less than Hershey because she's better than me, because she can't help me that she's better than me. And then I was like, but it's got to be, you know, like, I think my.

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Dr. Ayanna Abrams [00:15:51]:

My postdoc supervisor had said something like, well, you're going to be a psychologist, so it shouldn't be less than, like, 115 or, like, something like that. So I think I started at maybe 115 or 120. Yeah. Just very market research in the area. And I'm just like, hold on, I'm looking at three people's websites, and we're just going from there. And then when I got licensed, when I passed my oral exam and got license, I think I randomly, like, bumped my fee up by, like, $20. Like, I'm licensed now. 20 more dollars.

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Michael Fulwiler [00:16:26]:

Give yourself a raise.

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Dr. Ayanna Abrams [00:16:27]:

Yeah. And that was it. So I brought two clients over from the counseling center. And because I'd done my training at Emory, they also knew who I liked to work with. I was typically working with black students, black women, graduate students. So I started just getting a lot of referrals for black students who had either used up their sessions or just needed a longer term referral. So if they could pay, which is usually their parents, I was starting to, like, trickle in those referrals, and I also had three contracting jobs while I was building. So once I left Emory's formal postdoc position, I started contracting there for a few hours, maybe like, I think like 10 hours a week.

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Dr. Ayanna Abrams [00:17:14]:

So I was contracting at the student counseling center. I was contracting at Emory's EAP, and I was contracting at another universities counseling center just to kind of put money together until I could build my caseload.

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Michael Fulwiler [00:17:29]:

So this was before the day of online mental health platforms. Right? Like these EAP companies you can contract with. So you were doing that?

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Dr. Ayanna Abrams [00:17:37]:

I was doing that in real life, yeah. Emory was a different kind of site because their EAP is on site, so. And I had done part of my postdoc training there. So they also knew what kind of clients I like to work with, and I would see couples and stuff there, so they always needed referral sources in the area and surrounding. Emory has a lot of clinicians and physicians because it's a big university, but not a lot of black women and not a lot of black women psychologists. One of them I was seeing, and then there were maybe four or five other black women psychologists who were part of, like, the regular, like, Emory referral. So I knew that there was also a scarcity for black women psychologists, and, like, Emory was really, really needing more black women therapists, too. Refer to.

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Michael Fulwiler [00:18:23]:

Yeah, it sounds like you were fulfilling a need of a community.

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Dr. Ayanna Abrams [00:18:27]:

Mm hmm. Yeah. And I do remember at that time what was really interesting. So oftentimes when you're in an intern or a postdoc, you're in a cohort. And both years in my cohorts, I'm the only single trainee, and I'm the only black woman trainee. So I remember this very different experience in my cohort because a few of them were starting up practices, but they had husbands who had insurance, so they were just like, I can, like, build this up and, like, take my time because I'm taking care of it. I'm just like, I don't have that option. I need to have three jobs plus figuring this out.

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Dr. Ayanna Abrams [00:19:06]:

I can't do this slowly. I can't, you know, play around too much with numbers. I essentially kind of have a sliding scale, but I can't do sliding scale stuff. Like, I need to. To make money. I probably was also taking out. I think I was still, like, deferred on my loans. I probably had some cash, but, like, I need to do this in a different way.

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Dr. Ayanna Abrams [00:19:26]:

So I remember even talking to one of my peers in my cohort about just how different this experience was, and I was just like, I'm. This is like, it was trial by fire for all of us, but in a way, that felt much more, like, urgent and dire for me because they had backing in a way that I didn't have anybody else to talk to about. That's not my therapist. I didn't have anybody else to really talk about that experience with, because we are in totally different tax brackets. Scopes. All that kind of stuff figures out. Like, I felt like I was figuring this out by myself. And they had.

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Dr. Ayanna Abrams [00:20:02]:

Yeah, they had some. They had privileges, and they had. They had some padding that I didn't have.

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Michael Fulwiler [00:20:10]:

Yeah. Were you taking insurance at this time?

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Dr. Ayanna Abrams [00:20:14]:

I didn't. So when you can't take insurance if you're licensed. Yeah. And then I. Once I realized that I am doing this, I was like, I'm not gonna take insurance. I. I don't even know why. I just didn't wanna.

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Dr. Ayanna Abrams [00:20:27]:

I was actually. I do it. I was very anxious about the application. That Caqh stuff was a beast. Like, I remember looking at it one time, and I was just like, nope, can't do it. Like, can't. So it wasn't even about me understanding that insurance really takes a lot of my money. I just.

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Dr. Ayanna Abrams [00:20:45]:

The application process was just really, really overwhelming while I was just trying to find clients. But I did end up applying to be on an insurance panel the next year, and then it took about four months. It took until, like, the next year's summer to be accepted to the panel. And I chose that panel very specifically because that was the main insurance of Emory University, and they were my main clientele. So that's the only insurance that I ever took. The whole time I took insurance up until last year, and that was very, very strategic for me. I knew that once I got on this insurance, Emory's gonna flood me with referrals, and then I'd be good, so. And it worked exactly like that.

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Dr. Ayanna Abrams [00:21:27]:

Once I sent out that email that I'm on, that I was taking this insurance panel, I got referrals all of. All the time. All the time.

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Michael Fulwiler [00:21:35]:

When you look back, especially in the beginning, the first year or two, are there things that you would have done differently now or mistakes that you made?

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Dr. Ayanna Abrams [00:21:45]:

Absolutely, I would. And I'm still this way. I am very avoidant of numbers and tax stuff and money stuff. Like, I would have talked to my therapist about this business avoidance stuff, and I would have confronted a lot of my money stuff sooner. But I don't even know if I had the bandwidth for. I just needed the money. I was just like, I'm gonna put these jobs together. I just need money in my account.

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Dr. Ayanna Abrams [00:22:15]:

But I would have at least reached out for assistance around that earlier. So either by getting an accountant or even by talking to colleagues about money, I wasn't doing either.

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Michael Fulwiler [00:22:24]:

So when you say avoidance, what did. What did that look like?

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Dr. Ayanna Abrams [00:22:27]:

I was making money, but I didn't. I wasn't even established as a business until after I took insurance, like the LLC, doing all that kind of stuff. I had no clue about that. Having a business license, I knew none of those things. And for me, getting an accountant was this whole new process, because I was just used to having a w two, sending it to my parents, and having our family tax guy do my taxes. Like, me having to, like, get a receipt. I didn't have a business card, like, some meat. This whole, like, collecting your receipts, tracking your money.

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Dr. Ayanna Abrams [00:23:00]:

I didn't have a separate account to put it in. Everything was flowing into my personal account. Those kinds of things, I would have like I said, either sought more support from my colleagues who were figuring those things out, who were, like, right in the same. They were starting their practices around then, or I would have asked a colleague about accounting stuff for this and, like, figured out, like, what they were doing or who they were using or asking for some kind of help. But I got really silent about money. I was just making it, and it didn't feel like I was making it because I didn't have it still. I just made it, and it went right back out. I would have gotten some organization around that a year sooner than I did.

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Dr. Ayanna Abrams [00:23:43]:

I eventually got an accountant because I asked an older colleague who she uses, and she gave me this person's name, and then I just started working. He messed up all my shit up, but at least I work with him. If I have an accountant, I can't go to jail. He would go to jail. And that was my main thing at that point, was just, like, I can tell the feds that I have an accountant. I am out of this. So I just needed some type of backing that said, it's not me messing up my numbers.

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Michael Fulwiler [00:24:16]:

They signed the tax return. Right. So, listen, that's their license on the line.

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Dr. Ayanna Abrams [00:24:21]:

Yeah, that's. That's him. And I eventually got a new one years later. But again, I didn't know he was messing stuff up because I don't know anything about tax. I had no. When I say no financial literacy, I had no financial literacy. I mean, my family tax guy didn't educate me on stuff. It was just get your w two s to him, and he does whatever he does.

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Dr. Ayanna Abrams [00:24:43]:

So, yes, I would have done that stuff sooner. The money stuff is the main thing I would have done sooner. Like I said, internally confronting my own story and relationship with money and making money. I'm the only entrepreneur in my family. My family couldn't help me. I didn't ask them, but I also didn't ask them because they don't understand this. They have no clue about taking money directly and, like, any of those kinds of conversations. So the only people I would have had to go to would be colleagues.

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Dr. Ayanna Abrams [00:25:13]:

And I think I felt too embarrassed or, like, shameful around them, knowing that I don't have this figured out. So, yeah, I was just in the dark for a long time around that.

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Michael Fulwiler [00:25:24]:

Yeah. What about when you look back, things that you did do well? Are there certain keys to success that you feel, like set you up to have a, you know, successful practice?

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Dr. Ayanna Abrams [00:25:38]:

And I think that's something that I. That I did. Well, then that I took for granted that I think I do well now that some parts of me still take it for granted. But my, I'm extroverted. I have really good relationships with people. And that became the foundation of my business. And that was also there in grad school. It was there on postdoc and on internship and postdoc.

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Dr. Ayanna Abrams [00:26:04]:

While I liked doing therapy, I also wanted to have liaisons with different campus offices. Right. So I'm seeing students in other realms. I'm offering support. That's not therapy support, but it's, like, therapeutic. Because I am in the multicultural office having groups with students, talking about things related to black culture and dating or black culture and depression. I'm always in and out of the office space. So I think I built a number of relationships.

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Dr. Ayanna Abrams [00:26:31]:

It wasn't hard for me to email somebody and ask them to go to coffee. It wasn't hard for me to ask questions about these things, depending on the colleague. So I think that that really helped me because people knew I was in business and people knew who I liked to work with. I was. I was, as I probably am now, pretty loud about who I serve and why I serve them. And that being abundantly clear. I think the other piece is that because so many of my colleagues in the clinician area are white, they couldn't wait to have somebody black to refer to, because the other three black psychologists who were women were booked, filled up. So there was always this, like, oh, gosh, if a black student comes in and said they want to work with somebody black, who are we going to refer them to? So me being loud enough about that, I think was remarkably helpful.

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Dr. Ayanna Abrams [00:27:24]:

And that was something that I wasn't loud about in undergrad and I wasn't loud about in graduate school until the end, because the messaging was that you can't say that you can't just work with black people. Like, why? And or why do you want to work with black people? I remember somebody saying to me, yeah, you might want to work with black people. You're going to be poor. You're not going to make any money if you're just only going to have black clients. And there was a earlier in my career, I believe them, the stigma, even the stigma around kind of black people and money and, like, willingness to pay. And yes, that stuff is still exists in different ways, but I learned very quickly that I'm in Atlanta, and listen, if it's a place that black folks got some fun, it's Atlanta. So I was fine, like, and I really had to remind myself and kind of get evidence of, like, black people do take care of their health. Black people do go to therapy.

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Dr. Ayanna Abrams [00:28:24]:

Black people can do self pay or private pay. Black people will pay for therapy. They will send their children to therapy. They will go to couple counseling. Like, these are. There are all these myths that I was kind of butting up against that. Like I said, I did internalize and believe for a while, but had to keep just putting it out there. And I would get referrals, and they would come and they would stay, and they would come back, and they would come back, and they would come back.

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Dr. Ayanna Abrams [00:28:47]:

And then I started having more black clinician colleagues, and it was just like, oh, this is happening. Like, your practice is 60% black client, like, all this kind of stuff. So I really just needed to, like, externalize, like, all the things that I'd begun believing about black people and healthcare seeking. And that was also kind of a turning point for my practice, where, again, I was also. I was becoming more loud about black people and therapy and that marketed or branded, I sometimes don't know the difference, where more people reached out to me specifically. You bought me this, where black people were reaching out to me specifically because they wanted a black therapist. And then that just, again, I'm in Atlanta and it took off.

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Michael Fulwiler [00:29:31]:

Right. Does that shortage of black therapists still exist, or has that changed?

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Dr. Ayanna Abrams [00:29:37]:

It exists. There are more black therapists. There's still, you know, there's more black therapists, understandably, even at a master's level, than there are at the. At the doctoral level. So there are more black psychologists here now than I remember from ten years ago, ones who were here that I just didn't know about because they just be in a bubble, and then other ones who are training at Emory or kind of doing whichever it is. So there are more. But all those barriers in terms of education and finances and, you know, being able to take these kinds of risks to start up a practice still still exists, which is why I do some, you know, mentoring or some coaching for, like, emerging clinicians, because I didn't really have, early on, I didn't have so many black who I was talking to about this and about working with black people, how to market in certain ways to black people. So, yeah, so, yeah, so Atlanta.

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Dr. Ayanna Abrams [00:30:29]:

And Atlanta has also grown. So I would say that the numbers are higher, but the need is also higher in a lot of ways. So I think the gap still kind of feels the same, where there's still not enough of us to meet the.

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Michael Fulwiler [00:30:43]:

Population needs, the statistics that I've seen, and I don't know how up to date they are, but 4% of psychologists are black and 2% of psychiatrists. So still very much a small number.

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Dr. Ayanna Abrams [00:30:58]:

Still very much a problem. Very much a problem, yep.

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Michael Fulwiler [00:31:04]:

Was there anything that surprised you as a business owner going into private practice that you weren't expecting?

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Dr. Ayanna Abrams [00:31:12]:

A few things, I think personal things. Like, I was. I was surprised that the transition into a business owner, even though I know it intellectually, like, wouldn't be easy, I was surprised that it was pretty hard for me. I only kind of still rings true. I like doing therapy. I don't like none of this other stuff. And I thought that once I kind of got more of a savvy forward, I'd find some parts of, like, running a business that I like. Haven't found it.

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Dr. Ayanna Abrams [00:31:40]:

Don't like it. I would like. Yeah, don't like it.

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Michael Fulwiler [00:31:44]:

So you like, you like working in the business, but on the business you're not as interested in?

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Dr. Ayanna Abrams [00:31:50]:

I like therapy. I like therapeutic stuff. I like running my mouth on social media about mental health therapy and pop culture and all that kind of stuff. But managing, sure. Managing things or growing into, like, a.

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Michael Fulwiler [00:32:05]:

Private practice and hiring other therapists, is that I not something that you're interested in?

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Dr. Ayanna Abrams [00:32:10]:

Oh, I'm interested. I am terrified. Oh, I am always interested. I have had ideas for at least six or seven years about hiring other therapists and kind of building out this, like, wellness thing, but you ain't gonna see me do it because I am terrified and I'm busy. I'm seeing too many clients. So, no, always on my mind, but it's the same, the similar kind of, like, that's so much to think about and do and be responsible for and manage and keep track of. And when that gets really big, I go back to my default, which is what I know, and I do therapy, and I, if I get really anxious about trying to scale my business, I'm probably going to pick up another client. That's literally how it happens.

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Dr. Ayanna Abrams [00:32:53]:

That's literally how it happens. So, yeah, so I think about scaling and all those kinds of things. These are things that I was not thinking about early on. Early on was just about getting this stuff established enough, getting some regular clientele in there. And once I, once I started taking insurance, my practice was full in about a month. So then the surprise became about like, oh, I have a lot of people to manage and, like, things are happening here. I've got regular clients, I've got weekly, I've got people who are coming in I think it was weekly, and every two weeks was my. My cadence for all my clients.

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Dr. Ayanna Abrams [00:33:29]:

And I remember being really surprised by tiring. It was. It was just like, oh, I'm holding a lot of space for a lot of people. I, like most of my clients. All my clients are, oh, I'm doing good work in here, but I'm exhausted. I'm exhausted. So, like, I finally got. I remember getting to this point where, like, I finally gotten to the part of life where, like, I can do the happy hours.

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Dr. Ayanna Abrams [00:33:51]:

I can do all the things that my peers that I grew up with have been doing since they were 21 or, like, 22, and now I'm 26 or 27. I remember talking to my therapist about what felt like this, like, social developmental delay. I'm just like, oh, other people are, like, doing this, like, dating, like, all these things, and I'm just like, yeah, going out for a drink, like, all this stuff. Like, those are not things that were part of me as a grad student. They weren't on internship. I was exhausted. So I remember kind of coming into this whole new, like, oh, I'm, like, a 20 something person. Like, in Atlanta, I've got the career, but the rest of my life is not flushed out at all.

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Dr. Ayanna Abrams [00:34:37]:

My nucleus was Emory. I'd had some friends from undergrad who lived here, so we would, like, do some things, but I didn't really have a crew. I didn't have a clique. Like, it was just me going to work. And then I'd see my Syracuse friends, like, every now and then, but I wasn't, like, building. Building a, like, social community. And I just thought that those things would happen once I made it into the career. Like, I'm a professional now, and I had to do some.

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Dr. Ayanna Abrams [00:35:04]:

Some work to do, and that actually didn't really happen. I didn't really establish a social life and, like, circle until 2014 until, like, yeah, a few years later, feeling stabilized enough in the business to be like, okay, now I can, like, play a little bit more. And, like I said, just kind of feeling stabilized enough to do other stuff. I didn't. And I'm still shocked about just how much entrepreneurship takes from you. It is. It is relentless. It's not a.

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Dr. Ayanna Abrams [00:35:32]:

You know, they say, like, you got your nine to five and your five to nine. Like, it's just. I'm always working, and if I'm not working, I'm thinking about working. Like, this is just. I have not had a. My mind really doesn't have a break since 2012. Like, it's just there's always something that needs to be done, and I wish I would have mastered the small stuff earlier. When I say small stuff, I mean time task management around, like, hey, you have a session.

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Dr. Ayanna Abrams [00:36:00]:

Do your damn notes. Like, just, like, system things that I just never got onto early. You make this much, you know, money, or, like, every week or every month, you put this aside for taxes. Like, those kinds of things that are. That should be just very, very routine. You can just get yourself into a habit. I did not do those things early enough. So it was a.

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Dr. Ayanna Abrams [00:36:23]:

It's a. It was a big deal to, like, really bring those into a, like, structure. Five years into business, and I wish I would have, like I said, I wish I would have just mastered the small stuff sooner. Get your paperwork together and the logo and all this kind of stuff doesn't matter. But I ended up having, using a business consultant, and she was just like, you're gonna name your practice in two weeks because you're taking too long. You need to, like, like those things. Just like. And it doesn't matter.

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Dr. Ayanna Abrams [00:36:51]:

It matters what your practice name is, but it don't matter what your practice name is. Get a name. Get it going, figure it out later. Like, it's those kinds of things I would get really, really stuck in. I remember wanting to, like, make my practice name, like, the initials of my nieces, and I was doing all this. I cannot, like, looking back, I'm like, girl, girl, get it done. Like, just get it done. I was trying to make it this, like, business.

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Dr. Ayanna Abrams [00:37:22]:

And those are the things that, like I said, for some people, it does matter. For me, it actually doesn't matter. It's ascension. Behavioral health. Ascension don't mean nothing, but ascension. Like, yeah, nothing special or deep or honorable about my name. She gave me two weeks, and I said, okay. I put in a name generator, and here we are.

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Michael Fulwiler [00:37:45]:

So isn't there a concept in psychology that we, like, spend the time that's allotted to a given task, remember what the theory is called?

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Dr. Ayanna Abrams [00:37:54]:

But it's a p. It's a thing. Yeah, I forgot. It's not Pythagoras. Yes, yes, but exactly. You'll take the time that you have to do it stretching out for the full time. Yep. Right.

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Dr. Ayanna Abrams [00:38:07]:

That was me.

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Michael Fulwiler [00:38:08]:

Have you been able to find that community that you were missing early on of other professionals and therapists?

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Dr. Ayanna Abrams [00:38:17]:

Absolutely. I probably do more community than I do my damn job, but. Absolutely found them. I think this is where my. I take for granted my, I think, natural social skill. It's not difficult for me to go places by myself, to walk into an event and not know anybody and either just stay to myself or meet people to send an email saying, hey, saw you here. To send somebody a DM and make a friend there. So I actively, like, built my social community, like, non work related, and actively built my clinical community by just.

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Dr. Ayanna Abrams [00:38:56]:

I was going out and meeting clinicians every week or weekend for a while. This is like months, if not years. And some, like, repeating, like, now, like, building friendships and relationships with people. But I, like two of my closest colleagues, I think I went to an open house, and she. She's a psychiatrist, a forensic psychiatrist, and she can't. She or her office was in the same building. She came upstairs. She was just like, oh, black people.

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Dr. Ayanna Abrams [00:39:21]:

I was like, oh, we're friends. And she's been one of my closest colleagues. She's taught me so much about business. She's this amazing forensic psychiatrist. It's like, it's just. It's that easy for me. And a lot of my business, my clients, and how my business has grown is also because of my connections outside of mental health. So I go to community events, I go to different shows, I go to movie screenings.

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Dr. Ayanna Abrams [00:39:46]:

I am in Atlanta. And you just talk to people, and they get to know what you do, who you are. They start following you on social media. I end up getting these, like, random referral such and such from such and such. Mention that you're a therapist. I am. And then that turns into a client. So I would say that it really fed my.

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Dr. Ayanna Abrams [00:40:04]:

The clinical side of my business, but also fed me just socially and emotionally just to connect with different people. A few years into my practice, I started hosting meetups for black women therapists in Atlanta. So we'd have, you know, 30 to 50 therapists come out to these events, and we just, again, light bites and kind of light snacks. We would just talk and just get to know each other. You do this. You do this. Oh, you didn't know that you trained there the year after they did. And just making all these different kinds of connections.

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Dr. Ayanna Abrams [00:40:37]:

And I did maybe eight or ten of those kinds of events. So I was seeing people over and over again, lots of referral sharing. So that's usually how I got to know a lot of different therapists, and that's how you. I didn't do it for referrals, but that is how you get referrals. And people. People are more likely to refer to you when they have a relationship with you. I'll be in these Facebook groups, and I see a whole bunch of names all the time, but, like, I don't know you, so I'm less likely to refer to you. But the minute that we've gone to coffee or gone and done something together, you're at the top of my referral list.

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Dr. Ayanna Abrams [00:41:12]:

And because I was full, my practice got full, and it stayed full for years and years and years. I was referring, I'd probably get ten to 15 therapy requests, like a week from psychology today or just kind of in the community. And I would refer to my friends, I'd refer to people who I've met before and who I've met and liked before, and they would just be at the top of my list. And I'm saying, I'm getting 1010 options a week, and I'm just sending them all out. So that is how I've always operated and that's always worked for my business, but it was really rooted in relationships with people.

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Michael Fulwiler [00:41:51]:

We have a mutual friend in doctor joy of therapy for black girl. Shout out to doctor Joy. Yes, if you're listening. How did the two of you meet?

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Dr. Ayanna Abrams [00:42:03]:

I ran up in her emails. So I had heard about joy for years because she was one of the black women psychologists who was in the area. I knew that she had some connection to Emory. And then I heard that I was like, there's a practice in Decatur called therapy for black girls. Hold up, hold up. And I remember hearing about it for a little while here, but I remember asking my therapist about it, like, do you know her? Like, have you heard, who is this person? And the podcast hadn't started. I think she was full. I think she was fully clinical, and maybe she was.

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Dr. Ayanna Abrams [00:42:40]:

She was over at a university, a counseling center. But I sent her email saying that I've heard of you. I know you're in the area. I can't believe, like, you're, like, located right there. We haven't met in some way. Do you want to go out to eat? We had the same favorite place right over there by Emory, and we went to eat. I don't even know what year that was, but yeah. And that was that.

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Dr. Ayanna Abrams [00:43:03]:

A few, maybe a few months after that, it was the first time I had done an episode on her podcast, and I. And then we've been cool ever since. A few years ago now we have a group chat, and I've been on the podcast several times. Like, we do a lot of different events together, and that's what I'm talking about. I am not as worried about, like, appearing, like, creepy by, like, sliding.

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Michael Fulwiler [00:43:24]:

You have to shoot your shot, right?

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Dr. Ayanna Abrams [00:43:25]:

Yeah, minimal problem doing that. And I wasn't doing that to get on her podcast. I wasn't doing that to get on anything kind of after that. I was doing that because I'm just like, we are similar. We obviously kind of hold the same racial identity and gender identity, but, like, we work with the same clients. Like, what's going on in this community? Like, teach me something. You've been here longer than me, and that's how it started. It started with me looking for relationships and peer relationships and friendships.

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Dr. Ayanna Abrams [00:43:58]:

And then I do happen to have a number of colleagues or friends who are just doing, like, big shit. So then it just ends up then working out in these other ways, but I'm connected to them because I like them.

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Michael Fulwiler [00:44:11]:

Right? Yeah. I think the point you're making is super important, that, you know, building a referral network, it's all about relationships. And if you're coming in with intentions of, hey, like, I need clients, or, here's who you can refer to me, or do you have any clients? Or, like, it's going to turn people off. But, yeah, you did. If you go in with the intent just to establish a relationship, that's a great outcome. Right? Maybe you'll do an event together down the road or some other business engagement. But it all starts with. With relationships.

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Dr. Ayanna Abrams [00:44:46]:

Yeah. We literally went and had barbecue together. Like, that was the first friendship date. And then, like.

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Michael Fulwiler [00:44:53]:

And that was date other therapists, is what I'm hearing. You say, yeah.

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Dr. Ayanna Abrams [00:44:57]:

You say, what?

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Michael Fulwiler [00:44:57]:

Date other therapists. That's what I'm hearing.

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Dr. Ayanna Abrams [00:44:59]:

Yes, yes, they. Absolutely. I am a firm, firm, firm believer, and I still do that. If a colleague just reached out to me yesterday saying, like, hey, we had lunch a while ago. Let's do it again. Let's do it. Let's do it. All right.

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Dr. Ayanna Abrams [00:45:15]:

Works for me.

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Michael Fulwiler [00:45:16]:

I want to talk about your non clinical work. So, in the beginning of this conversation, we talked about consulting. I know you also do trainings and speaking. Could you talk about that side of your business and, like, how you're thinking about it and how to balance it with the clinical work that you're doing?

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Dr. Ayanna Abrams [00:45:35]:

Yeah, I even. I came into that in the same way, like, by way of just relationships. Like, me just running my mouth so much about therapy or mental health or, like, black community, people started asking me to come and talk to their small group or their event, or, like, can you come to my church and, like, talk about this on Sunday? And it was just like, sure. I mean, I wouldn't charge nobody then I would do that differently. Child I would. Child I would. I've done too many free things. Hence, we were talking about that in our group.

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Dr. Ayanna Abrams [00:46:05]:

So that's how it started. It would just be me talking about how important mental health and black community and relationships and functioning all kind of stuff is. And people picked up on ways in which they could bring this back to whatever it was they were doing. Like I said, it would be churches. It would be different organizations. I remember somebody inviting me to come and talk at a family reunion about stuff. Like, it's just people want this kind of information, and they don't have a lot of resources, or maybe they don't trust a lot of different resources to come and talk. So I was fine doing things like that.

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Dr. Ayanna Abrams [00:46:36]:

And I would fill in my schedule just a little bit. It'll be a Saturday afternoon. It'd be a Wednesday night or something like that. And I didn't think about it in terms of, like, a. In a. As, like, a business arm until a few years in the, when, like, bigger organizations would stay stuff, and then they would say, this is our, you know, honorarium or, like, this is our speaker feed. I was just like, I could. There's money in this.

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Dr. Ayanna Abrams [00:47:05]:

Like, oh, I could charge for this. And I talked to other people. I was like, you should be charging for that. Like, I would do trainings, and they would be free. I do trainings over at Emory and kind of stuff, and I wasn't even thinking about charging them because I really just wanted to be a resource specifically as it related to black mental health in, like, white spaces that were just, like, desperate and, like, harming people. So I'm just like, if money's gonna get in the way, I don't even want to think about it, but, like, please stop saying this kind of stuff in session. So it wasn't until, I think, right before we had started meeting a few years ago, and I was doing some stuff, and I'd get some money, you know, here and there, but I didn't have a fee. I didn't have a rate.

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Dr. Ayanna Abrams [00:47:45]:

I didn't have any of that stuff from me. If they wanted to pay me, they would pay me. If they didn't, I'd probably say yes anyway. So I'd be doing podcast episodes. I'd be doing different local events. I think by that time, I started using social media a little bit more. I was talking about some things, and then 2019, I was doing more stuff with a specific organization that was bigger. So they were paying me for different talks and some.

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Dr. Ayanna Abrams [00:48:11]:

And not paying me for other talks, but liked being able to, you know, speak to companies like Sony and Def Jam or talk about this or talk about this. So I didn't, I didn't need pay per se. And then it wasn't until 2020, when there was this other boom around racism based trauma, that it was just like, oh, companies are gonna pay. Wait, wait a minute. The folks who got the money are gonna pay. And having to really actually make a lot of decisions about making money, having those kinds of conversations, doing those kinds of trainings in spaces when it was also performative. And it's like, oh, it's these one offs. And so, you know, 2020 was a huge boom for my business, and I'd gone virtual.

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Dr. Ayanna Abrams [00:48:59]:

I closed my physical office space. But 2020, my business did really well. In 2021, my business did really well, unfortunately, because people were so unwell. And what I always say is that I will never be out of a job, fortunately. And unfortunately, my job stability is sealed. A therapist job stability is. Is sealed. I know people are scared of AI.

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Dr. Ayanna Abrams [00:49:23]:

Just figure out how to use it. All right? But my. I am not worried about AI. I don't know if I should be, but that's a different conversation. Um, but, uh, bullying people are so unwell that we are in a high demand. We are in a high demand service. So 2020, when now there was Dei stuff, and now we're talking about racism in the workplace and racism and how we're navigating, seeing images, things that had been there before that I was already talking about. But now people are willing to pay for it so that they can feel better about their companies or their mission statement or their black box.

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Dr. Ayanna Abrams [00:50:04]:

And I remember kind of feeling a bit of guilt around it being like, nah, you can't take these people, honey, don't do that. Because they're not, like, doing, like, deep, transformative work. At the same time, I'm just like, well, I'm black folk, too. I also need reparations. So I talk to these people and they're going to be uncomfortable, and I'm going to say things, and we're just. That that's what it's going to be. And obviously, that has now dried up, as we know. And so.

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Dr. Ayanna Abrams [00:50:30]:

But 2020 and 2021 saw me now with a consulting hat being like, wait a minute, I need to structure this. I need to figure out a way to actually make this a very clear offering of mine. And I didn't know how to do that. Hence, I met you. I think it was Whitney. It was Whitney who posted on social media like, hey, this is happening. Sign up now. I was just like, okay, Whitney, I'll do it much.

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Dr. Ayanna Abrams [00:50:59]:

But that was really where the more formal hat I came in for me to think about rates and conversations at different kinds of organizations and who to speak to in organizations if I am going to pitch myself versus people coming.

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Michael Fulwiler [00:51:12]:

It'S such a mindset shift, right, for a therapist who is trained that I charge an hourly rate or my session fee is $150 an hour. So if a company is reaching out to me and they want me to give an hour talk, I'll just charge my hourly rate. I'm going to charge $150 for a talk, when in reality you can charge two 3510 thousand dollars for that type of talk. And then even going back to that company and saying, hey, instead of a talk, here's how I work with organizations as a consultant. I come in, I'll conduct an evaluation, the six month program, this is my price. So thinking about how to package up your expertise in a way that you can sell it as a consulting service where now you're not making $150 an hour, you're making $1,000 an hour or more. And those companies will pay.

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Dr. Ayanna Abrams [00:52:11]:

Yep. And that was the, working with you kind of in that, in that cohort was the biggest shift for me in terms of like, oh, I got to get out of this, like, hour again. I'm still stuck there, obviously, but I got to get out of this, like, hourly, I'm better. But that was, again, you just, you do what, you know, and I was viewing the hour as the same hour because I'm just looking at it as 60 minutes. Like, it's the same. I'm just like, no, it's not the same. It's not the same hour. It absolutely is not the same hour.

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Dr. Ayanna Abrams [00:52:41]:

And then you factor in like, yeah, I want to do tech checks. You want to meet beforehand, you want a handout, you want to write all that kind of stuff. It's really not the hour. Even if companies still, they'll still play games. They'd be like, but it's just an hour. But now I know it's like, no.

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Michael Fulwiler [00:52:54]:

No, it's actually ten years of experience.

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Dr. Ayanna Abrams [00:52:58]:

Yes. And you're recording this and you get to use this for this and this and this and this. So now we talking licensing agreements, baby. So, like, different conversations now. So. But that was, like I said, that 2021 was, again, it's the same thing as my business. Before. I was already doing this stuff, but the structure came after I was already doing the work.

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Dr. Ayanna Abrams [00:53:20]:

I wasn't structured before. And then moving forward in this, like organized fashion, I go the opposite direction, which creates more stress for me.

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Michael Fulwiler [00:53:30]:

We're coming to the end of this conversation. I want to wrap it up with the segment that we call the footnote. What is one thing that you want therapists to take away from this episode?

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Dr. Ayanna Abrams [00:53:45]:

I would like therapists to know or to remind them that our training or our skills, I think are some of the most transferable skills out of any industry, and we are not taught that. But your skills are applicable across any industry you can think of, not just ours, and to not limit ourselves to our industry with consulting or whatever it is you're thinking about. But you have the most transferable skills than any other industry.

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Michael Fulwiler [00:54:16]:

I love that. Doctor Anna, where can folks connect with you if they're interested in learning more about you or they want to get barbecue with you?

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Dr. Ayanna Abrams [00:54:27]:

Atlanta. They still open, we still go. But in my practice is ascension behavioral health ascension and the website is ascensionbehavioralhealth.com. the best place to find me is Instagram. As you know, I've been running my mouth a lot on there about clinical stuff and non clinical stuff. Don't get me going. We're out here. So my Instagram handle is doctor Ayanna A.

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Dr. Ayanna Abrams [00:54:52]:

That's d r a y a n n a a. I have a TikTok. Don't worry about it. Just do Instagram. Playing around on threads also. Don't worry about it. But Instagram will give you all of that information.

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Michael Fulwiler [00:55:06]:

Great. We'll drop that in the description. Thank you doctor Ayanna again for coming on the show.

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Dr. Ayanna Abrams [00:55:12]:

Thank you for inviting me. This is good.

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Michael Fulwiler [00:55:15]:

Thanks for listening to this episode of.

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Michael Fulwiler [00:55:17]:

Heard Business School, brought to you by Heard, the financial back office. For therapists, visit the Heard resource hub at joinheard.com to support you in your journey as a private practice owner. And don't forget to subscribe on YouTube, Apple, Spotify, or wherever you get your podcasts. We'll see you in the next class.