Scaling From a Solo to Group Therapy Practice with Elizabeth Earnshaw

Elizabeth Earnshaw [00:00:00]:

Running a business takes integrity, and you have to be willing to do the right thing every single time. Even if it means that it makes you broke for a week, even if it means it makes you feel bad inside, it makes you look bad. Whatever it is, you have to do the right thing.

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Michael Fulwiler [00:00:18]:

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. Understanding the nuances of human connection isn't just reserved for therapy sessions. It's a critical element for thriving in business as well. My guest this week is Elizabeth Earnshaw, also known as Liz listens on Instagram, an extraordinary human being who embodies this principle through every facet of her enterprise. Elizabeth is a licensed marriage and family therapist, certified Gottman Therapist, American association of Marriage and Family Therapy Clinical Fellow, and the founder of a Better Life Therapy, a thriving group practice with six locations. In our conversation, we discuss intentionally networking with lawyers, accountants and other professionals to seek vital advice and referrals. She shares her disciplined spending approach, prioritizing essentials over frills, and the significance of flexibility in her fee structure.

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Michael Fulwiler [00:01:27]:

She emphasizes the complexities of starting broad and then niching down, promoting diversity within her team and the unexpected revelations about financial management that came along the way. Here's my conversation with my friend, Elizabeth Earnshaw. Enjoy. Elizabeth Earnshaw, welcome to the show.

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Elizabeth Earnshaw [00:01:49]:

Thank you for having me.

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Michael Fulwiler [00:01:51]:

Thank you so much for being here. You're a certified Gottman therapist, which is how we met. I remember I was running marketing for the Gottman Institute. We had a workshop in Seattle, and you flew out from Pennsylvania. This was probably ten years ago, and I knew about you because you were this, like, up and coming certified Gottman therapist. You were building an audience on Instagram, and I just remember being really excited to meet you, and it's just been so fun to follow your journey over the years.

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Elizabeth Earnshaw [00:02:27]:

Yeah, it's been nice being connected to you for so long now and following your journey. You've had a journey?

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Michael Fulwiler [00:02:34]:

I certainly have. Definitely want to talk about Instagram. I want to talk about how you've built this thriving group practice with six locations. I know you just opened a new office, so I definitely want to talk about that. I'd love to start in the beginning and talk about why you decided initially to leave community mental health to start a private practice in the first place. Was there like an event or a series of events that led you to ultimately make that decision?

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Elizabeth Earnshaw [00:03:12]:

Yes. So I was working in community mental health prior to that I was working in a school, and I was actually being paid pretty well in the school, which is kind of surprising, I think, for people, but for a new therapist. And I moved, and I took a new job in community mental health. With the move, they offered me an equal ish salary. It was a little bit less, but I thought I needed to move, whatever. And a couple months in, my paychecks were bouncing. And then they called me into their office, and they said, we made an error. When we offered you your salary, it actually is supposed to be 10,000 less.

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Elizabeth Earnshaw [00:03:51]:

Sign this document saying that you understand that your paychecks are going to be different moving forward, and, you know, you're going to be accepting less money. And so this was a lot less at that point than I had been taking. And my paychecks weren't even caught up at this point, and they said they weren't going to be caught up because now I make less anyway, so they don't owe me any money. I owe them. So I remember I went home, and I was just really upset. My dad's an attorney, so, lucky me. He was like, no way.

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Michael Fulwiler [00:04:19]:

Yeah. I was gonna ask, is that even legal? I assume you signed an offer of employment, you know, with your salary and all that.

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Elizabeth Earnshaw [00:04:26]:

Yes. And my. Since my dad's an attorney, I said, I'm not signing your letter while I'm in this room. I'm gonna go home and think about this. And, you know, he was just like, you need to quit tomorrow, and you need to tell them that all the money they owe you needs to be in your account by Saturday. Whatever they have to do to get it there, they can overnight it. And, you know, they kind of ignored me. So he wrote a letter, and he went in and got my stuff for me so I wouldn't have to go in.

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Elizabeth Earnshaw [00:04:51]:

But I ultimately left, and it was really upsetting. I mean, I went home to my parents house. I had no money. Like I said, they hadn't paid me. I had just moved, so I had paid all these security deposits. I was, like, broke. I went to my parents house, and I remember I was just crying. I was like, I really love my clients at this place, and I actually really loved what I was doing.

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Elizabeth Earnshaw [00:05:13]:

And now I have no money, and I'm not going to find another job. And if I do, it's going to be the same thing all over again. And I was just really upset. And I started applying to lots of jobs, like that night, but they were all kind of confusing in terms of what they offered. It was like, oh, you might get clients, you might not. It was just all over the place, really low fee community mental health stuff. And, yeah, so that is how I kind of exited the community mental health space, even though it was a really hard decision, but it just wasn't sustainable.

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Michael Fulwiler [00:05:47]:

And then you're looking for jobs. At what point are you like, I'm just going to start my own thing. And then what was that process like? What were the steps that you took to start your own business?

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Elizabeth Earnshaw [00:06:00]:

Well, similarly, my whole family, they are entrepreneurs. When I grew up, I didn't know anybody that worked for anybody. So every single member of my family worked for themselves. My dad said, you should just open your own thing. And I said, are you nuts? I have no money, right? And I don't have a license, and I don't know what I'm doing. And what are the rules to opening something? And he was like, I don't know, just take a job and open something or whatever. But it's probably better than these big kind of corporate agencies that are never going to do anything for you. And I looked at a few jobs, and then I said, you know what? If I get something that works with these other places, maybe I'll work for them, but in the meantime, I'm going to start a practice.

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Elizabeth Earnshaw [00:06:50]:

And so I decided in that moment that I was going to do it again. I'm not kidding. I had a deficit of money. I was counting coins. I still remember I had a wawa behind my apartment. For those of you that don't know, wawa is legendary, and it's legendary. And the only thing I could do is I was collecting coins out of my old purses, and I was using quarters to buy my food. So I was like a month behind on rent, and I would use four quarters to go get a Mac and cheese.

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Elizabeth Earnshaw [00:07:26]:

That's what I would eat all day. So I was broke, broke very badly. Getting calls from my student loan company that I just decided I was going to do it. And I. Podcasts weren't really a thing then, but there was something similar where you could go online and, like, people would upload audio that you could listen to. And there were some people who talked about business, and I would just sit up all night and listen to it. But I made the decision very quickly.

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Michael Fulwiler [00:07:51]:

Yeah, and you got an office, right? Like this tiny office.

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Elizabeth Earnshaw [00:07:56]:

So I didn't have money to get an office initially. What I did first, which I think this is good for people to hear, is I kind of fudged and said, I had an office on my website, but I didn't have an office, and I built a website. Just looked everything up that I could look up about SEO and would just be sweating. Like, I don't know if you ever feel this way, but when you're over the computer for too long and you get all, like, sweaty and red, like, feral. I have, like, greasy hair and I'm, like, typing at 02:00 a.m. and I was just building this website, and I put, you know, I have an office in Center City, but I had no office in Center City. And what I decided was, if somebody calls to schedule, I will tell them I have an availability a week out, and I will do whatever I have to do to find a spot. Whether I have to sublet or see them in my backyard, I don't know.

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Elizabeth Earnshaw [00:08:50]:

So I did the website, I got phone calls, and I was like, yep, I can see you. I have an availability. And six days from now, here are the times. And then I had six days to find a space. And I did call my dad again. I'm lucky that I had him. And I was like, can I have some money? I forget how much. Maybe he gave me $1,000.

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Elizabeth Earnshaw [00:09:13]:

I have it written somewhere. I don't know, but it wasn't very much. And he was like, sure, but I'm not going to fund this for you. You have to do it yourself. And so he gave me a little bit of money. I went and I found a place. It was. You could sign a lease for a month at a time, and it was $300.

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Elizabeth Earnshaw [00:09:29]:

I will always remember that. And it was my wingspan. Like, I could touch each side of the wall on each side with my arms. So I could fit, like, this very mini couch, which I actually still have, and I could fit a chair. And I brought in, like, I asked my mom if I could go. In the basement of left behind toys and furniture, I found this, like, desk that I had when I was ten. The leg was missing, and I duct taped. So really I had, like, no investment at all into this.

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Elizabeth Earnshaw [00:10:05]:

But my clients met me that scheduled, and they showed up and they didn't even notice the duct tape desk. That's what I always say to new people, like, stop with all of the beauty. You don't need all that. Nobody cares. So they didn't care what it looked like. I actually had a guy who was a shared office. The guy next to me was an attorney's assistant. And, like, he would be listening sometimes to porn in the room next to me.

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Elizabeth Earnshaw [00:10:32]:

So it was just, like, not great, but it was fine. My clients came. They didn't care. They were happy.

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Michael Fulwiler [00:10:37]:

Well, everyone starts somewhere, right?

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Elizabeth Earnshaw [00:10:40]:

Everyone starts somewhere.

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Michael Fulwiler [00:10:42]:

What type of clients were you seen at that time? Was it, like, anyone that you could work with, or were you trying to focus in on niche or population?

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Elizabeth Earnshaw [00:10:52]:

So when I first started the practice, it was actually called a better life for families and youth. I wanted to be a family therapist. That's what I had been working in schools. I had been in community mental health. I very quickly realized I like working with the grownups. And then, you know, I started to realize I want butts and seats, and to me, I just want to see people. I would rather have all 20 of my slots filled than be sitting for six months waiting for, like, these ideal clients to come in the door. This might be different advice than you give people, but my advice, if you are someone who is already, like, esteemed in the field, for sure, like, you will get butts and seats for just specifically EMDR or just specifically couples therapy.

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Elizabeth Earnshaw [00:11:37]:

But if you are a brand new therapist, people don't know what you do. You don't really know what you do. You don't have that many certifications. My advice is, you want to be seeing people. And the reason you want to be seeing people is because the more people you see, the more word of mouth there is. The more practice you get, the better you get, the more feedback you get. And so I really saw anybody, and if they couldn't pay my rate, I saw people for $20. I saw people for $10.

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Elizabeth Earnshaw [00:12:05]:

I'm not kidding. I would see 30 people just because I wanted it to be really successful and I needed to make my rent. And so those people are still seeing me today at my full rate, which is $300 an hour. But I saw people for $10 an hour and used those quarters by Mac and cheese for a year.

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Michael Fulwiler [00:12:27]:

I would agree with that advice. I think that there's certainly benefit, right, in niching down. It doesn't need to be, like, incredibly niche, but it just makes it easier to market yourself. Right? Like, even in the beginning, saying I work with kids or I work with men, or it can still be broad, but having some sort of guardrails, I think can be helpful. But I think there's also something to be said about the fact that you don't really know yet, to your point, who you even like to work with. And it's worth working with different populations if you didn't get that experience, say, in community mental health or at a group practice, first, wherever you may realize, you know, I just don't enjoy working with couples or I don't really want to work with kids. Like, it's just really difficult for me. I'm not energized by it.

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Michael Fulwiler [00:13:19]:

And, like, that's also okay, too, right? Like, you have that choice as a business owner and who you want to work with. But I think starting a little bit more broad is probably helpful.

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Elizabeth Earnshaw [00:13:29]:

Absolutely. And one of the ways that I dealt with that was that I made specific. So I will say you don't want to be too broad. Like, if somebody looks at your psychology today profile and it's 800 things that you specialize, and they're not going to think you specialize in anything, so you don't want to be too broad. But one of the ways that I made sure to deal with that is I really worked on search engine optimization for my site. And I had many sites within my site. So I had a site that was, you know, Elizabeth Earnshaw. Here's my profile.

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Elizabeth Earnshaw [00:14:04]:

But my profile would say, I work with young women in their twenties who are navigating transitions. That's all that page said. Then it would be the exact same bio, except I would take that out and I would put, I specialize in systems therapy. I went to school for couples therapy, blah, blah, blah, blah, blah. Then another profile for families. That way if somebody was googling therapists for people in their twenties in Philadelphia, that profile showed up and I didn't look diluted to that person. I looked like, oh, this is just what she does. And they were hidden pages on my website.

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Elizabeth Earnshaw [00:14:39]:

So it wasn't like if they went around, they would be like, oh, weird. She has another bio about family therapy and she has none of that happened. They would just see it if they'd googled the thing. And I think that that was something that was helpful. Of course, I only put things I actually did. I wasn't making pages that said I did everything. But I think that actually really helped me in the beginning because people would call and say, you specifically help young women. And I have a daughter who's at college near you, and I send her your bio and I want to work with you.

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Michael Fulwiler [00:15:12]:

I think that's a very smart idea. What you're talking about is really creating search engine optimization, optimized landing pages, basically, and thinking about it as what would that potential client be searching for online and then creating a page specifically to match that search. I will say SEO. In the last five to seven years, it's gotten a lot more difficult. There's just a lot more websites and content now, but I think that's a great, pretty simple approach for folks who are just thinking about how to get started. I'm curious, were there other challenges that stand out to you when you look back on kind of that, like first year of private practice when you were just getting started?

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Elizabeth Earnshaw [00:15:59]:

A million challenges. I think there's something missing in my brain, though, where I'm not really afraid of risk.

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Michael Fulwiler [00:16:08]:

You just blocked it all out.

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Elizabeth Earnshaw [00:16:10]:

I probably have, like, lesions somewhere. I don't know. Cause I'm always just like, whatever, I'll figure it out. I think if you're going into private practice, you do need some of that. You need this, like, sense of, I actually don't know what I'm doing, and it's okay. A lot of people think that before they can start a business, they need to know what they're doing. There's this sense of, oh, you probably need an MBA or all these people that have businesses, they must know what they're doing. I had no idea what I was doing, and I spent a lot of time googling.

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Elizabeth Earnshaw [00:16:43]:

I didn't have a business coach or anything. My family, although they own businesses, are wildly unhelpful. They're not the parents. They're like, let's sit down and figure out what we should do here. So early on, I think a few things is like, my name was too niche. A better life for families and youth. I didn't want to work with families and youth within a year, and so I had to change the name, which is fine, but adds complications because you're going to have to have some wonky tax years and bank changes and all sorts of stuff. My biggest issue was that I hired an accountant that somebody did recommend they were affordable for a reason.

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Elizabeth Earnshaw [00:17:28]:

And the first year they accidentally put that I made the amount of profit that I actually made. So for anybody listening that doesn't know what I'm talking about, when you have a business, you have a revenue amount, but then there are obviously write offs that show I didn't actually make this much. So whatever I made that first year in revenue, they put it as profit. So I got. I had only been open from October to December or something, and I got a tax bill for $35,000, which was incredible, especially as I've shared. I had no money. I was very afraid of the IR's. I thought that if you make a mistake with the IR's, it means straight to jail, not the case.

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Elizabeth Earnshaw [00:18:20]:

You can fix your mistakes. But I thought straight to jail. Oh, my God, I'm freaking out. I called my dad. Did you ever have this happen? And he's like, probably every year of my life. I don't know. He doesn't even care. He doesn't give me any advice.

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Elizabeth Earnshaw [00:18:34]:

So I put it all on a credit card. I opened a credit card. I paid my taxes on a credit card because I was so panicked. And with that came a lot of fees because you have to go through this company that will let you use a credit card. Anyway, I paid it, and then, you know, my dad came in and was like, months later, you know, you should probably talk to my accountant that I've used for my whole life and my business. And I was like, yeah, why didn't you recommend them to me so far? And he looked at everything, and Washington, you know, just said, I'm so sorry that happened to you, but please don't ever just do things for the IR's. Always ask somebody first if it doesn't look right. We need to get your money back.

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Elizabeth Earnshaw [00:19:21]:

And so, you know, he got me all my, my money back, but I had to pay him to get my money back. I had to. I had already paid lots of fees that were never going to be given back. You're probably just like, working at her. You're like, oh, my God, I wish.

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Michael Fulwiler [00:19:35]:

Heard existed squirming here in my seat. But it's not uncommon. Unfortunately. One of the reasons why Heard exists is there's a lot of predatory accountants and cpas out there. I mean, that feels like something that an accountant shouldn't overlook or miss. Right? Just to save an example of this, for folks listening, when you pay your taxes on what's called your taxable income or your profit that you mentioned, right? So if you make $100,000, you're not paying taxes on $100,000. And I think this is important, too, for folks who are independent contractors who are paid as 1099 contractors. Like when you get your 1099 at the end of the year, that's not the amount that you're paying taxes on.

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Michael Fulwiler [00:20:27]:

You're paying taxes on your profit. So you're able to reduce your taxable income with any expenses, right? And so say you make $100,000, you have $20,000 in expenses. You're paying taxes on 80,000, not 100,000, right. Which is why bookkeeping and tracking your expenses becomes important. I'm curious, as you started to build your business, how did you manage the financial side of things?

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Elizabeth Earnshaw [00:20:56]:

So luckily, I did get this amazing accountant who has been with my dad forever and is very old school, and he very quickly came in and taught me a lot of what to do. He still, to this day, calls me a major idiot, so I'm not great at it.

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Michael Fulwiler [00:21:12]:

It's not very nice.

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Elizabeth Earnshaw [00:21:14]:

Oh, he. We joke with each other like that. I love him. He's like my grandfather. He's like, you're just being an idiot again. I like to say that out loud because, again, I think everybody thinks you have to be, like, really smart at everything to do stuff like this, and you don't. I'm over a decade into this, and my accountant is still like, liz, what are you doing? What are you doing? What I started to get really good at is tracking expenses. I'm kind of joking about myself.

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Elizabeth Earnshaw [00:21:45]:

I am not terrible at it. I track my expenses. This was a learning curve. So there's been an evolution my accountant has really had to work with me on. Just because the money's there doesn't mean you can offer it, doesn't mean you can spend it. Does it mean, like, yes. Talking about employees? Yes. It would be nice to be able to offer all of these things and, like, there's all these expenses.

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Elizabeth Earnshaw [00:22:11]:

This is going to be the taxes. This is going to be that. So I've had to get good at tracking. I've had to get good at understanding that the revenue amount is not your amount, that you have to recognize your expenses. You have to recognize the costs of taxes, unforeseeable expenses, all sorts of things. And the other thing I've gotten good at is not freaking out. And so just recognizing that when you have really good team of people on your side financially, that things can get fixed, that someone can look at something and say, this is okay. I've learned to not get embarrassed.

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Elizabeth Earnshaw [00:22:49]:

I know that. And I'm sure you experienced this when you're working with therapists at Heard. I think people are very embarrassed, so then they don't go to anybody. I was really embarrassed when I thought I owed that much money in taxes. So I didn't tell anybody at first. I didn't even say anything to that accountant because I thought he would think I was failing because I couldn't afford to pay these taxes. And so something I've learned, though, is, like, none of it's embarrassing. Like, if you feel like something's not adding up, if you can't make the numbers work, whatever it is, accountants and financial professionals are there to help you.

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Elizabeth Earnshaw [00:23:30]:

And I will say that in my business, the growth of my business is 100% related to me having an amazing accountant. Like part of it is me, but a lot of it is that my accountant is very good at helping me to understand how to spend money, when to spend money, what to deduct, how much to pay myself, how to pay myself. And thats really just made a huge difference.

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Michael Fulwiler [00:23:54]:

Im so glad youre bringing this up because there is so much shame and so much avoidance around talking about money. And I feel like entrepreneurship and small business brings up a lot of money stuff for people too, right? So I think its important to give yourself grace. I talked to therapists all the time who they start their private practice. Theyre six months in and they havent taken any money out of the business. They havent paid themselves in six months because they dont know how to do it, but theyre too scared to ask. So they dont want to get in trouble with the IR's so they just leave the money in the bank account. But its like they haven't paid themselves in six months, or therapists who haven't paid taxes in years just because they're so afraid of making a mistake that they just avoid it. And, you know, if that's you, that's okay.

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Michael Fulwiler [00:24:50]:

I'm curious, Liz, was there anything that surprised you when you started your own business that you weren't expecting?

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Elizabeth Earnshaw [00:24:58]:

That's a good question. I think. I mean, a lot of it surprised me. I do think the thing I keep coming back to and so I'm like, beating a dead horse is just the idea that nobody really knows what they're doing. And that's okay. I think that was surprising. It's okay if you don't get everything right. People can fix it.

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Elizabeth Earnshaw [00:25:17]:

Like, I had so much fear going in. If I don't put the LLC the right way, or if I don't file my business name the right way, or if I don't do it right with the state. And the thing is, is that if you don't do it right, as long as you are somebody that actually cares, I'm not saying just start something and just don't do it right and don't care to do it right. As long as you're somebody who actually cares and is continually doing the research, continually taking feedback, continually seeking advice, you're going to fix it all. And so if I did something wrong with taxes, or if I did something wrong with the way I filed with the state to open a business, or I didn't lease the right office, whatever it is, it's okay. It could all be fixed. As long as you're willing to ask questions, as long as you're willing to do research, as long as you're willing to be a really active participant in the business, it's okay. And that was surprising to me because I am, like, very afraid of punishment.

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Elizabeth Earnshaw [00:26:13]:

That's, like, my biggest fear in the world. And so it was good news. You don't get punished as much as you think you might.

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Michael Fulwiler [00:26:21]:

Yeah. And you'll figure it out, right. One way or the other. Either you'll find out the answer, or you'll get help from someone else. And I've also found, in my experience, people are very willing to help. Is that consistent with your experience as well? Meeting with other therapists and other professionals?

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Elizabeth Earnshaw [00:26:42]:

Yeah. People are so willing to help. In the beginning, I made sure I was really focused, like, where do I want to use my time? And I decided I didn't want to use my networking time with other therapists. I wanted to use my networking time with other professionals. And so I started networking clubs that invited, like, lawyers, accountants, business owners in the area, and we would all meet. And it was great because they always had people to refer to me. I had people to refer to them, but also they would help me a lot. And that was great because I would talk about this new business I'm opening, and the lawyer would be like, I think you should have.

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Elizabeth Earnshaw [00:27:18]:

Do you want me to write you an operations agreement, or what are you going to do with that? So I always just surrounded myself with people who knew things I don't know, and I'm open to letting them help me. I don't try to pretend like I know.

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Michael Fulwiler [00:27:33]:

So you've been building this business now for ten years. You've gone from this office, this size of your wingspan, with a guy listening to porn next door to six offices in two states. Right. You're in Pennsylvania and New Jersey. I'm curious, as you look back, are there keys to success for you or things that you did right that made a difference? In retrospect, yeah.

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Elizabeth Earnshaw [00:28:03]:

I think some things I did right was I spent money in the right places. So I did not spend money on frills at first. Used what? Furniture. I could get cheap furniture. I got cheap office spaces, but I spent money on things that I think make a difference. Like, I paid people well. When I started bringing on team members, I made sure to spend money on trainings, all of those types of things. Not anything frilly, like, didn't buy copy machines, none of, like, the office things you think you need.

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Elizabeth Earnshaw [00:28:36]:

I actually downgraded my cell phone and got a flip phone. So one of the things that I think was most important was I was really smart with money, and not because I'm good with money, but because I became really disciplined with being smart with money early on and thinking what matters the most. And I think when you're starting a practice, you can become very distracted. By what. Luckily, Instagram was not a thing then, my God, there's too much advice. I think I could have gotten very distracted if it was. And when I am coaching new therapists, they're spending money on way too many things, like this business consultant, this designer, this branding person, this, all of this stuff. In the beginning, that stuff will come.

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Elizabeth Earnshaw [00:29:24]:

I, of course, have spent money on a branding person and a website and everything. Now, the beginning was not about that. The beginning was how do I spend money where it matters and then everything else I do myself. So that was really important. The other thing I think set me up for success was providing really good care. And I know that this is a controversial stance, but I let myself be broke for years so that I could provide really good care, get a good reputation in the community, and have a lot of clients. And so I was very flexible with my feet for years. I saw almost anybody that would come in the door, and that, for me, is what built my business.

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Elizabeth Earnshaw [00:30:10]:

So I was less money focused. Of course, I needed to make money. I made people pay for their cancellations and if somebody was taking advantage, I would terminate. But I was care focused and my clients really knew I cared about them. And I was constantly trying to be better and really, really showing up as the best possible professional I could. I was very professional. Wrote back to emails immediately, called people back immediately. Everybody got a call back.

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Elizabeth Earnshaw [00:30:38]:

And then when I started to have more clients calling than I could see, I brought in a colleague and I would say that was the next thing that was really important to my success. She ended up being very similar to me in mindset in terms of, yes, let's take everybody we can so that more and more people know about us so we can provide good quality care. She's one of the clinical directors now. She still works with me, but bringing on that colleague was really, really important because of a few things, you know. One, people weren't being turned away, they were getting to work with her so the business could continue to grow without just my hour to my hour. The second thing that was great is that we were casting a wider net. Now. There was more than one person on my website.

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Elizabeth Earnshaw [00:31:21]:

So if somebody is searching for. I didn't provide substance use counseling. She did. If somebody's searching for that, they're hitting on her. If somebody's on psychology today and looking for that, they're hitting on her. So more people were coming to us because of that person. And then I continued to just grow a really wonderful team. And I think that those things in the beginning were just the thing that really helped propel me forward.

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Michael Fulwiler [00:31:47]:

It sounds like there was this natural progression for you of starting your business. You got to a point where your caseload was full, so then you brought someone else in and sort of that process repeat itself. For now, that person was full. Now we hire someone else. Or did you have a plan in your mind of, you know, I want to hire five clinicians by the end of the year. Like, did you, were you thinking about the growth of your business in that way, or was it more just a reaction to the demand that you were getting?

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Elizabeth Earnshaw [00:32:15]:

So in the beginning, it was a reaction to the demand I was getting. I always was just learning as I went along. I was not, I didn't have a business plan, none of those things. I went into this because of urgency. I don't have a job, so I'm starting a job for myself. So at first it was either demand from clients or if I had a friend who was like, I would love to get into private practice, you can just join mine. And so demand from colleagues as well, who would join the practice. And then what I started to recognize is the more robust of a team with some sort of nucleus I had, the more people we were going to get.

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Elizabeth Earnshaw [00:32:56]:

So our nucleus became systems. We all do couples therapy. But what I wanted is to make sure I had somebody who could do EMDR, somebody who could understand substance use disorders, somebody who worked with men's. And specifically, because if I could have all of those things, then my net was being hit on by all sorts of people who would not have come to me because I don't have those specific skills. So my business plan became, I want to have a lot of couples therapists, but my goal is going to be to hit all of these other things. I'm going to have EMDR, I'm going to have DBT, I'm going to have not just Gottman, im also going to have pact. And so that was my personal plan.

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Michael Fulwiler [00:33:43]:

That makes a lot of sense. Youre basically filling in the gaps. How did you find those people? Because I imagine its very competitive, especially now. Its easier to start a private practice than it was when you started, just with the adoption of technology. How did you find those people and hire them? And also, how have you been able to retain therapists over time?

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Elizabeth Earnshaw [00:34:06]:

I wish I knew an answer to this because I consult with a lot of people who can't find anyone to hire. I've never had a problem with that. When we open a new location that is in a very different area, I might have to put something on LinkedIn for like a day, but I have never had to really work to find people. I always find amazing people, mostly through word of mouth. So I have a lot of employees who will say so and so that I used to work with at this detox place or so and so that I used to work with at this community mental health center. They're amazing. Would you interview them? And so I've been really lucky. I think that word of mouth hiring is the best because you already know that the person that works for you is somebody that you really can work alongside and provides quality care.

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Elizabeth Earnshaw [00:34:53]:

And if they're saying that they really enjoy working with somebody, then you're kind of getting that. That word of mouth there. I guess the answer to that would be what makes or the thing to look at there is what makes your employees want to recommend their friends to you. One of the biggest things in the last few years, maybe last four years, I've recognized is that there needs to be opportunity for growth. So if you're a private practice that has no hope for growth, people are just going to come in and there might be people who want that, but there are going to be people who want growth. And the growth is either going to be that they leave and start their own thing or that they feel they have some sort of fulfilling trajectory with you. And so my business plan to retain then became, how do I maintain these amazing people? Well, I have to have some roles for them. Let me figure out what those could be.

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Elizabeth Earnshaw [00:35:46]:

Maybe I could open another office location. And because I have that new location, one of these amazing therapists can be the clinical director there if they want to be. And really thinking about where are these opportunities now? The opportunities can't just come out of thin air. They need more revenue because it costs money to pay people to do these roles. So you have to think, what are some revenue generating opportunities? A new office will bring in new revenue. This person can then be paid to run that office. We have an internship program now. So we have an internship director.

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Elizabeth Earnshaw [00:36:20]:

We have supervisory positions. We have all sorts of things that people can really see themselves in and they see that. I'm open to thinking about ways to help them grow. So I can say to them, that might not happen in the next three years, but I love the idea. Like, let's think about what that could look like moving forward. So I think growth opportunities, being really kind, paying people well, and very easygoing. So as long as you do what you're supposed to do, I'm easygoing. I think all those things are important.

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Michael Fulwiler [00:36:52]:

Yeah. I mean, you said that you haven't had a hard time hiring, and you also worked very, very hard in those first years. Right. You said you were, you know, basically not making any money. You're building your reputation, the work that you put in then. I'm sure you're seeing the results of that now. Right, just in terms of.

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Elizabeth Earnshaw [00:37:12]:

Yeah. And I think one thing I'll share, actually, is when I was growing up and I watched my dad, my granddad, my uncles, their biggest value was employees first. And we would have periods of time growing up where my dad would not pay himself because he would be paying his employees. And he was an attorney. And, like, sometimes, you know, you get $60,000, and sometimes you're not paid for, like, three months. And so we would go, and I remember watching my mom at the table being, like, balancing the checkbook and saying, I don't know that we can pay all these bills this month. And my dad being like, but I have to take my paycheck, and I'm taking it to the office, and I'm giving it to my employees. And I will always remember, all the men in my family did that when we were growing up.

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Elizabeth Earnshaw [00:38:03]:

They were the ones who owned businesses. The tables have turned, but I did the same in the beginning. There would be weeks where I was. I was paying. I used to pay people week to week. I do salary now. And for whatever reason, the bank account wouldn't be right, and I would not take my money. I would pay the other person.

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Elizabeth Earnshaw [00:38:22]:

And there was a time where somebody's paycheck bounced, and I drove to their house with cash, and I said, here's the cash. We'll deal with it. You know, running a business takes integrity, and you have to be willing to do the right thing every single time. Even if it means that it makes you broke for a week, even if it means it makes you feel bad inside, it makes you look bad. Whatever it is, you have to do the right thing. And I do think that that has played into why I've kept people on my team for so many years. I hope that they believe I really do try to do the right thing. Always.

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Elizabeth Earnshaw [00:38:58]:

And I want them to feel. I feel proud that I have generated money, that I get to pay people. That is, like, so exciting to me. Where money did not exist. Money exists and I get to give it to people. And I think your people have to know you feel that way about them, that they aren't. They are your customer. Your employees are your customer.

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Elizabeth Earnshaw [00:39:17]:

They are not just your money makers. And I think that's been really important.

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Michael Fulwiler [00:39:22]:

I think that's great advice. Do the right thing. It sounds really simple, but, you know, stuff will. Yeah. It'll come back to bite you in the ass later on, you know, if you don't do the right thing.

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Elizabeth Earnshaw [00:39:35]:

Yeah.

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Michael Fulwiler [00:39:37]:

You're also a content creator.

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Elizabeth Earnshaw [00:39:40]:

Yeah.

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Michael Fulwiler [00:39:41]:

You have over 250,000 followers on Instagram. Liz, listens, is your Instagram account. Could you talk about, like, when you started posting on Instagram and, you know, when you became more serious about it?

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Elizabeth Earnshaw [00:39:56]:

Yeah. So in 2018, I started posting on Instagram. I opened my business in 2013. So I had been using word of mouth and website searches only up until that point. And I was never big on social media in 2018. I remember being on my Instagram and thinking, that would be really interesting to share information. I didn't really see that anywhere at the time. I was only following friends.

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Elizabeth Earnshaw [00:40:24]:

You know, like, I. There was not really accounts like that. There were a few, like, mindful MFT existed, but I only found mindful MFT once I started thinking of doing this, because I was thinking about, who are my therapy clients going to be? Some of them know about therapy. They're asking their doctors. At the time, that was more popular, where to go. So they're going to find me because of my networking. Some people, they don't know who to ask, so they search it quietly in their basement, and those people are going to find me on a website. Some people, they don't know at all.

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Elizabeth Earnshaw [00:41:03]:

They don't know. Am I allowed to just make an appointment? Am I supposed to find somebody specific? Do I even have a problem? And I thought that if I went on Instagram, I could just share information, and those people, if they felt like it was right for them, could then connect over to my website. And so I just started sharing really horrible graphics that I made.

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Michael Fulwiler [00:41:27]:

This was before canva, probably, right.

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Elizabeth Earnshaw [00:41:30]:

Canva didn't exist, so it was. I don't know, maybe it was just Microsoft Word or something.

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Michael Fulwiler [00:41:37]:

Yeah. I remember making social media graphics on PowerPoint.

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Elizabeth Earnshaw [00:41:42]:

Maybe I. Ten years ago, maybe nothing. Yeah. I don't know. I just remember it took forever to make them you should, like, drag things, right?

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Michael Fulwiler [00:41:50]:

You move one thing and then everything else moves.

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Elizabeth Earnshaw [00:41:52]:

Yeah, exactly. I started doing that and figuring out, like, at first, they would also be really boring, you know, like a picture of my office with something written. And then I started realizing these are things that people like and kind of evolving with what people like. I think I hit the right moment in many ways. It was a little bit easier to get in at that point. Not that it's not now. I think that it still is. But my content didn't have to be particularly good.

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Elizabeth Earnshaw [00:42:22]:

I was just one of the only ones doing it, so. But, yeah, it really. It helped bring business, and it also helped give me other opportunities.

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Michael Fulwiler [00:42:34]:

From what I remember, you were one of the first, like, large therapist Instagram accounts, and now there's a lot more therapists on Instagram and TikTok. I'm curious, did it create any challenges for you, people reaching out to you in your DM's looking for advice, or have you had a post that got negative feedback or pushback? Has there been a negative side to the audience that you've built on Instagram?

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Elizabeth Earnshaw [00:43:04]:

For sure. I mean, the first two years was very different. 2018 and 2019, I honestly didn't. And I think that when people did post pushback, it was polite and manageable. So it would just be something like, oh, you know, this is really helpful, but have you ever thought about this? Or this kind of leaves out this person? But I understand. Thank you so much. And I remember it being really fulfilling. Like, I loved the DM's.

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Elizabeth Earnshaw [00:43:31]:

I got a. Did I get some that were rude sometimes? Like, oh, you're impacting your profession. This is so unprofessional. Sure. But most of it was positive. I would say in 2020, it became really unmanageable, in my opinion. People started to really become very myopic and split and vicious towards each other, and not just me. And so during that period of time, there were a lot more.

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Elizabeth Earnshaw [00:44:01]:

You spelled a word wrong, or, how dare you write this? Or why would you post this and not this? And da da da da? And just a lot of controlling behavior. I understand. That's what we do when we're stressed. We become either fighters or we flight or whatever. And so there was a lot more of that, and it really became someplace that I didn't like to be very much. And so I pulled back a lot starting in 2020, because for me, I don't want to do anything that makes my life worse. I only want to do things that make it feel better. So, yeah, I've gotten stuff, but I've learned to negotiate that by saying, okay, well, then, like, what are you gonna do about it? Do you just not read the comments anymore? Do you delete comments? Do you respond to them as if you don't care? Like, what do you do? But I've had to figure out, how do I navigate that so it doesn't impact me negatively.

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Elizabeth Earnshaw [00:44:50]:

So I can handle it.

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Michael Fulwiler [00:44:51]:

I imagine at a certain point, too, you can bring in someone to help as well. Do you have help with your social media, or are you still the one that's managing it?

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Elizabeth Earnshaw [00:44:58]:

So I have somebody that makes my graphics. I have tried a few times to get people to help. The issue is that it never really sounds like me, and I don't like that. You know, the responses end up. There will be responses to certain things that don't sound exactly like how I would have framed it. And I'm sure it's all fine, but I'm the one who's, like, still in my DM's and still in the comments. I only read my comments for 15 minutes after I post, and then I never look at them again. So I've done a lot of things to try to distance myself from it.

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Michael Fulwiler [00:45:33]:

Yeah. I'm curious. As you've built your private practice into a group practice, how do you think about your role today in the business? Right. Because it's no longer just you providing therapy now it's Liz, the manager. Right. And the director of the business. And are you still, like, working in the business? Are you still providing therapy? Are you more focused on, like, on the business?

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Elizabeth Earnshaw [00:46:00]:

Well, I told you, something's, like, missing in my brain. So I do still provide therapy, even though I have, like, 30 employees, six locations.

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Michael Fulwiler [00:46:10]:

And you're providing intensive, right? Like, more than weekly sessions, or do you both?

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Elizabeth Earnshaw [00:46:15]:

Yeah, so I do intensive. I still have clients from before who I see. I see about 15 clients a week, and so I see them, and then I do intensives in the business. That's evolved. So I used to be the main manager. I was a touch point with every single person. I was their manager. And since I've started the locations, I've clinical directors.

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Elizabeth Earnshaw [00:46:38]:

So they manage everything. It's cut and paced. So every time we make a new place, the same training happens, the same types of things, and then I just meet with the directors. And so the day to day operations of the business, I'm not doing the referrals anymore. The scheduling, the answering of phones, employee conversations, those are being done by the directors. And then I meet with those directors every single month. So I'm more high level in terms of. I'm looking at how many referrals did we get this month? Like, what's the reporting look like? How much money did we make? Is everything with salaries making sense with the splits and everything? What's going on with that person's calendar? Why aren't they getting as many referrals as somebody else? So I'm looking at all of the business stuff, but I'm not in it every single day doing all of.

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Elizabeth Earnshaw [00:47:28]:

There's a lot of delegating, which has helped to allow me to focus on the big picture.

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Michael Fulwiler [00:47:33]:

I love the idea of thinking about each location as almost its own independent practice. Right. And you have the clinical director. That's basically like running that business, which allows you to take a step back 100%.

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Elizabeth Earnshaw [00:47:47]:

And I actually let them choose how they want to decorate it. So I know that, like, some branding rules would be keep it the same. We don't keep it the same. I give guidelines, I choose, ultimately the furniture. But each office has its own vibe. So, like, this office is a lot more like kind of cozy and folksy that the clinical director here, that's like, kind of her vibe. The downtown office is, like, very modern looking. We have a Jersey office that looks very beachy because she's very beachy person.

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Elizabeth Earnshaw [00:48:19]:

The clinical directors have ownership of the spaces that they manage.

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Michael Fulwiler [00:48:23]:

What are some challenges that you're facing in your business today, and how have those changed since the challenges we discussed when you first started the practice?

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Elizabeth Earnshaw [00:48:33]:

As you get bigger, you just have more people that you have to satisfy and that's challenging. You want to do the best for every single person, but there is a little bit less individualization that you can make for multiple reasons. As you get bigger, there's going to be more rules you have to follow. If I do this thing for this person and not for this person, then that could be problematic. So you have to make sure that you are being really fair. You have to make sure you're listening to everyone, but that you still have a leadership voice where you can say, I hear that, but that's, like, not what we're doing. So as you get bigger, the challenge is just more people, more needs. How do you keep the majority of people happy and how do you also cope with the people pleaser inside of you that you won't be able to make everyone happy? There are going to be people who ask for more money and you have to say no because there's a.

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Elizabeth Earnshaw [00:49:25]:

Isn't more money. There are going to be people who say, well, I have this like specific thing going on in my life. Could I not work for six months? And like, I'm actually pretty flexible. I might say, yes, absolutely, that's fine. Some business owners might have to start being like, no. Like, I'm sorry, but we can't support that. So that becomes really difficult. I think you have to have harder conversations and you have to become the bad guy a little bit more.

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Elizabeth Earnshaw [00:49:53]:

The other thing that is a challenge as you grow is I think there's more burden on your shoulders. So I am now responsible for over 30 people's livelihoods, which means that if we have a slower month, like the summer is coming up, my poor husband the other day, I'm spiraling and oh my God, what if referrals dry up? There's two people that are kind of not getting as many as they should get. And he was like, Liz, you do this every may. I was like, what if we go out of business? You know, I don't know what I would do. And he's like, every single may you have this spiral. The more people. And I think you can tell I'm very focused on the people part of it. So it's not a challenge to me administratively.

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Elizabeth Earnshaw [00:50:39]:

It's not like I don't. I can work until three in the morning, I don't care. But I get very worried and stressed out about can I pay people? Can I continue to give referrals? Are the better helps of the world going to eat everything up? So that's the challenge. But the way I've focused on that is continuing to make a good environment for employees and always being focused on marketing. You cannot sleep on that. I remember when I first started, my stepdad was like, don't get too big for your bridges. Like if you, you have so many clients, that's wonderful. But you were putting 5 hours a week into marketing before.

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Elizabeth Earnshaw [00:51:17]:

You still need to do that every single week. So don't stop. Keep putting all of this time. Network. Da da da da. And so we've been focusing now. It used to be mostly website, then it was instagram. We still focus on those things.

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Elizabeth Earnshaw [00:51:33]:

But the challenge now is we're being a lot more community focused, sending people to do workshops with doulas or whoever. Because I feel like that's the last section that we kind of ignored. But yeah, I would say that just the pressure is the challenge.

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Michael Fulwiler [00:51:48]:

Yeah. And also managing your personal life. Right. As well with the business. Now that you have kids. And I imagine that has just totally changed a lot of your priorities.

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Elizabeth Earnshaw [00:51:58]:

Yeah, I think that's actually an important thing to point out is my husband actually left his job because it is so much work. Somebody I was consulting with the other day asked me, and she was consulting with me and some other owners that have pretty big practices. And she was like, you know, I feel like my practice isn't becoming successful, and I'm putting so much work into it. Like, how many hours a week are you guys working? And we were, like, 60. When you own a business, you're always on call. You can't just disappear. And I remember she was like, oh, I'm just doing, like, 20. And we were like, yeah, you gotta work a lot.

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Elizabeth Earnshaw [00:52:37]:

When you have your own business, you have more flexibility around the work, but you have to work a lot. And so my husband did leave his job, and he stays home with our baby so that I can do all the business stuff.

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Michael Fulwiler [00:52:50]:

We could talk for hours about this stuff. I know, Teddy, we're coming to the end of our time. Would love to wrap up this conversation with a segment that we like to call the footnote here on the show. My final question for you is, what's one thing that you want therapists to take away from this conversation? If they only remember one thing from the last hour, which you've said a lot of really helpful stuff, but I'm curious, just, like, one takeaway, what would that be?

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Elizabeth Earnshaw [00:53:20]:

There is no magic to starting a business. So don't pay a ton of money for easy, quick fixes. Don't buy into, oh, you should be able to just charge this massive fee and build a business. It's going to be so easy. Leave your job, start a practice, da da da. It's actually very hard. And I'm not saying that to scare anybody. I think everybody should do it if it's for them.

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Elizabeth Earnshaw [00:53:43]:

But I want people to recognize, because when I'm consulting with people, this is the biggest area that they struggle with, is they feel ashamed that they're not making progress, because there's all this stuff out there saying, you're going to get clients, charge your high rate, da da da da da. It's going to be so easy. Within a couple of years, you're going to have this big thing, and then they're like, but why am I not? And it's because there is not a magic thing. You just have to really be willing to learn everything. You can learn to work really hard, connect with people, do a very good job, be very good to people, and that is the thing I want people to take away, I think. Don't feel bad if it's not working out because it doesn't easily work out for anybody. You just have to keep pushing through. Just keep working.

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Elizabeth Earnshaw [00:54:32]:

Just keep trying to understand. And that's how you get results.

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Michael Fulwiler [00:54:36]:

Love that. Thank you, Liz, for coming on the show.

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Elizabeth Earnshaw [00:54:40]:

Thank you for having me.

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Michael Fulwiler [00:54:44]:

Thanks for listening to this episode of Heard Business School, brought to you by Heard, the financial back office. For therapists, visit the Heard resource hub at joinhaerd.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.

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