Natalie Milom and I have been friends in the private pay circle for a minute, and I finally got her on the show.

Natalie runs Potential Realized, a group practice in the Atlanta area, and she's licensed in Georgia, California, Indiana, Vermont, Florida, and South Carolina. She's a certified EMDR therapist and consultant, certified EFT couples therapist and supervisor candidate, and a TBRI practitioner. She only sees clients two days a week, does intensives once a month in Buckhead and LA, supervises staff, and is working on her PhD.

She left insurance because with only two client days, she needed to maximize income. "I'm not about to fight with insurance companies about my money." She's the only one in her practice not taking insurance - her staff still does.

We got into:

• How she structures her week around school, clients, and supervision

• Running intensives in multiple cities using colleagues' office space

• Her PhD research on EMDR with Black clients and why representation in the literature matters

• Secure Black Love - her second business focused on Black couples with bi-weekly Instagram/Facebook lives

• Recording trainings as evergreen products (and the CE credit considerations)

• The upcoming EMDR for the Culture Refresher course: April 2-3, 12 hours of EMDRIA credit

She got my Niche Positioning Report and called it "phenomenal" - said it reminded her she's an EMDR consultant and EFT supervisor and people need to hear more from her.

Find her at dopetraumatherapist.com or nataliemilom.com

Rachel Bentley jumped on last minute when my scheduled guest got sick, and I'm glad she did.

Rachel owns COR Counseling in Michigan - a group practice that grew from 3 therapists sharing one crappy office to 35-40 clinicians serving about 1,000 clients. She also runs Next Level Private Practice, her consulting company, and hosted a summit last fall with 120 attendees and 30 speakers.

She started the practice in 2019 as an exit strategy from 10 years in state government child welfare. A friend told her: "You worked in child welfare for years. Think about everything you endured. If you can do that, you can probably do anything."

We got into:

• The "bleeding heart part" that drove her to keep hiring during the COVID boom

• Why she teaches her 1099 contractors to self-market (and why some group practices think that's controversial)

• The difference between post-COVID hiring and now

• What it means when a therapist tells you "this is the first place I've ever felt safe to work"

• The parts that show up when you run a business: inner critic, perfectionist, fear of failure, people-pleaser

• Having to take hard conversations about bad hires to her own therapy

• Why "I want to start a group practice so I can make more money" is not a reason to start a group practice

Her biggest win wasn't revenue or headcount. It was a therapist writing on the office whiteboard: "I have never worked in a place where I felt so cared for and so safe."

Find her at nextlevelprivatepractice.com

Coming Very Soon:

The Playbook Workbook Group — 8 weeks working through The Private Pay Practitioners Workbook together. Live on Zoom. Small group, max 8 people.

Most people buy workbooks and never open them. This group doesn't let you do that. You'll do the exercises. You'll get feedback. You'll actually build the thing.

Details:

• Sundays, 1–2:30pm ET

• March 22, 29 | April 12, 19, 26 | May 3, 17, 24

• $400 (payment plan available)

• Founders: $280 through March 21

• BIPOC Access: $260 with code ACCESS35

Register: https://www.privatepaypractitioners.com/services/p/playbook-workbook-group

I keep seeing therapists spread themselves thin trying to post on Instagram, TikTok, LinkedIn, Facebook, YouTube, Threads, whatever new thing just launched.

You don't need to be everywhere. You need to be where your people are - consistently.

Pick one. Maybe two. Get good at it. Let the rest go.

DJ

This week I sat down with Ingrid Johnston, a marriage and family therapist in Washington State who's been in private practice for almost 10 years.

Ingrid had a decade of steady growth. Then she took a 3-month sabbatical after burnout - and when she came back, she just... coasted. Didn't put energy back into the business. Didn't market. Didn't realize the landscape had changed.

By 2025, her caseload had dropped and she was questioning everything. She even started substitute teaching to see if she wanted to keep doing therapy at all.

That clarity came. She did want to keep doing this work - but differently.

We got into:

• Why she wishes she'd never taken insurance, even for just one year

• Going from generalist to niched (chronic pain, religious/spiritual trauma, couples where trauma is the driver)

• Dropping free consultations - and what the EAPs taught her about that first session

• Raising rates from $100 to $250 - and now bumping to $300-$350

• Tightening her cancellation policy from 48 to 72 hours, weekdays only

• The parallel process: her transformation mirroring her clients' growth

• What she wants beyond 1:1 (teaching, workshops, maybe an e-book on chronic pain)

Her take: "You have to feel those nerves, feel that fear, and just do it. The more you keep doing it, you're like, okay, I got this."

She's 10 months into the rebuild and about 80-90% back to where she wants to be.

Find her at ingridjohnstontherapy.com or @ingridjohnstontherapy on Instagram.

Ready for your Full Practice Review? Spots are filling up fast. Sign up today https://www.privatepaypractitioners.com/services/p/full-practice-review

This week I sat down with Inna Zusman, a bilingual couple and family therapist in Maryland who specializes in multicultural relationships.

Inna came back to therapy after 20+ years in corporate HR. She'd been recruiting therapists for years, so when she decided to make the switch, she treated it like a business decision - not a dream.

We got into:

• Her idea to give discounts to clients who stayed longer - and why I almost fell out of my chair

• Premium rates for evening and weekend sessions - and how nobody questioned it

• Building a YouTube channel to reach her ideal clients

• ChatGPT recommending her to potential clients - a whole different SEO strategy

• The trap of hiring a social media manager before you understand your own business

• "If you're not running your business, somebody else will run your business"

She works with multicultural couples and families navigating language, culture, and tradition - and she's not trying to keep them forever. Short-term therapy. Give them the tools. Shift and go.

Find her at www.innazusman.com

https://www.youtube.com/@CrossCulturalwithInna

https://www.facebook.com/InnaZusmanRelationships/

https://x.com/Healingbondsnow

Tiffany Castellanos has been in private practice since 2009, but everything changed when her husband became disabled and she became the primary breadwinner. Add in clawback horror stories from colleagues, and she knew it was time to drop the insurance panels.

Now practicing from Madrid, Spain (yes, legally - we get into that), Tiffany is building something unique: a practice serving expats navigating life abroad AND dentists - a profession with sky-high rates of depression, anxiety, and suicide that nobody's talking about.

In this episode, we dig into:

• How she landed on two completely different niches (and why both work)

• The Spain licensing loophole that lets her practice without local credentials

• Why free consultations burned me out and what I do instead

• The mindset shift from "accessible to everyone" to "sustainable for me"

• What to do when clients are surprised by your rates (even when they're on your website)

• Why "works for now, can change later" is the best policy advice I can give

Tiffany's only 4 months into private pay, but she's already doing the work - podcast appearances, articles, webinars, and collaborating with a UF professor researching dentist mental health. This is how you build a practice.

Website: tiffanycastellanos.com

Instagram: @tiffmarg

This week I sat down with Michele Tulk, a psychiatric nurse practitioner running a solo private pay telehealth practice in Washington state.

Michele's path: stocking shelves at Target, pharmacy tech, CNA, RN in the ICU and ER for years, then psych NP on a specialized inpatient PTSD unit at the VA. She started her private practice in 2018 as a side gig while working full-time at the VA, working 65 hours a week for almost a year before she felt safe enough to make the leap.

That scarcity came from growing up in a big, low-income family. She talked about being 20, working at Olive Garden, and not wanting to suggest appetizers because she didn't want to exploit people who might not have the money. That same energy followed her into building a business and setting rates.

We got into:

• How scarcity from childhood shows up in your practice and your pricing, and the work it takes to combat that

• The "nurses eat their young" culture and the friction between NPs, physicians, therapists, and every other credential - and how financial stress brings out the worst in all of us

• Not everyone deserves to be in your network. If you wouldn't want to sit with someone, don't send your clients to them either.

• The concept of private pay as a corrective experience - rewriting past experiences of feeling controlled, trapped, and mistreated by organizations that only cared about volume and RVUs

• Being authentic and neurodivergent in practice - she started out masking, wearing uncomfortable clothes and makeup she could feel on her face, and it took 20 years and therapy to finally show up as herself

Her take: "I'm not controlled. I'm not trapped. I don't feel like I'm in trouble. I go to sleep at night soundly because I know I'm doing a good job and giving it my all."

She also said something that hit: "I've always had my own back. I didn't feel any loss. In fact, I felt a gain."

Michele specializes in medication management for neurodivergent adults with trauma histories, including queer and transgender clients. She's accepting new clients in Washington - telehealth statewide and in-person in Bellingham.

Find her at www.nwtelepsychiatry.com

Private Pay Isn't a Dream. It's a Decision.

This one is short and direct.

Every day I see therapists who treat private pay like a wish - hoping clients will show up, hoping the numbers will work out, hoping it gets easier.

Hope is not a strategy.

Private pay works when you stop waiting for permission and start building with intention. It works when you treat it like the business decision it is.

You didn't get licensed to stay stuck. You got licensed to help people - and you deserve to get paid well for it.

Private pay isn't a dream. It's a decision.

You just have to make it.

www.privatepaypractitioners.com for additional resources and consultations

This week I sat down with Anna Cimburek, a palliative care and hospice social worker turned grief therapist.

Anna's dad died from pancreatic cancer in 2011 - 7 weeks from diagnosis to death. She was 27 and couldn't find any literature on adult child loss. That experience eventually led her to hospice social work, where she spent 4.5 years doing inpatient end-of-life care. After her brother also died from cancer in 2023, she moved from Seattle to Arizona and pivoted to private practice.

She never wanted to be a therapist. Someone asked her: what's the difference between sitting with a dying patient and their family versus sitting across from someone on Zoom? She couldn't answer that. So she leaned in.

We got into:

• Working with acute grief (right after loss) and delayed grief (2, 3, 15 years later when something triggers it)

• Ambiguous loss - I shared my own story of losing my foster daughter when family showed up right as we were filling out adoption paperwork

• Why checking the "grief and loss" box on Psychology Today doesn't mean you actually know how to sit with someone in it

• The business side being scarier than the clinical side - "2026 is my year to make it or break it as a business owner"

• How we worked through her pricing in December and she finally landed on a number she can look at and say "yes, I've earned every dollar of that"

Anna's take on death: "You get one chance to die, and you have an opportunity to do it well. And by doing that well, you're giving a gift to your loved ones - giving them permission to grieve well."

She's also thinking about grief intensives for people who are years out from their loss and want to do deep work without dragging it out over months of weekly sessions.

Find her at https://kindwaterscounseling.com/

This week I sat down with Steffeny Feld to talk about intensives - what they are, who they're for, and what therapists get wrong about them.

Steffeny started her practice during COVID and never touched insurance. A friend connected her with a business coach who said "you don't need to get on any panels" - even her clinical supervisor thought it sounded "sus." But it worked.

She went from weekly sessions to adding intensives to intensives-only, and now she's fully serving therapists through her Intensive Design Lab.

We got into:

• The restlessness that signals it's time to shift something in your practice

• Pricing intensives: from hourly math to 40% markup to transformation-focused pricing (she knows people charging $700-900/hour)

• Why intensives aren't a life preserver for a struggling practice - you need a full caseload first

• The biggest mistake: treating intensives as "just longer sessions" instead of positioning them as a solution for a specific client's urgent problem

• Intensive math - clients guessing how many weeks of therapy they just skipped

• Using AI scribes for intensive progress notes

Her take on marketing intensives: "If someone says, hey, X, Y, and Z on the consult call, being able to say with confidence - yep, I can help you with that."

Anna asked about organizing all her intensive ideas. Steffeny's advice: brain dump everything, rate each idea by energy and effort, narrow to 3, then pitch them and see who responds.

Freebies from Steffeny:

• Client Intensive Script: https://www.intensivedesignlab.com/free-client-intensive-script

• The Secret Podcast (behind the scenes of 5K intensives): https://www.intensivedesignlab.com/the-secret-podcast

Find her at intensivedesignlab.com