Attachment-based group practice with Anne Luckinbill

Dan King: [0:00] Hello, everyone. I am privileged today to be joined by Anne Luckinbill. She's a licensed professional counselor and founder of Seasons Counseling in Virginia. Anne, welcome. How are you doing? Anne Luckinbill: [0:13] Thank you. It's lovely to be here with you. Dan King: [0:15] Yes, always, always. Tell me the basics on Seasons. How long has it been around? How many clinicians is it? Give the audience, please, the basics on Seasons. Anne Luckinbill: [0:24] So we have a Seasons is in central Virginia. It has gone through, It used to be Luckinville Counseling under my name when it was a solo practice. And then as we expanded, it was less about me, less about Luckinville Counseling, and more about the other therapists and the practice itself. So it transitioned to Seasons Counseling in 2023. The name change happened about 2023. I started on my own. And then I had a former colleague from community service work that reached out. And she said, hey, do you mind if I work with you? And I said, sure, let's try that. And then so she came on and then we hired our first resident in counseling, which is a pre-licensed therapist. That went well. So we hired another resident and then we didn't have enough space. So we moved to a bigger office in Culpeper, Virginia, and then filled that up, filled it up with clients, filled it up with therapists and added a second location and then a third location. And now we have a fourth location in this geographical area. Dan King: [1:25] So it sounds super organic. There was no master plan at the very beginning that this is the way it's going to look. It seems very organic by the way you describe it. Anne Luckinbill: [1:34] It was very organic. It still is. We still grow very organically. We wait for doors to open before we take a next step. And if something feels complicated or there's some resistance, I have learned that that's not worth pursuing or not a path to take. Anne Luckinbill: [1:49] So I just kind of wait for the idea and the easiness of that growth, and then we do it. Dan King: [1:54] I'm inspired to back up just a little bit and ask, you were a teacher. How did you get to this whole group practice owner thing from there? Give us the high level steps of the journey because it's an unusual background for doing this. It actually makes a lot of sense to me that you would have that background and I can see the two backgrounds working beautifully together, but it's not one that I see very often for group practice owners. Anne Luckinbill: [2:13] Yeah, I was a teacher. So out of college, I was in Indiana at the time. And at that time, teaching jobs were hard to get. That was in the early 90s. and I was not going to get one in Indiana. So I applied all over the country and got a teaching job in Virginia, took it, moved to Virginia, taught elementary school, loved it. Taught elementary school for about six years, third and fourth grades. And then I, in that time, I got married. And when we had our first child, I decided to stay home with him. So I stopped teaching, stayed home, raised children. It was time to go back to work. My husband was ready for me to have some more, some income. And I was too. And I didn't want to go back to teaching. By then, it was a different world. So that would have been when it was time for me to go back to teaching was about 15 years ago or go back to a job. And I didn't want to go to teaching. It was a different world in education. Still is kind of. So I was like, OK, now what? So I got my master's degree in counseling. I thought I could I could do that. Got my master's, did work in community services Anne Luckinbill: [3:10] and then decided to go into private practice. And it's been that teaching background has been really, really helpful as a therapist and now with with my staff as well. Dan King: [3:19] What made you decide on counseling? Anne Luckinbill: [3:21] Well, I really wanted to help families. Like, we have a nice family. We have nice kids. Um... And we have our house had a revolving door of children always. And I was like, I really want to help some families and some children. And the best way I see to do that is through counseling. I can touch young moms. I can help raise those help raise those young families in healthy ways and decided that was a good avenue to do it to make the most impact. Dan King: [3:49] So family was really kind of a guiding force, you thought to yourself. I think I figured something out about family having raised one. Anne Luckinbill: [3:56] Yes. And as I sit here, I'm looking into my kitchen and I can just picture all the children and families coming through here was pretty constant. And we have an expression in the house. It's always, always room for one more. And we always had room for one more. So I learned a lot about children and the different ways parents parent their children. Anne Luckinbill: [4:15] And I thought I can help here. On one level, so there's a few things. One thing I also did, I was on school board in Culpeper County, Virginia, for 16 years. So I stayed involved in education. I just ended that. I just ended my school board term two years ago, less than that. So I had done that for 16 years. So I was still very involved in education. Anne Luckinbill: [4:39] And that kept me current on what happens in education, what happens in public schools. And so a lot of our clients are children, teens, and teachers and parents. So they're all in the school system. And that helped. Then I could use that knowledge base and those experiences with my therapist to inform our clinical practice about school-related issues and what teachers go through. We have a lot of clients who are teachers and how hard it is to be a teacher and the stress of being a teacher. Anne Luckinbill: [5:11] So we had a really solid base in what education looks like, which could inform clinical practice. And then now I'm still a teacher. Right. As for my staff, I'm still teaching. Just this morning we were teaching. And I won't say my therapists are like students because they're not, but they're eager for knowledge. And to be able to have those conversations is beneficial to me, to them, to our clients. So we have very much a teaching model. And actually, another one of our supervisors comes from a teaching background. And so she enjoys teaching staff as well. So we very much have a learning culture in the practice. Dan King: [5:45] And I know core to the practice's therapeutic methodology is attachment theory. In what ways are teachers caregivers? Anne Luckinbill: [5:52] So many ways. Teachers are, and in my head, I'm picturing elementary school teachers, but it certainly goes up through middle school and high school as well. I could talk forever about the changes in education in schools. But teachers have become more and more of caregivers expected to fill roles that aren't happening at home necessarily or in healthy ways at home. So kids are coming into the building with a lot of stuff. And teachers have a lot of balls in the air every single day, caring for children, trying to teach the content, caring for each other. They care for other staff members. Teachers are absolutely caregivers. It's a hard job. Rewarding and hard. Dan King: [6:29] It also makes me think about clinicians. Sometimes early clinicians struggle with boundaries. And I'm imagining a lot of younger teachers may struggle with boundaries there, too. Anne Luckinbill: [6:37] Yes. Yes. You know, and everybody has their own stuff. Right. So a teacher has. His or her own baggage too. So then when they try to carry the load of their students, it can be complicated and hard for them. Anne Luckinbill: [6:50] And it is hard. With the expectations put on them, it's hard for them to set boundaries. Dan King: [6:54] This is a natural segue to your resident program. Can you describe what that is? Can you tell the audience a little bit about your resident program and its significance? Anne Luckinbill: [7:02] We hire residents in counseling. That's what they're called in Virginia, which are clinicians who have finished their master's degree and they're in their residency period to get their counseling license. We also hire social workers who have finished their master's degree. Both require approximately 3,000 hours of clinical time between degree and licensure in Virginia. So we hire those residents is what I'm going to call them for the sake of this conversation and give them really good supervision. They're required to have 200 hours of supervision in the mix of the 3,000. It's actually 3,400 in Virginia. So we give them the 200 hours of supervision at no cost to them. And we give them a ton of direct client hours. And we grow these people from someone who just has their degree to someone who's ready to be licensed for independent practice. It's an amazing process. We love it. So we now have three supervisors on staff And we have two, well, we have three supervisors for residents on staff and two supervisors for our social workers on staff because they have to be separate. We can't supervise each other for some reason. And we just, we're a great place for a residency. The word's really getting out nicely that Seasons is an excellent place to do a residency in Virginia. And we're proud of it. We're proud of these staff members. We hire carefully. Anne Luckinbill: [8:29] We hire well. And we treat them really well. Dan King: [8:31] I definitely wanted to dig into how you hire because I think that's another your particular interview process is really distinctive. And I think will be super, super helpful to group practice owners who are always hiring. But before we get there, how many residents have you trained? And are there additions to this program you could make? So you've already built something cool. Do you see what else it could become? Anne Luckinbill: [8:54] Yeah, so how many have we, I have some that are still with us They started with us as a new resident and now they're licensed One of them's even a supervisor now, so she's been with us, a long time, five years. How many have we trained? Well, there's 18 of us on staff right now, and we've put some out into the licensure world. So I'll say sort of a guess, but I'll say 22-ish. Are there additions? Absolutely. I'm looking now at how to partner with, not to complicate the conversation too much. So there's different types of residents. And then there's also interns, which is someone who's in their college program. So they're in their master's degree and they have to do what I would compare to student teaching in the counseling world. So I'm talking to a couple of schools in Virginia right now, colleges, about partnering to take those interns who are still in their degree program, offer them internship opportunity, which is a little trickier because that can't bill insurance. An intern cannot bill insurance. So it's a little more complicated. And then move them into their residency and keep them. So I'll have an intern who becomes a resident who becomes a licensed person. And that would just be a really nice channel. I'm smiling as I think about it, growing really good therapists to have them for that long. Dan King: [10:06] And part of growing really good therapists is hiring really good therapists Dan King: [10:10] in the first place, right? And so what is, how would you, if you were to describe to a fellow group practice owner, how your interview process works? How would you do it? Anne Luckinbill: [10:20] We have three interviews. It's actually slightly more than that. So there's an application, a resume, and then I take the first phone call with the applicant. I go over the benefits, the particulars of the job, and I sort of rule in or rule out the candidates. If, and this candidate does the same for me, right? Like I'm interested in seasons. I'm not interested in seasons. If we proceed past that phone call, then we schedule a first interview and a second and a third interview. I am only in one of those. I mean, it just really depends on my schedule, which one I pop into, but the interviews are with the team. It's with a supervisor for sure. And then one or two members of the staff. And we just, we don't care who sits And other than the supervisors, we don't care what staff member is in the interview. It's a team culture and the applicant gets to decide, can I see myself here? Can I see myself with these people? And of course, vice versa, right? We're watching that as well. So we have three sets of interview questions that I have worked on really thoroughly. I have used AI and I've run them through AI programs to weed out sort of answers that could give us red flags. So we have sheets that we're looking for what's a desirable answer here. And what is a red flag answer on these questions? And it's very effective, very, very effective for each interview that we do. So no matter who's doing the interview, they know what they're looking for. Dan King: [11:43] Sorts of red flags that you're screening for. Anne Luckinbill: [11:46] Well, we look for, we want to look for answers, of course, that have clinical content and show empathy and consideration for ethical, consideration of ethical concerns, consideration of worldviews, sexualities, cultures. The red flags pop up when we ask questions and the applicant answers with their own story, their own personal story. Or rather than talking about a client, they talk about their child. And we asked some attachment-based questions in our interview. Who in your family are you similar to? That's a very enlightening question, right? The applicant can answer that any way they want. And that, for me, as an attachment person, that's a really interesting answer, no matter what it is. We ask questions like, how are you at making conversational banter with a stranger? And the applicant's like, what? The applicant is thrown off a little by that question, which is part of the intention, right? Because they're expecting, what theory do you like? So the answer needs to be, right, I'm pretty good at it. I can talk to Iraq is what we need to hear. Their response, their answer to that is very telling. Dan King: [12:53] These are not questions that come up in most interviews. Anne Luckinbill: [12:56] Not usually, right? Dan King: [12:57] And it's true. When you throw someone off a little bit, when you bring in the unexpected, I think you are more likely to get someone's first instinct, right? I think you're likely to uncover some truth. Anne Luckinbill: [13:09] Yes, yes. It's nice to be able to sort of dig deeper, right? Like, so tell me the last time you struck up a conversation with a stranger. What was that like? What did you talk about? What was your impression of that person that you were talking to? And there's a lot to be learned from those sorts of answers, you know, because we're looking for a therapist, right? I'm not looking for an engineer. I'm looking for a therapist. So it's, yeah, very helpful. Dan King: [13:31] So many clinicians have a personality type that for whatever reason, whether it's, you know, energetic or something else, so many clinicians have a personality type that naturally draws people to open up to them. And so there's going to be some clinicians who might be quite extroverted, who are going to approach and are going to kick off that conversation with a stranger, but there's a lot of clinicians that are going to naturally draw a stranger to open up to them. Anne Luckinbill: [13:55] We hear that too, right? Someone will say, I don't naturally engage, but people feel like they can tell me anything, right? I feel like I'm a magnet for that kind of stuff, which just leads to another question from me, right? Because how do you respond to that? How unloading on you. Dan King: [14:12] I'm thinking you're more the expert at hiring therapists than I. I'm thinking people could range at different places on the extrovert-introvert spectrum and be very good clinicians, right? We're not necessarily screening for extroversion versus introversion with that question. Anne Luckinbill: [14:29] No, not at all. Dan King: [14:30] And their relationship to impromptu communication. Anne Luckinbill: [14:33] That's right. It's impromptu. And are you comfortable with it? Right. Because we we get clients in sessions that don't know what to say. They don't know what they're going to talk about. They don't. So it's sort of our job to evoke. Right. So are these therapists able to evoke that conversation or, you know, does that make them clam up? Right. That doesn't work real well as a therapist. So even it's not honestly, Dan, it's not my go to to talk to a stranger in a grocery line either, but I can do it. Dan King: [14:59] Right. Anne Luckinbill: [14:59] So can you do it? What's it feel like for you? Dan King: [15:02] So I was in an Uber a week ago, and after about five minutes, the driver of the Uber introduced me to his daughter, who was not in the Uber. He decided to call his daughter, and I ended up speaking to his daughter on the phone. This was one of the most interesting Uber rides you could ever imagine. Anne Luckinbill: [15:19] So I have so many questions here. So what did you talk to this daughter about? Dan King: [15:23] I think there were two angles to it. It was interesting. We won't dwell on this, but it is kind of fun. The two angles were, I think he was trying to set me up with his daughter. Then the second angle was she happened to be a therapist in training. And after three minutes, he was like, you're so interesting. What do you do? And I always debate whether to talk about that at an Uber. And I gave him the very basics. And he said, oh, you're in mental health. My daughter is blah, blah, blah. Oh, and I think you're really going to like her. So, immediate rushes to the phone, doesn't ask for permission, and there we were talking to his daughter, who was as shocked as I was. Anne Luckinbill: [15:59] She was like, Dan, not again, not another Uber ride. Dan King: [16:05] But that's, I mean, as in the moment, sort of flummoxed as I was, those of us that have a lot of conversations have a lot of the same conversations, right? And so that novelty was, well, challenging in the moment, that novelty is something I'm going to remember, right? Anne Luckinbill: [16:20] Absolutely, right? So she might too, unless Dad does that often. Dan King: [16:23] I ended the Uber ride hugging the Uber driver. And, you know, he was this Italian immigrant who had come to the States however many years ago. And Ubers actually are an interesting place for therapy-like conversations. Anne Luckinbill: [16:38] I believe that. Dan King: [16:38] Because so many of these drivers spend a lot of time with people that they want to talk to but can't. And so I've even run into Uber drivers. And I am Uber's best customer because I've never owned a car. So I might get into Ubers all the time. Oh, you've got a breadth Anne Luckinbill: [16:53] Of experience here. Yeah. Dan King: [16:54] I'm Uber's best customer. But some of them, I mean, I've even read it to people, drivers that say, you know, I just really want to talk to people. I don't need the money, but I do this so that I can talk to people. Really? So I wonder whether there's a therapist interview process in the back of it. Anne Luckinbill: [17:08] Maybe. Maybe my question should be, how are you in an Uber? Are you Dan King? Anne Luckinbill: [17:13] Can you just talk to anyone on the phone even? Dan King: [17:15] So what's driving you now? You know, you've built this practice. You've got a really interesting resident program, right? You're teaching folks. What still excites you and what's motivating you to keep going? Anne Luckinbill: [17:25] It just happened this morning. We have three types of supervision, individual, and then group supervision, which is at the office site. And then once a month, third Wednesday, we do a whole group supervision, which is we all come together virtually from each office location. And we have gotten to the point where we have to set an agenda because there's now 18 of us. So we want to make sure we cover what we need to cover today's was we talked about ai because we're implementing ai into our note taking which is a game changer and the therapists are so excited about this it's actually it's a game changer i could say a lot about it but it's changing their workload it's changing the quality of our notes so many things so in group soup today we took our whole group soup we talked about ai for a while celebrations concerns because we've only been doing about two weeks and then we had i had posed the question to them after we did that. A week or so ago, I sent an email and said, for discussion in whole group, I would like to talk about what brings your clients back to counseling with you. Not what brings clients back to counseling, generally speaking, what brings your clients back to counseling with you. And I think everyone contributed an answer and they were all individually and unique and wonderful and accurate. Like as they were talking, I was like yeah that's right that's this therapist that's why these clients are coming back to this therapist so they knew themselves which i love to see yes. Anne Luckinbill: [18:51] And felt comfortable enough to share in front of 18 other people. So that's what keeps me going. Growing these great therapists who are just providing wonderful care to our clients. That's what keeps me going. And to expand our reach. Dan King: [19:04] Love that. And I'm sensing another interesting theme here is that you are in your approach to building the practice, to leading it. So human, but also open to technology. Yeah. Oh, yeah. That also is a rare combination. And so I'm curious to hear Dan King: [19:19] more and more about this AI note-taking. I mean, I'm right there with you. I think it has tremendous opportunities to lighten the workload to just make everyone's life easier. Tell me about that process. Anne Luckinbill: [19:29] That's amazing. So it's embedded in our electronic health record. They're rolling it out. We were sort of some of their test dummies. Our practice was. So it records the session. The therapist hits a record button. It records a session. It transcribes it. It creates a soap note, as much as we use. As soon as the therapist reviews the soap note, signs it, the transcription and the recording are deleted. It's fully HIPAA compliant. And the note is done. Three, four minutes of the note is done. And therapists just, I cannot tell you the joy that it's bringing them. It just, well, you know, I have a couple, of course, every practice has a couple that struggle with documentation and they say, you know, this is making me love my job because there's no downside. There's no, it's not like, oh, I've got to do notes. It's done. And the notes are better. So we accept insurance and Medicaid and audits are a thing. I get them a lot and chart reviews and all the things. And these notes are making me feel so confident. In what is going to, or what will be audited. It's, I can't say enough good stuff. Dan King: [20:31] Do they need to be reviewed by a human afterwards? Anne Luckinbill: [20:34] Sure. The therapist needs to look through, right? And make sure there's nothing in there that they wouldn't want in a note. Because if the client's talking about, pick a topic, domestic abuse, right? Probably don't want that in the note. It's gonna, it will be there because it's AI and doesn't know that it shouldn't be there. The therapist just deletes that section. So it's not there, it's gone, it signs it. Dan King: [20:53] I think AI will get to a point where it can probably screen for that sort of stuff itself. Anne Luckinbill: [20:57] The conversation we had, it's screening for, it's learning from the notes. Like it's learning from the client's chart what we've been working on. Anne Luckinbill: [21:06] It has a brain. I swear it has a brain. Dan King: [21:08] Yeah, yeah, yeah. Yeah, it's brilliant. So as we come towards the end of our time together, we've covered some really interesting territory. We've talked a lot about practice building, your journey to get here. When you're not inspired to build a better and better practice at Seasons, what do you do for fun? Anne Luckinbill: [21:23] My kids, my husband, all of our whole family now, our youngest is 21. So we have four full-blown adults, which is just good fun. No grandchildren yet, and we are perfectly fine with that. Gene and I have been married for 28 years. We love empty nesting. We enjoy each other's company. I run most days of the week, early in the mornings, and I like food. I eat. I would say I cook. I used to cook. I don't cook as much anymore, and we just eat a lot of good food. Dan King: [21:50] What are your cuisines of choice? Anne Luckinbill: [21:52] I mean, it sounds like, yeah, right. But it's really anything. If it's good, it's fair game. Dan King: [21:59] Yeah, well, we'll have to. Now that I know you're a fellow foodie, we'll have to jam on that at some point. Anne Luckinbill: [22:04] My favorite thing is, if it's good, then I say, I can't make this at home. And I'm a fairly decent cook. But if I'm eating a meal that I can't make at home. Dan King: [22:13] It's... That's when you know a restaurant has hit a certain level. Anne Luckinbill: [22:17] Yeah, yeah. So those are the things. And we have some really good friends. We like to laugh. Dan King: [22:21] Yeah, we're prolact. Yeah. And so, so good to connect with you. Such, such interesting goodies here for practice owners and clinicians alike. So thank you for sharing your wisdom.