Ketamine therapy and clinician retention with Kimia Moghadam

Dan King: [0:00] Hello, everyone. I am delighted to be joined by Kimia Moghadam, the clinical director of MyTherapyNYC. Welcome, Kimia. Kimia Moghadam: [0:58] Hi. Thank you so much for having me. Dan King: [1:00] Pleasure to have you. So tell me about MyTherapyNYC. What is it? Kimia Moghadam: [1:05] Yeah, good question. We're a group private practice in New York, Manhattan. We have about 30 clinicians right now. We have every year we get about four to six interns. We serve over 500 clients at the practice currently, and we offer many services, individual therapy, couples therapy, EMDR, different types of group therapy. Recently, we added ketamine-assisted therapy as another service as well. We also have a meditation group, so lots of things that we do. Dan King: [1:36] Lots of things for us to delve into. How do you see the role of the clinical director? Because I get different answers from different people. Kimia Moghadam: [1:42] It is something that can look differently in different practices. But a very traditional clinical director role is a therapist who supervises a handful of therapists and is in charge of doing clinical trainings for their staff, as well as just managing the business overall. So that's really my role. And I see my own clients. I have my clients. I supervise our staff. I am the person who runs the internship program, too. I wear many hats. Kimia Moghadam: [2:14] And I think that's a clinical director. You wear many hats. Dan King: [2:17] Let's start with the training piece. What makes for a good training for clinicians? Because they are bombarded, right? There's so many different training providers saying, hey, we want to teach you things. We want to sell you things. What makes for a good, effective training? Kimia Moghadam: [2:29] Good question. I think for newer clinicians, if you are new into the field, I think it's really investing money in one training that sets you apart from other therapists, whether it's a niche of treatment like EMDR, for example, or ketamine-assisted therapy, or you also can dive into little trainings to kind of understand what you're interested in, thinking about the population that you want to serve long-term, your own identities that will be part of your work with your clients, and kind of just like focusing on those and finding out your identity as a therapist. So with newer clinicians, that's really what we focus on, figure out your identity as a therapist, your interests, the population that you really want to work with, and then invest your money and time in empowering those parts of your identity as a therapist and eventually Kimia Moghadam: [3:19] finding very unique trainings that you want to do as a skill. Dan King: [3:22] What was that journey like for you of understanding your identity as a therapist? Because it's interesting, beyond therapists, I've worked with a lot of actors over the years, and they go through this really beautiful, rich journey of there's certain types of work, and I'd put acting and therapy in the same bucket this way, right, where identity influences impact, influences how you show up so much. What was that journey like for you? Kimia Moghadam: [3:43] I think it's an ongoing journey. I think I'm still exploring my identity, and sometimes it changes as a therapist because my interests change over the years. But I do think my identity as a woman, a woman of color, and someone who struggled growing up with body image issues, disordered eating, those became a lot of my interests just based on my own personal experiences with it. And when I graduated from school many years ago now, I kind of wanted to really focus on those and work with clients that deal with similar issues and share similar identities than mine, like women, for example, women of color and trauma, racial trauma. So a lot of that became my focus in the early stages of my work. I also used to work at the UN. So politics was an important piece of my journey in the Human Rights Council. So I really wanted to focus on that as well. And I brought part of that world into my work as a therapist. So a lot of the clients that I started working with were the ones dealing with racial trauma, inequality within marginalized communities. Dan King: [4:50] Sometimes the training in any discipline, you know, I'm not a therapist, I'm a lawyer, but I've had this experience where sometimes the training can Dan King: [4:57] seem very technical and we can lose track of our humanity. And I've seen therapists tell me they've had this experience, and it's so important to see and reflect on the implications of the different parts of yourself. Kimia Moghadam: [5:09] Absolutely. I love that. I say that to all of my interns. I say the most important intervention that you can ever use is your own personality as a human with your own personality traits and sense of humor. Everything else that you learn as a therapist with interventions and training is just going to be a bonus. Dan King: [5:27] This wise person once said to me, I used to be a coach, never been a therapist, but said, are you inclined to subconsciously save a version of yourself? Right? You ever heard that idea before? Kimia Moghadam: [5:39] Yeah. Dan King: [5:39] What comes up when you hear it? Kimia Moghadam: [5:40] I don't know. For me, it's so hard to separate myself and my own experiences as my therapist identity. So a lot of the things that I've had to work through in order to figure things out for myself are the things that come up in therapy sessions with my clients. And because of my own experiences, I feel like I can help them get through it from a very personal lens. Dan King: [6:06] And that seems to me to be so key because one of the key questions that comes up in the therapy business is how should customers choose a therapist, right? And yet there seems to be, I so often see that the more effective therapy experiences, at least that I've had, that people I know have had, have been, there's almost this sort of mystical connection between person and therapist, where we seem, for whatever kind of reason, and it can be hard to explain, drawn to people at this very, very deep, rich level. Kimia Moghadam: [6:33] Absolutely. I think it's so important. I think finding the right therapist is really like dating. You'll have to go through a few experiences that are not so great to learn your needs, learn what you actually want out of that relationship, because it is a very vulnerable relationship. And I think at least through the modality that I practice, the relationship between the client and the therapist is the thing that heals the client and also the therapist. So I think it's incredibly important that you find a therapist that you have a really, really close relationship with you like them and you just feel so understood by them. Dan King: [7:07] How does that relationship feel? Kimia Moghadam: [7:08] Well, I think a lot of our experiences in the world are reflected in the relationship that we have with our therapist. That therapeutic relationship or that room is a reflection of the world and how we navigate the world and see the world. And if whatever is triggering outside of that therapeutic room, the traumas you've gone through, they're going to come up in therapy. And if you have a different experience with your therapist, you can really start healing those wounds. If you have trauma around being abandoned, for example, and feeling like you're so unloved, and then you end up working with a therapist that shows up for you consistently every week and just gives you so much love and care. Over time, that's healing that wound and you start believing that you are lovable and that you are deserving and that you can have very secure relationships with people and they won't leave you. Kimia Moghadam: [8:01] And that's just an example of how that relationship can heal. Dan King: [8:04] So turning then from that challenging decision of a patient choosing a therapist, how should a therapist choose a group practice? Kimia Moghadam: [8:11] I think you've got to think about your values as a therapist. So what are you looking for, especially around supervision, especially if you're early on in your career? You should choose a therapy practice that is going to give you the training and the supervision that you want, the modalities that you resonate with. Whenever we interview for a psychotherapist role, we always kind of give them some clinical questions to get a sense of their style. But we also tell them how we would approach that as clinicians, because then that teaches them what type of training and supervision they're going to get from us. And we always say, as much as we're interviewing you, you're interviewing us to see if this is a good practice for you. Think about team culture, what type of colleagues you want to have. I think being a therapist is an incredibly isolating job. And most of us are in our rooms throughout the day, just seeing our clients. And it can get very lonely. So are you the type of person that wants to be around the team, be social with people, or are you okay with just being by yourself in your office? So really thinking about the team culture as well. Dan King: [9:11] How can I distinguish between the different cultures that practices have? Because you look at a website, most group practices have very similar websites, even very similar names. I think in a few years of working in the mental health space, I found about 10 practices called Clarity, right? So many have the same name. So it can be hard, especially if I'm a newer clinician, I haven't worked in a group practice yet. How can I distinguish between what makes the culture of this place distinct? Kimia Moghadam: [9:36] If you look at our website, in every page, you see the values of our practice. We talk about what we believe in, what the modalities that we practice. You see all the services that we offer. Anyone who we hire knows. Accept specialized trainings. They're going to be offering individual therapy. They're going to work with couples. We are an LGBTQ practice. So a lot of our clients identify within that, even our therapists identify within that community. And that's very evident from our website. You'll look at our therapist page, you see all our team, you see their intro videos, you get a sense of their personality. So it's really good to just kind of dive deep. We have a pay where you can program. We accept insurances. All of that changes the clientele that you see at the practice as well. So it gives you a lot of information. You do that type of research. Dan King: [10:25] Remember when we first spoke, it struck me how deep your videos are, how deep your practice goes in showcasing what makes each of your clinicians distinct, right? So it's quite rare that you'll actually have a two-minute video for your typical group practice demonstrating, hey, this is what makes this clinician interesting. This is how this clinician sees themselves and what they offer. Dan King: [10:47] Have you done that for a while? Kimia Moghadam: [10:48] Yeah, we've done that for a very long time with the videos. And actually, we changed our intake process as well. Because before, we used to kind of assign therapists to clients. But because of all the changes that we brought to the practice, we added all these videos. We have the clinician's pronouns, specialties. The clients get to choose their therapist. That is our intake process. They see the bios and they tell us who they want to work with. And that's really important as well. Dan King: [11:16] Can you say more about that? So if I'm a new patient, I'm immediately given, when I say I want to be a customer, I want to be a patient at this practice, I'm given a list of every clinician. Is that, walk me through how that works. Kimia Moghadam: [11:27] Yeah. So most of our intake is very automated in a sense that there's a form. Clients fill out the forms, the get started form on the website. They have to answer a series of questions. And based on that, they get a link to all the therapists that are available within that preferences that they're telling us, including insurance. So that is how they get to see those therapists. They know for sure that this therapist has these availabilities and they just book it. They tell us that, hey, I want to work with this client and this clinician this time virtually or in person. And then we'll just schedule it. Dan King: [12:04] So you guys are a mixture of in-person and telehealth. Kimia Moghadam: [12:07] Yeah, and that's super important for us for the reasons that I mentioned, like team culture. One of the reasons that we are very adamant about being on a hybrid model is just creating the environment where we want to be together, we're social, we come to the office. And also, we're seeing a lot more interest in in-person sessions than before. Dan King: [12:24] So what percentage-wise, how does that break down? What percentage roughly of sessions are in-person versus tele? Kimia Moghadam: [12:30] Honestly, I think right now with our practice, it's half and half. All of our clinicians come to the office three times a week and work remotely twice a week. And I think half of our clients come in person for their sessions. And I do think it's because their jobs are also changing. We have to think about that. A lot of offices are now requiring people to go to the office at least three, four times a week. So before people were doing more virtual days at home and it was easy for them to also do therapy within their work days at home. But right now we're seeing a lot more people wanting to come in person early morning, late in the evening. So yeah, I do think there's a big interest now in in-person sessions. Right. Dan King: [13:12] And as you're offering services, like I'm guessing EMDR is pretty hard to do remotely. Kimia Moghadam: [13:17] You can do it remotely. There is a software that we pay for. It's identical. It replicates what you have in person. So it's actually pretty Kimia Moghadam: [13:25] easy to do EMDR virtually. Dan King: [13:27] So speaking of services and everything you guys offer, I think one of the other things that makes you guys distinctive is this vision you have to build a broader wellness practice with therapy integrated into it. Can you say more about that vision? Kimia Moghadam: [13:38] Well, the practice was founded. I mean, it's still called My Therapy and My See Mental Health and Wellness Services. I think for most of the time that we've had this practice, we focus on mental health aspect of it. And this year, we really want to push for the wellness part of it and just have a wellness services, collaborate with wellness providers and have more just a holistic approach to therapy. So right now we do have, for example, monthly meditation groups, but we're hoping that we can have yoga groups, we can have like workout classes, we can collaborate with dietitians and nutritionists, so many different providers, wellness providers, even like financial planners. When I think about wellness, it's a very holistic approach to wellness. Finances is part of it. Physical, mental wellness. So we're really thinking of different providers to collaborate with. Dan King: [14:29] I think it makes a great deal of sense because as our lives are increasingly complex, these different facets, right, of the journey, right, if my nutritionist is working with my social worker The outcomes could be so different, right? Kimia Moghadam: [14:45] Absolutely. It's just, again, like such a holistic and collaborative treatment where the client really feels taken care of in so many different ways. And they just know that they have a team of providers that are constantly working together, talking together to make sure that the client is doing well. Dan King: [15:00] Is your sense this is what patients are asking for? Kimia Moghadam: [15:02] I think so. I mean, right now we do have a wellness community part of the practice that we just have a lot of providers that we internally refer clients to as they come to us and they tell us about like something that they're struggling with, but we just want to make that much, much bigger and make, create a wellness community where like we just have different wellness providers as part of our team that constantly providing these services. Dan King: [15:28] It's interesting. I think in particular nutrition is one of those areas where there is such potential for collaboration between your typical mental health Dan King: [15:35] clinician and the dieticians, nutritionists. And there's some really, really interesting research done by a guy named Chris Palmer, who's a Harvard psychiatrist, about showing the effectiveness of the keto diet for some of the tougher mental health conditions, which is really, really remarkable. Kimia Moghadam: [15:52] Absolutely. And I think on the flip side of it, it also makes the therapist's job a little easier because often I know to this day, I still fall into this where my clients come to me and they're really suffering. I try to be everything for them I try to tell them like little tips about eating or hold them accountable for things and I constantly have to remind myself that like that's not my job I don't know actually what to do here and then in those moments I feel helpless so if you have a team of providers then I just feel like the responsibility all of the responsibility isn't on me I'm not the only provider on the team. And that I know what my job and role is. And I know that they're getting they're being taken care of in all these other areas with other providers that actually know what they're talking about. Dan King: [16:39] Yeah, it's ultimately like a boundaries issue, right? Kimia Moghadam: [16:41] Totally. Absolutely. And and again, I'm not stressed so much of like, I need to fix this for my clients. Yeah, yeah, yeah. Dan King: [16:48] I think being in that space where there is a problem that someone you care about has and you can't solve it and being okay with that is it takes a time to get there. Kimia Moghadam: [16:57] Absolutely. It's hard. I still have to remind myself. Dan King: [17:00] Turning to the business side of the equation. So it's interesting. You have this vision to build out a broader wellness practice to integrate, let's call it therapy, MDR, the other modalities that we more commonly associate with mental health with this broader wellness business. So does this mean hiring a whole team of people to integrate them as W-2 employees into the practice? What does that look like from a business perspective? Kimia Moghadam: [17:23] Technically, we wouldn't be able to employ them as W-2s, but we will be able to hire them as contractors and pay them for the hours that they're providing a service to our clients. Just because as a social worker or mental health counselors, you can't hire, for example, a doctor. And it requires different credentials and licensing, but you can hire people as contractors to offer services, which is what we're hoping to do. Dan King: [17:48] And do you see the future, including medical services, speaking of doctors, or no? Kimia Moghadam: [17:53] Absolutely. We would love to have, for example, a psychiatrist that we work very closely with, and they are part of our team, and they see our clients, let's say, once a week or once a month. They spend five hours, come to our office and see our clients, whoever wants to make an appointment with. That's ultimately what we're hoping for, that on a regular basis, very scheduled, we know who's going to be providing what service for our clients, and we can just let people know. Dan King: [18:20] I think it makes sense because there's increasing research that shows when you have a full array of behavioral health services, right, the outcomes for patients are just stronger. Kimia Moghadam: [18:30] Absolutely. And we're still pro-medication at our practice that it's just an important part of treatment for us to make sure that our clients, Kimia Moghadam: [18:38] again, like they're really getting everything that they need in order to heal and get through life. Dan King: [18:42] Right now, do you refer out to medication providers? Kimia Moghadam: [18:45] Yes, right now we do refer. Again, we have a handful of people that we personally collaborate with. We know them. We trust them. So anytime our clients come to us and they want to start talking about medication, we kind of just refer them and give them the information. Dan King: [18:59] I'm curious. One of the other actors in this story is New York City, right? So you guys are integrated in this amazing city. It's full of all kinds of beautiful experiences, all kinds of intense, sometimes soul-crushing experiences. What is it like to do therapy in New York specifically? Kimia Moghadam: [19:14] Up and down. It's amazing. It's fun, but also incredibly hard because you have so many different types of people that live in New York and see you. So it's always a range of clients that you see, which I think to me is very exciting and fun. But also it can be incredibly challenging if you are not used to certain type of people or you constantly see newer presenting problems or newer things that you just never knew that it was there. Or communities that you are not part of or never heard of, and now you have to learn a whole new, just something completely different. So I think it's really, really fun, but it can also be challenging because of all the newness of things. Dan King: [19:58] Yeah, I've got to wonder, and this is going to be super stream of consciousness, but as a clinician, there's certain communities, certain identities that are going to come more naturally to me, they're going to be closer to what I know. There's a lot to be said also for stretching oneself, right? For working on either new problems or working with people who have identities Dan King: [20:14] that are dissimilar from my own. How do you think about that as a clinician? What is sort of the ideal balance there? Kimia Moghadam: [20:20] I'm biased in this because I actually, even though I started off working with majority women, I think like my caseload or the clients that I see now has tipped over to other identities that I don't share with my clients in particular. But I think like I've actually really, really enjoyed that because I love working with women And I think it's just a very different type of work because I identify with their problems. I know how it feels. So there's already this bond between us, which makes me feel so close to them. But on the flip side of it, when I work with clients that I don't share that many identities with, it gives so much room for me to be curious and not make assumptions or not feel like, oh, I know this problem and this is the answer. So with working with women, sometimes I have to check myself in that way because sometimes I may over-identify with a client and assume what they're going through. But when I work with someone that I don't have anything in common or don't share identities with, I can't make assumptions. So it gives me so much room to be curious and ask questions and learn. And I love that too. And so much of my clinical growth has been working with clients that I don't share identities with. Dan King: [21:33] I got to assume it's going to be very easy after practicing for many years to lose that curious edge. Kimia Moghadam: [21:38] Absolutely. It's so easy, especially because you get comfortable working with certain population. And then that's it. You feel like you don't really need to grow. And this is not a conscious choice, but like it just feels good and comfortable. Kimia Moghadam: [21:51] It's hard to be curious or want to push yourself to learn. Dan King: [21:54] In terms of curiosity, in terms of growth, what do you see as your edge as a clinical director, right? You've done this for a while at this point. You've been an experienced clinician. What is your own edge as clinical director? Where's the growth opportunities, do you think? Kimia Moghadam: [22:07] I think my edge or the thing that I am really proud of is just, again, my curiosity and my commitment to myself to do one big training every year that is very skills-based. For example, EMDR or recently I became certified in ketamine-assisted therapy. I think that is what I want to do. I want to every year for as long as I'm going to be in this role, I will continue to learn about the trends of the world. Where we're headed, the things that are my blind spots, the things that I have an interest in and actually invest money and time in a big, big training every year to continue to grow in that way and be able to Kimia Moghadam: [22:44] teach my staff, be able to supervise them around things that I may not know. Dan King: [22:49] I'm a clinician and I'm exploring the possibility of learning about ketamine-assisted therapy. Tell me about that. What makes that interesting? Kimia Moghadam: [22:56] So for me, I really am the type of therapist that wants to really focus on the future and the future of this industry versus what's happening right now. So all the trainings that I have done or continue to do are mostly focused on newer things that are coming into this industry and into this field. And that's just, again, my commitment to my role that I want to stay ahead and stay on top of the new things that are coming into our world, our industry, and where we're headed. Because that allows me to, figure out visions for the future and build and expand. And ketamine-assisted therapy is one of those things that it's very, very new still. Obviously, it's very controversial. People have different opinions about it, but it is something that is happening. People are doing it, and it's incredibly beneficial. And I was like, I have to learn it. I need to know it. Dan King: [23:51] Could you say more about what you learned in that domain? I see more and more practices offering it, right? So it's getting, you're absolutely right that I think it's going to be a bigger and bigger part of the future. There's a super increasingly strong evidence base for ketamine itself. We talk about ketamine therapy. What have you learned? Tell me about your experience of learning it and doing that work. Kimia Moghadam: [24:14] It's very similar to when I did my EMDR training a few years ago. I think it's just fast-paced, structured, short-term therapy that does wonders. It's there's so much evidence and from also patients that have said like doing ketamine assisted therapy has felt like 20 years of regular talk therapy in like five sessions and it's true the benefits of it is that it's incredibly short term it's very very structured it's just fast healing but again it doesn't it's not a quick fix you'll have to also understand that like if you've never been in therapy before in your life and you have complex history of trauma it's not going to be like magic in three sessions to five sessions. A lot of people that do this type of treatment, it's been in therapy for many, many years. And this is just another sort of treatment that they're adding. So you'll have to think about it as something that you're doing it on top of other types of treatments you've done. And also really the success of it or the duration of it also depends on your history and the trauma that you are experiencing or have experienced. Dan King: [25:18] Yeah, no, I think that's a super important note for patients that are considering it. What would you say is different about from a clinician's perspective? What do you think is different about it? Kimia Moghadam: [25:28] Very similar to how I feel about my EMDR training. It just, it's completely different on what your vision of like a therapy session is. What we do with our clients, they come in, we talk for 45 minutes, we laugh, we cry together. But with these types of treatments, that relational piece is not so evident. And it's not a big part of the work. I think it's incredibly still important that you create a very trusting and safe environment with your client and that they trust you because they're going on a journey essentially with you and they need to trust that you'll be there for them. But I think like when it comes to individual therapy or couples therapy, the traditional sense of therapy, the relational piece of it is what healing happens. But with other treatments like ketamine assisted therapy or EMDR, the relational piece is not. Kimia Moghadam: [26:21] Biggest part of the treatment. Dan King: [26:24] Because this other tool, right, has independent healing power. Kimia Moghadam: [26:28] Exactly. So much of that healing is just coming internally from yourself and what your brain does. Dan King: [26:33] Super interesting. I'm curious if you think about what's fun for you when you're not being a clinical director, when you're not seeing your own patients or learning a new modality, what do you do for fun? Kimia Moghadam: [26:44] Outside of work or still at work? Dan King: [26:46] Outside of work. Kimia Moghadam: [26:46] Outside of work. Sorry, I'm a very social person, spending time with family, friends, partner. I have a dog. I love taking him on long walks out by the river. I live close to the river in Manhattan. So those are my self-care. I love Pilates. So at least three to four times a week, I'm doing a Pilates class. Those are like some ways for me to actually my self-care. Dan King: [27:10] East River or Hudson River? Kimia Moghadam: [27:12] East River. Dan King: [27:13] East River. Yeah. Kimia Moghadam: [27:15] Yeah. Dan King: [27:17] Kimia, thank you so much. Such an interesting journey and such an interesting, Your practice, I think, is such an interesting window into the future, right? It holds so much potential as therapy practices in the wake of the pandemic are evolving and thinking about who do they want to become, right? What do people need that may have been different than they needed in the pandemic? Dan King: [27:35] And what tools are available to help people get those outcomes? So super interesting conversation. Kimia Moghadam: [27:40] Thank you so much for having me on this. This was really fun for me as well. Thank you for listening to your group practice. If you're involved in building, expanding, or managing a group practice, make sure to subscribe so you don't miss any future episodes. Until next time, thank you for tuning in.