Five-step scaling method for therapy practices with Nicole McCance

Dan King: [0:00] Hello, everyone. Excited to be here, especially excited for another interview Dan King: [0:04] today because it is with Nicole McCance. She's a retired psychologist and a business coach for therapists. Nicole, welcome. Nicole McCance: [0:11] I'm so happy to talk to you today. Thanks for having me. Dan King: [0:14] It's great to have you. So tell me, what's the story of how you got into this? Because there aren't too many business coaches for therapists out there. Nicole McCance: [0:21] Yes. Like everyone probably listening, I was doing EMDR and couples therapy for 15 years and I loved it. But honestly, if I'm honest, Dan, the amount of clients that I had to see to have a great life was a lot. And I became sick of hitting the ceiling in my income. And then I became pregnant with twins. And I remember thinking, okay, I can't see more clients though. So what do I do? I'm about to buy two cribs, two strollers, two high chairs. Like all those are expensive. So guess what I did? Nothing. I did nothing for two years. The twins were born and they were two years old. And I did nothing because there was no guide back then. There was nobody who had actually done it like a business coach. And so I was able to grow it in three years to 55 therapists, multiple seven figures. And in my fourth year, I sold it. But what I'm really proud of is that it was automated and I got to be a new mom of two baby boys and actually be home. So when I did sell it and retire as a psychologist, I said to myself, I need to take this to my peers. Nicole McCance: [1:28] I did something very, very fast. And I, I'm now committed. That's what I'll do for the rest of my life is help my peers. Dan King: [1:34] Very cool. How long have you been doing it now? Nicole McCance: [1:37] Four years. And I've just, oh my gosh, it's just so much fun. Dan King: [1:40] Scaling to 55 in three years is pretty rare. How did you do it? Nicole McCance: [1:44] Oh my gosh, it was a whirlwind. I do have a bit of a formula. I call it the five-step scaling method. Do you want me to, I can go through all the steps? Okay, amazing. So step one, please systemize. It's systemize your operations before you hire. You want to build the container before you fill it. I don't know about you, Dan, but I see so many therapists saying like, ah, how hard is it just to post on Indeed? But then what happens is they become not a CEO, they become a CQA, chief question answerer, because nothing is systemized and they become very overwhelmed. The first thing I did, which made all the difference as a new mama, was get everything out of my head and create SOPs, higher-ended men, Nicole McCance: [2:31] and systemize with a really good practice management software. That's step one, systemize. Dan King: [2:37] Okay. And do you find when you actually talk to clinicians who are starting new group practices, I'm sure they appreciate the value of it. What percentage of them are well-suited to systematize? Nicole McCance: [2:50] Okay. So first of all, Well, I'm a very organized, almost regimented person. Like, I'm a bit embarrassed to say that, but I really am. Ask my husband. You know, he doesn't love that part of me. I'm being very... So people who are disorganized actually love working with me because I give them all of my systems. So I was able to sell my clinic, but I still have the shell of how I systemize. So those who are disorganized, I help them. With the systemizing. But I also work with people who are naturally quite organized and enjoy that. Most people don't, though. It's kind of boring. Dan King: [3:24] Let's be honest. You know, it's not the most fun. My mind doesn't, I'm ADHD, my mind does not work that way. Yes. But I appreciate the value of it, right? And so it sounds like even folks that are in my camp, and there are a lot of, I meet a lot of ADHD practice owners, even for them, your success rate is pretty high in getting them to do it. Nicole McCance: [3:43] Yes because i do it for them so so in my program everything is done the employee manual done the privacy manual by the way you need one most people don't know that it's done the sops the operations the exact things you should get your admin to do so i feel because of that it feels less overwhelming that they just have to customize and not create from scratch because that day you know never comes Dan King: [4:09] That that's a struggle for sure so that's step one tell us about step two. Nicole McCance: [4:14] Step two build your team i believe this is where the true freedom comes your first hire should be a mini me i'll tell you a quick story when i was 27 i fell in love i got engaged and i moved to russia that's a whole other podcast maybe have me back for that long story i gave my whole practice to someone for free. I know, like not a businesswoman at all back then. And she was, I made the biggest mistake. She was nothing like me. I'm a big personality. I'm direct. My clients were used to that. She was more timid and passive. And guess what? Not one of them stayed. I think they were thinking, what is happening? What has Nicole done? There needs to be some sort of brand consistency. Like when you go to Applebee's in Chicago and Applebee's in New York, you expect a similar brand experience. So I made that huge mistake. Thank God I moved back. I took all my clients back. I fell out of love and I took them back. But I learned the hard way. And here's the thing. Pick your mini me. Now I'll explain what that is. It is somebody who shares your personality, a similar vibe, energy, modality. Clearly they're going to be providing your modality, but most of all demographic. Nicole McCance: [5:28] If you're 27 something, I believe your first hire needs to be a 27 something. If you hire a 50 year old, I find the retention is lower if it's a different demographic energy personality modality. And the first thing that we want to be doing is I did anyway, was offloading some of my clients, just a few so I could work on the business. And when I found a mini May, I was able to retain those people. Dan King: [5:55] What's interesting is that a devil's advocate question would be just like when you're forming a business partnership, you want complementary skill sets. Yes. You would sort of think to yourself, my first hire should be able to do things well that I am not so good at, right? That would be a devil's advocate perspective, but you don't buy that. Nicole McCance: [6:13] Your admin can be that person, for sure. Your admin is the yin to your yang or the yang to your yin. That's amazing. But this would be your first hire is a therapist. So your clients are expecting that calm vibe if that's what you provide, because that's the brand that you're emanating. Now, your second hire, if you have a whole lot of clients to give, you could hire another mini-me. But your second hire, typically I suggest, you want to hire what you're referring out. So i was referring out children and families well eventually my next hire were those who see children and families so i can keep everything in house because guess what i was actually building somebody else's group practice no lie i was sending her five ten like children and families per week and she told me one day i'm building a group practice and i'm like oh my god wait why don't i do that Dan King: [7:09] Yeah yeah yeah very interesting so i totally get what you're saying when it comes to brand consistency because the reality is there are a lot of group practices out there you want to understand both from the perspective of a patient as well as a clinician what makes this one distinct why should i work there or why should i be a patient there right yeah and so it's been interesting seeing you know through this podcast a very wide variety of different practices I've seen Christian practices, right? I've seen very social justice-oriented practices. And there's something about our industry that actually lends itself very well to taking a stance in the world, to believing in something, to having a set of values that are definable because some of the work of good therapy is helping patients understand their values. So if you can't do that yourself as a practice owner... You're missing something important. Nicole McCance: [7:58] Yeah. Yeah. And I think with the mini me piece, it's why it really boils down to this. Why do we pick the therapist we pick? What is that? At first, it's shallow because we don't know them. And I think it's like likability. You like their picture. You like their bio. You like their voice. It could be simple as I like their voice on the console call. I haven't seen their face yet. You know, they remind me of me. They're in their 20s or they're a mom or, you know, whatever it is. So that's also what I mean by consistency, that something about you is attracting these people. Your first hire should have that je ne sais quoi, that X factor that you have. Yeah. Dan King: [8:38] Isn't it the case that the energy of a new business, the energy that is there when it begins is a powerful thing that in some way is going to remain there as long as you're there? Nicole McCance: [8:49] Yes. And then number three. Do you want me to go to number three? Dan King: [8:52] Absolutely. Nicole McCance: [8:53] So you've hired, you're systemized, you've hired, but now where's the clients? You need the clients, which is step three, attract clients with digital marketing. You see, I leaned on digital marketing because I was an overwhelmed, burnt out therapist with twins. And I really needed something that could work while I sleep. So I was, I told myself, okay, I'm going to invest in digital. And I want to talk today, 2026 about AI and, and getting now is the time to get show up in AI search. But how do we do that? Well, we do that by investing in SEO. Because right now, AI ads actually just got released last week. Not sure if you know that they're just, just, just releasing AI ads like four days ago. So who knows how that will evolve. But right now, ChatGPT and Gemini, they're pulling from the words on your website. So the first thing I would like your listeners to do is add FAQ. So digital marketing, if you add frequently asked questions to your website in spoken language, then there's a high chance that if it matches that you're going to show up in ChatGPT, Gemini, etc, which is the future. So I was investing in things like that. So I could be with my family, be a leader and still show up in the most important place, which was Google and now ChatGPT, etc. Dan King: [10:17] So does this mean then you were allocating more of your energy to digital marketing than you were to old school referral generation, building relationships in the community? Or were you doing both equally? Nicole McCance: [10:28] I would say for me, it was digital all day. Digital all day. We were local, of course. We were one of the largest. We had 24 rooms, 7,000 square feet in Toronto. I invested in the relationships. But for those that are listening who don't have the time, they're like, I don't have the time right now, then I would invest in the digital marketing. But if you are to spend your time on relationships, I think the first place to go is doctors. In Canada, we call them family doctors. I think you might call them primary care doctors. But doctors, because they see so many people in a day. And once I connected with doctors in my area, it was an avalanche of clients. But of course, it's like keeping that relationship. Dan King: [11:13] But it sounds like you're encouraging your clients to start with digital. Is there execution risk? You know, the average therapy practice owner doesn't know much about digital marketing. And there's this whole new world of, as you say, needing to learn about not just SEO, but AI ads. How well positioned is the typical therapy practice owner who has studied to become a clinician, not a digital marketer, which is a whole skill set? How well positioned are they to learn it and execute on it? Nicole McCance: [11:40] Oh, most important, they're not doing it. The fastest way to lose your money would be to do your own Google ads or do your own SEO. So number one, before they do anything is to invest in a really good website. A website's kind of like a bad haircut. You don't really know if you have one, you know what I mean? Like unless other, and that I find a lot of people like that, where they think they're attached to their website, but does it actually convert? Number one, invest. This is why we have digital marketing people in my program, Nicole McCance: [12:11] website people in my program. So I hook them up with the right people to learn. It is cost investment, but you will spend way more money if you do it yourself with your therapist brain, for sure. Dan King: [12:23] I like to say you'll be setting money on fire, right? Nicole McCance: [12:27] Exactly. Exactly. Yes. Dan King: [12:29] Especially if you're doing paid traffic. What's interesting here is I think there's also, to play devil's advocate a bit, there's also a skill set in learning how to outsource marketing. So there are people who spent years doing marketing themselves and then years knowing enough to be able to outsource well. But I guess part of the value you're bringing is I've done the work to vet these providers. These providers know what they're doing. you work with me, you get access to proven people who are the rare marketer that actually knows what they're doing. Nicole McCance: [12:57] Yes. And I have a list. I vetted a few of them, all that work with Canadians because I only work with psychotherapists, psychologists, social workers in Canada and the States. And so we have separate ones and separate. There's employment lawyers in my program as well, HRs and accountants. So they've all been vetted. But also I give them the exact interview questions, like go and interview them and make sure they're a good fit because I think you're right. It's like, what am I even looking for? And they have to work specifically with therapists because we are a different breed and there's so much we're not allowed to do. Dan King: [13:29] Yeah. Any regulated profession, there's so many constraints, right? So not only do you need to be good as a marketer, you need to work within those constraints. One hand behind your back. Nicole McCance: [13:38] Exactly. Do you want to move on to step number four? Dan King: [13:40] You sure can. Nicole McCance: [13:42] Okay. So now you've attracted the clients, you have the team, but those, they're actually not clients. I didn't mean clients. These are the leads. But now it's time to convert leads with consult calls. I'm a big fan of online booking. Pop quiz, when do you think most people book therapy? What time of day? Dan King: [14:02] That's a great question. After work? Nicole McCance: [14:04] You got it. After 7 p.m. And it's funny because when I heard this stat, Dan, I was like, oh no, my admin goes home then. We're losing all these people. Number one, my admin, Now I got an admin team of six that worked from 8 a.m. to 8 p.m. But most of all, we use online booking. Here's the thing. More people fill out multiple contact forms and just hope that they get a response back. But again, research tells us if they book a consult call, give them that dopamine hit, they'll book with a therapist, allow them to book with an actual therapist, bypass the bottleneck, bypass the intake team. They get the dopamine hit that help is on the way. the research tells us that the show up rate is higher when they book their own call as opposed to a contact form human going back and forth four times and doing it for them. Dan King: [15:00] So this is through a system like a Calendly or something similar? Nicole McCance: [15:03] I love JNAP because it shows, this is really important, it shows faces. I can even give you a coupon for two months for your people if you want it. Faces are 30 to 50% more clickable. So if you go, I won't say the other platform names, but every other platform, there's no faces. So if you, what I loved about Jane is it's a mini psychology today. You see all the faces, you see the bios, you click, you book and done. Dan King: [15:28] Yeah. People are craving human connection, right? Nicole McCance: [15:30] More than ever. Dan King: [15:31] The faces just humanize the whole process. Nicole McCance: [15:34] Exactly. It increases the conversion rate from the calendar. Also, I do believe that the consult call should be 20 minutes. I tested this. I tested 15. I tested 30. 30, our conversion rate went way down because they felt fabulous. And they were like, it's fine. I don't need to book. Here's why 20 seems to be the sweet spot. You need 15 minutes to build rapport, gather information, share your modality. But then you need five minutes to close the deal. I know I'm talking in sales terms and that's like hard for therapists to listen to sometimes but here's what i mean you need five minutes to do three things one go over the cancellation policy They're way more likely to show up if you go over that. That takes a minute. You're going to rush through it if you do it in 15. Two, get their credit card. HIPAA compliant. It'll save. I'm going to take it now. Don't need to waste your time in the first session. Number three, my favorite, book four to six sessions. Share that an average treatment plan is 12, 16, 20, whatever it is, and just say, I'm going to book four so you're in the calendar. They're committed. And of course, they can cancel within the cancellation policy, but I find that retention is higher because they've already booked their life around that therapy for one month. Dan King: [16:54] That's so intentional. I love that. It's so, so important to think about the behaviors you want to incentivize. Dan King: [17:00] Use the consultation call as a vehicle for those. Nicole McCance: [17:03] Yes. And lastly, number five, people skip all the time and it's follow ups. It's now you want to retain clients with follow ups. Are you following up if they no show? Most therapists aren't. If they no show or cancel, there's three different times. So one, if they no show or cancel. Two, what if they don't book on that consult call? I have to get a babysitter, talk to my husband, check my insurance. Are you following up? and then lastly what if they ghost you're in the middle of great work you went too deep and you just never see them again i think that we've been brainwashed in our industry that that's solicitation nicole you're being way too salesy but i will tell you my members get feedback from their clients oh my god thank you i can tell that you care thank you so much it's been a rough couple of weeks i'm just not motivated to book and i'm booking now Dan King: [17:57] In general, it's so interesting to reflect on clinicians' relationship to sales. So just like there's an interrelationship to money, there's an interrelationship to sales. And so many clinicians struggle with it, right? And I think in a lot of ways, it speaks to a struggle to appreciate their own value in the world. Dan King: [18:13] Do you help people on that inner work side of the equation as well? Nicole McCance: [18:16] Oh my gosh, my podcast is all about that. It's very strategic like this. And my program, I think that even asking for like a self-pay certain rate, my rate was 275, and that's a big deal in Toronto. It is an act of self-love. What would you rather to see a therapist that is struggling and with their own stuff? I think that we put out that energy in the room when we can sit across from somebody and say, you know, I'm worth this. Dan King: [18:44] That's right. Our anxious or avoidant attachment comes up in those moments where we're making a big vulnerable ask, right? But the more you do it, the less vulnerable it is, the more it's just the simple truth of who you believe yourself to be. Nicole McCance: [18:55] Yeah. And I tend to attract people like me in my program who really want more from life and they just want to invest in like, okay, I just need help getting there. Dan King: [19:06] Yes. Perfect. So for this, this five steps, you know, this is a method that even if you, you know, you're at the very beginning of the journey, you haven't even started your group practice yet, you know you want to, you can use this, but you can also use it if you're further along in the process, right? Nicole McCance: [19:21] Yes. We have some people with 20 clinicians on their team that they're like, it's a bit of a mess. I just keep, we call it, we want to hire our hell yeah, that person that you're in front of them and you're like, yes, I hope they picked me to work with. So I work with a lot of people that are really struggling to find the good people or who are a bit of a mess. They're like, I just need help systemizing and growing. Dan King: [19:44] Right. Okay. So do people, so you're helping people always implement the whole method or if I just need help with step three, for example, can I just get help about that? Nicole McCance: [19:54] So it's a six, I would just, I have one program, like just one. I think I've nailed it with that. I think too many business coaches, they try to do too much. So they come in and we, there's gaps in everything. I think it's, you know, there's tweaks where it's like, I need better metrics. Help me understand my money and sales metrics. Help me increase my retention and conversion. help me connect with a good lawyer. So I think that there's usually cracks in every step. Dan King: [20:20] And this is always in a group setting, Nicole, this program? Nicole McCance: [20:23] Yes. So there are, I have a, I have a Canadian arm and an American arm that are completely separate because we're all self-pay basically here. So I do coaching in groups and then they also get individual coaching with my team, accountability, like literal emails from a human because I find people need a human to be like, I'm going to follow up to make sure you, you fired that person. You've been holding that fear, that lack of scarcity, you're holding onto that person way too long. Right? Right. So we have like a team of people like accountability is so key. Dan King: [20:56] Yeah, no, accountability is super, super important. We're becoming someone different and our business needs to become someone different. And there's a lot that can go wrong on that journey. So accountability is vitally important. Nicole McCance: [21:06] Yeah, that's a really good piece that you just said that there's this massive identity shift as you go from therapist to boss and leader. That is, we weren't, I mean, gosh, we weren't taught business, but for sure, for me, the hardest transition was how to, like, what is a good leader? I just did a podcast on this. How do I be a good leader, but not their friend? I didn't know where the line was. And I still don't. I have a team of 15 now, and there's still times where I'm like, and because we have an employer, employment lawyer on in the McCants method, I'm always listening to what they say. I have to remember, like, keep your employer hat on. Because I... Generally, as a human, I don't want it to be hierarchical. So I think we need to remind ourselves sometimes, like, wait, I'm an employer. You know what I mean? Like, I'm the boss here. I have to be careful with taking them out for coffee or who I take out for coffee and, Dan King: [22:03] You know. A hundred percent. Those boundaries really matter. And it's easy as a sensitive, emotionally thoughtful person, as most clinicians are, as anyone who's psychologically trained is. It's very natural to care about the human in front of us. And I think there's a place you can get to where you start to see that there's a very particular way in which this relationship needs to be structured. It doesn't mean that I'm not human or that I'm not warm. It's just that this moment and this relationship calls for me to lead. And that's that can be a burden for some people. But it ultimately, I think, for an emotionally sensitive person is very healing to sort of remove from your shoulders that obligation to be friend, business partner, everything. Nicole McCance: [22:47] Right. Yeah, exactly. Dan King: [22:49] It's like simpler this way. Nicole McCance: [22:50] Yeah. It's like finding your way, though, you know, because a lot of people in my program, they're trying to be the perfect boss, the perfect leader. And I always say, like, just show up as you like show up vulnerable. You know, Brene Brown's work like people will connect. You can just say, I don't know the answer to that. You know, those are the best leaders. Dan King: [23:08] Yes, absolutely. Maybe as we start to come towards the end of our time together, Nicole, I'm curious what you're seeing in all of these different clinicians that you work with. What are some sort of industry trends that you're seeing that you anticipate being very important for the future? Nicole McCance: [23:22] Moving to in-person. I think that after COVID, anyone with a laptop could start a practice and there's a huge shift. You will get better ad costs, acquisition costs. People want in-person and it's easier to market locally. They trust you when you're local. I see because of PSYPAC in the states that there's a lot of clinicians that want to be because they can be in multiple states. But I think they underestimate the complexity that comes with that tax-wise, HR-wise, legally. They have no idea. And they come to me in four states and they haven't thought of any of that. I think a lot of people too, they open up a second location too quickly where the first one I call doesn't it doesn't float yet so it's in this little like boat in the pool and and then they ignore it and then it's at the bottom of the pool not that they ignore it but by definition you can't give it 100 it's like children right like you can't give it 100 percent of your focus, and then you replicate the mess. You actually scale problems. You're not scaling the good stuff. So I teach a lot of like focus on one thing, do it very well, have it be revenue generating, and then either just enjoy your life or create another one. Dan King: [24:41] It makes infinite sense. And I see the same thing, I think, in the really high quality therapy practices. In-person is a huge trend. And look, therapy just works better in person. This isn't to say that we shouldn't do it virtually. We need to. It's good for society that we have the ability to do it virtually. But therapy is different from medication management. There's something beautiful about the connection between therapist and patient. And it can be effective remotely. The studies show that, but it isn't quite the same. And in Canada and the US, we're very isolated, atomized societies. And part of the reason we go to therapy is because we know we're missing certain aspects of our humanity, consciously or subconsciously, right? And so in-person helps meet that need. Nicole McCance: [25:24] 100%. I think as the bots take over, we'll will crave human because you feel each other's energy. There's a lot of studies on that. So I think we're actually going to go back Nicole McCance: [25:35] even in a bigger way as time goes on to wanting more in person. Yeah. Dan King: [25:39] So Nicole, when you're not building your coaching practice for therapists, what do you do for fun? Nicole McCance: [25:44] Oh my gosh. We have a cottage up north in Muskoka. I don't know if you know Toronto very well. And my husband just made a rank. We're true Canadians. So playing really bad hockey with my sons. My twins are nine now. Dan King: [25:57] Love it. Love it. Yeah, if you can, Muskoka's wonderful if you can survive the drive up there. Nicole McCance: [26:03] Yes, which I barely did this weekend. We've got like three minutes now right now. Dan King: [26:08] Nicole, it was lovely to have you. Thanks for sharing this five step method. Look, I think you're hitting so many of the important points that practice owners desperately need help with. So I hope that they look you up. Are there resources that you might recommend they take a look at to get to know your work more? Nicole McCance: [26:24] Sure. If you like podcasts, I have one. It is called The Business Savvy Therapist. Every single week there's an episode. I also have a free masterclass where they can come hang out with me. It's called How to Build a Seven-Figure Group Practice. Nicole McCance: [26:37] And I go way more deep into the method. I'll send you that link. Excellent. Dan King: [26:42] Please do. We'll put that in the show notes. Thank you again, Nicole. Such a pleasure to be with you. Nicole McCance: [26:46] Thanks for having me.