Therapist autonomy in group practice with Patrick Cleveland
In this episode (quick summary):
Therapist autonomy in group practice is the operating principle behind how Patrick Cleveland built Daybreak Counseling Center—hiring for clinical alignment, creating safety for clients, and supporting clinicians without micromanaging. You’ll hear why Patrick treats therapy as an “art” grounded in relationship, how he thinks about quality when he refuses intrusive measurement, and what practice owners can learn about culture, retention, and sustainable growth.
TL;DR:
Build a group practice where clinicians have real autonomy, and you’ll often get higher-quality care, stronger retention, and a clearer culture.
What you’ll learn:
- How aligned hiring becomes your real quality-control system when outcomes aren’t easily “measured”.
- Why over-indexing on metrics and manuals can push therapy away from story, safety, and relationship.
- How to design clinician autonomy with enough support to prevent drift and turnover.
- What “creating a space for change to emerge” looks like in both therapy and practice leadership.
Patrick Cleveland’s quote: “I create a space for change to emerge.”
Best for: group practice owners hiring clinicians, clinic operators improving retention, and leaders who want client-centred care without rigid micromanagement.
Key terms: therapist autonomy in group practice, aligned hiring, client-centered/client-centred therapy, clinical quality, therapy relationship, counselling/counseling culture, organisation/organization design, documentation load, practice leadership
Therapist autonomy in group practice: how Daybreak scaled quality without micromanaging
“I create a space for change to emerge.”– Patrick Cleveland
Patrick Cleveland, LMFT, founder and executive director of Daybreak Counseling Center, joins Dan King to unpack a leadership decision many owners debate but few operationalise well: building therapist autonomy in group practice without sacrificing clinical quality. Patrick’s path into group practice wasn’t a master plan—he loved solo private practice—but steady demand and clinicians asking to join him turned a one-person office into a multi-clinician model grounded in client-centred work and strong cultural fit. :contentReference[oaicite:1]{index=1}
The episode starts with a reality check on “quality”: in therapy, it’s not always a dashboard metric. Patrick describes how repeated intake calls from clients who’d had negative experiences shaped his standards—people didn’t want worksheets and an agenda, they wanted space to tell their story. That becomes a practice strategy: if you want consistent client experience at scale, your first lever is hiring. He screens for therapists who align with the practice’s humanistic, narrative, mindfulness, and psychodynamic orientation, and he’s explicit that the model is not built around manualised approaches. :contentReference[oaicite:2]{index=2}
From there, Patrick pushes against the assumption that more measurement automatically creates better outcomes. He doesn’t use client surveys because they feel intrusive and shift the energy of the work toward “proving” something rather than creating safety. Instead, he watches for signals of drift: retention dropping, complaints increasing, or clients disengaging. You may disagree with that stance, but it highlights an owner-level question worth facing: when the relationship is the intervention, what operational decisions protect the conditions for trust?
Dan and Patrick broaden the lens beyond clinic operations into philosophy and meaning-making—especially for younger clients questioning externally imposed definitions of success. In practice terms, this matters because your clinicians are having these conversations every day, and your culture either supports that depth or pressures people back into checkbox care. Patrick’s argument is practical: an autonomy-first practice can attract clinicians who want to do real work, while also building a client experience that feels fundamentally different from “high-volume” therapy environments.
Importantly, the episode doesn’t romanticise “hands-off” leadership. Patrick notes that too much autonomy can create turnover, which is why Daybreak evolved: adding a clinical director to provide more support and relationship-building while keeping independence intact. For owners thinking about practice growth and clinical leadership, this is the core design challenge: give clinicians freedom, give clients safety, and build just enough structure so both stay stable under scale.
Takeaways
- Define “quality” operationally before you scale: hiring criteria, supervision rhythms, and client-fit standards matter more than a perfect KPI set.
- Aligned hiring is the foundation—screen for clinical orientation, worldview, and comfort with autonomy, not just credentials.
- If you reduce micromanagement, replace it with clarity: expectations, boundaries, and support pathways must be explicit.
- Therapist autonomy in group practice works best when you pair freedom with lightweight clinical support (e.g., a strong clinical director function).
- Protect the therapy relationship from “agenda pressure” by keeping systems from pushing clinicians into performative outcomes work.
- Expect your model to evolve: autonomy can be a retention advantage, but too little connection can create drift without the right support.
Transcript: therapist autonomy in group practice with Patrick Cleveland
“I create a space for change to emerge.” — Patrick Cleveland
Read the full transcript
Dan King:
[0:00] Hello, everyone. Daniel King here again with another episode of Your Group Practice. And today, I'm looking forward to a juicy conversation with Patrick Cleveland, LMFT and founder of Daybreak Counseling Center, which is in Long Beach and Cerritos, beautiful Southern California. Patrick, how are you doing?
Patrick Cleveland:
[0:19] I'm good. Thank you. How are you?
Dan King:
[0:21] Oh, my. I am embroiled in way too much work, but I'm relying on you to be the fun part of my day. Can you live up to the billing?
Patrick Cleveland:
[0:28] We'll see, man. I'll try my best, yeah.
Dan King:
[0:30] There you go. Patrick, what got you into opening a group practice? Why did you do that?
Patrick Cleveland:
[0:35] Well, it's the, I mean, I'm sure this story's been told a lot of times on your show, but just I could only see so many clients myself. And my goal was not to do group practice. I really enjoyed being in private practice, having my own office, and I really, really enjoyed that. And that was great. And then someone said, an associate called and said, hey, I really like your website. Like, can I come, can I come, can I work for you? And they said, okay, well, yeah, you can take Saturday. And then someone else called and said the same thing. And she took Sunday and that's kind of how it started. And then I just kept getting calls from clients who had bad therapy experiences. That was kind of the impetus for growth or like to start a group was just that continued, you know, conversation. Because at this time, I didn't have a practice manager. I was doing all the intakes. I was answering the phone. And so I would constantly get these, you know, calls from people who had a bad therapy experience. And it was usually one of two things when I went to therapy and my therapist didn't say anything and it was really awkward and weird. Or the more common one, which was I went to therapy, they gave me a bunch of homework that I didn't want to do, and I didn't get to tell my story. And that really, you know, would bum me out to hear that. So then that really let me know that there was a space for humanistic, person-centered, psychodynamic therapy where the focus was on the client and letting them lead and tell their story and not, you know, the more sort of manualized approaches that are being taught in graduate schools today.
Dan King:
[2:03] So since you had a bunch of therapists with an impetus to join you that they didn't think therapy was doing being done well out there, how do you ensure
Dan King:
[2:12] that you're providing something higher quality? How do you actually solve that problem?
Patrick Cleveland:
[2:16] Mainly in hiring. So I look for therapists that share the same vision and the same goals and values that we do. And, and yeah, unfortunately, that's a really hard thing to track, you know, like, like, sometimes I'll joke about that with the therapist on my team, you know, I'll call them up and I'll be like, hey, you know, you're doing a really good job. You know, your retention is good. But the healing just isn't there. You know, like your healing level, like you need to heal more, you know, which is totally stupid and silly. Like I'm just joking with them. And then we all kind of bust out laughing because it's this factor that like, how do we really track that you know and so it's a mystery you know i think um it's the way we track it more is like and i and i always tell them this too is like unfortunately it's like in not hearing anything bad you know like only the only time it's hard to track things going good if you're not doing like surveys and sort of like you know that's you know doing client surveys i guess which which i don't do and i don't believe in so if we're not getting signs that things are going bad like client retention is bad, or we're getting complaints, clients are dropping like flies, then we tend to believe that things are going good. Yeah. So I know probably not the answer most people want to hear.
Dan King:
[3:28] Why don't you do client surveys? Why don't you believe in them?
Patrick Cleveland:
[3:31] It just it just feels intrusive. And it feels like one, I'm not too big on goals either, like having goals, like like the idea of a treatment plan and goals and all of that documentation, treatment plans, all of that I see as an aside. Like I see it as something that we have to do because the licensing board tells us to do it. Like if I, if I had my way, I would never do a treatment plan. I would never have goals. I would never write progress notes. That's how I would do it if I could do it my way. You know what I mean? But you know, this is the way we have to do it. So, you know, yeah, to me, therapy is more of an art, like rather than this scientific thing where we have goals and we're like tracking outcomes and things like that. It's like People come, they tell me what they want to work on, maybe in the first phone call, first session, and then they come for as long as they want, and I don't... You know, once in a while, if I feel like things are stagnating, or we're not doing anything or going anywhere, I'll kind of ask like, hey, how was you know, kind of check in? Hey, how therapy is going? You know, you know, something like that?
Patrick Cleveland:
[4:35] Is there anything else you want to work on? You know, I might if I get that feeling, which isn't which is pretty rare, or, or ever, but I guess that maybe that's why I don't particularly believe in client surveys. And then that would just be and like I said, before, I hate paperwork, you know, so that would be more paperwork for meaning that I already that I already don't like that I'd have to do more of, you know? yeah
Dan King:
[4:55] Paperwork either but we might be the wrong business both of us so i'm curious then if for you therapy is more art than science what are some of the drawbacks of the scientific approach to like results measurement and an obsession with making therapy more scientific are there are there real drawbacks you see to that.
Patrick Cleveland:
[5:14] Back to the outcome right like to get the outcome like it's almost like this you're focused on the end goal instead of the process and and it's it's like the idea of the philosophical approach of like the therapist is doing the work or I'm going to do something to you to generate this outcome versus I'm going to create a space where something can happen where the thing that you want can happen and it's a less is more approach so I guess outcome wise like or like the downside to that is one the therapist can be too preoccupied with their agenda you know like I have an agenda to have this outcome so they can have like all these interventions in their head and like, oh, this is how the session is going to go and, and all that, which kind of ignores the subjectivity of the human being and their experience and the what something mystical and magical that can emerge here because you got so much, you got so much in your head there, you know? Yes. In terms of like what you think it's going to go. So like,
Patrick Cleveland:
[6:11] There's an old Buddhist proverb about this, like the student goes to the master and says, how long will I take to reach enlightenment? And he says, I think he says 10 years or something. He says, well, how about if I try really hard? And then he goes, well, 20 years. And he goes, well, how about if I try even harder? And then he goes, well, 30 years. You know what I mean? Like, in other words, if you have one eye on the outcome, you don't have your both eyes on the process. And so I think that can be a downside. You know, the big research is that the therapy relationship is really what is the biggest factor in change. And so even people who are sort of in those camps, they tend to, from what I know, like get good outcomes as well. But that would be another downside, I guess, would be the way it would affect the therapy relationship. Those phone calls I got, those phone calls I would get from people saying, hey, my therapist didn't let me tell my story. I got a bunch of boring homework I didn't want to do. So that could be another sort of... You know, downside of, you know, you think you're doing this thing, but really the client wants something else, you know, but they're just following your lead because you're supposed to be the expert. So it can, can cause all these sorts of weird mismatch problems.
Dan King:
[7:21] One way to think about what you're saying is that super important relationship between therapist and clinician. It's easy for the therapist to get into their head and it's easy for them to try to impose their sense of how the sessions should go. The reality is human life and healing are such complex forces. We don't really understand exactly how people heal. We don't really understand the complexity of life. And so by just showing up
Dan King:
[7:47] with some humility and purely seeking to create a space, we can let the mystery unfold as it's meant to.
Patrick Cleveland:
[7:54] Yeah, I like that a lot. What's coming to mind too is recently, I'm gonna be volunteering doing free therapy at Homeboy Industries in East Los Angeles, which is a gang recovery program. Father Boyle there, he has a similar approach, you know, they're asking him like about outcomes and whatnot. And this is what drew me to them, too, is we have a similar philosophy of, you know, how do you do gang rehabilitation? You know, what do you do to them? What are you as an older white male, you know, help these Hispanic gang members? And he says, I don't do anything. I create a space for change to emerge. And that clicked. I was like, oh, yeah, that's us. Like, that's exactly what we're doing. you know, is like, Like it's a less is more. It's a marathon, not a sprint. Change happens when people feel safe, you know, when they have a relationship, a trust. And that's when the, you know, that's when things happen. That's when the good, that's when the real therapy starts to happen rather than this sort of evidence-based or outcome-focused therapist who is constantly doing and filling the space with, you know, worksheets, homework, talking. Sometimes silence is the best intervention.
Dan King:
[9:05] One of the things I've come to believe is that the sort of energetic connection between people can be so healing. When we seek to control it, even just thinking about an outcome in your head sometimes can create this almost kind of energy of control. And I think that's felt subconsciously. It's felt at deeper levels by people. And there's ways in which, I mean, I'm not a therapist. I used to be a coach. In working with owners of therapy practices, I can see how in super vulnerable moments, you know, in my case, we're investing in their business. We're talking about a very deep partnership. The energy of it's easy to sort of impose my agenda on the moment. And it's easy to, as a business person, think about all of the goals that your investors or that the larger institution that you operate within. It's so easy to be motivated by those goals. and it's not necessarily that I think we should reject them completely, but there is something so powerful about
Dan King:
[10:04] the authenticity of allowing someone else's truth to emerge and being guided by that. It's easier in a way. It's more relaxing for me.
Patrick Cleveland:
[10:14] Yeah, no, definitely. Um, I listened to Rick Rubin a lot, who's like, like a music producer. And once again, like just his approach to art, don't force anything, don't push anything, you know, let it flow naturally, let it emerge. Like I really I really like that or like I've heard Dr. Dre and Pharrell talk about the moment you get into a studio and you even have the thought of, we want to make a hit song, everything goes to shit. And no hit song ever come that way. We're going to make a hit.
Dan King:
[10:49] Have you heard of, in your study of French philosophers, have you come across René Girard? Does that name ring a bell?
Patrick Cleveland:
[10:57] Yes, the name does ring a bell.
Dan King:
[11:00] So he's become famous. He's dead. He became famous for mimetic theory. And I bring it up here. My crazy mind is bringing it up here because mimetic theory is a theory of human desire. It's about why do people want the things they want? And what he would have said was that most of the things we think we want, we don't truly at a deeper inner level actually want. These are imposed desires. So we see people in the world who model certain ways of being, and those models plant seeds in our head, plant seeds of desire. We see someone who, you know, we see the rapper with the champagne and the really cool car, right? And we want those things. Had we not seen a model, we wouldn't want those things. Whereas the deeper work of life, he would say, I think is to get in touch with your internal truer desires separate from all the models that you see around you. And so in therapy or in a business context, we're almost, you could sort of say that we're spreading mimesis, we're spreading mimetic content by imposing our agenda as opposed to enabling people to be in touch with what is true within themselves.
Patrick Cleveland:
[12:13] Absolutely. You know, one of the reasons I did a second master's in philosophy and one of the reasons I did that was because I felt like a lot of a lot of questions, a lot of a lot of things that people take for granted in the mental health world, like what is the good life? You know, how ought we to behave? These questions I felt like were taken for, you know, what is happiness? What is meaning? I feel like a lot of those questions were kind of taken for granted in mental health circles, which was at the time at least a real drive towards like be positive, you know, like positive thinking and that sort of backdrop to,
Patrick Cleveland:
[12:48] you know, cognitive behavioral therapy. You know you're you know you've got negative thoughts and you know those need to change you know and and and and that is like a uh sort of a zeitgeist you know or like an ethos at the time and still is to some degree but just those yeah those kind of questions about this sort of influence to be that way or to think that way or like oh this is the way which you know really is it though you know and and are there other ways of being or other answers to these questions that that's like at least in the therapy world, they kind of take for granted sometimes,
Dan King:
[13:21] I think. Yeah, yeah. There's so much potential for philosophy and therapy to interact. And they generally, I mean, is your experience that they're not interacting that much?
Patrick Cleveland:
[13:31] My experience is they interact all the time, you know, that people come in with really profound spiritual questions, existential questions. You know, especially right now, there's a lot of talking around about, you know, the meaning crisis, right? Like that a lot of people are not feeling a sense of purpose a sense of meaning the sort of um spiritual vacuum that that capitalist system provides not not not that i have anything against capitalism but but it does focus on the dollar and the product you know primarily and leaving out the the spiritual component of human life you know and and because that's like the main focus and i and i get that but that does leave a spiritual vacuum in terms of like, well, why else are we here? And what else are we doing here? People wanting a greater sense of purpose. And so... Yeah, I feel like those questions come in the room a lot, you know, of like, okay, what are we doing with our lives? Why are we here? You know, I feel like I get that from a lot of younger folks, especially.
Dan King:
[14:31] One way I might think about that is that just like in the therapy room, mimesis can be a powerful force, can be a very powerful force in capitalistic context too, but that doesn't mean that it has to be. So if I show up in a business context modeling other people, modeling the way they are, instead of bringing my authenticity to the table, then maybe capitalism can be meaningless and maybe it can contribute to people feeling purposeless. But maybe there's also just like in therapy we can can just like we've talked about here you know your view is there's a less is more approach which i generally i think operate the same way and i might even sort of add in when we remove inauthentic we remove certain inauthentic aspects of self what we're left with is really interesting and energetically powerful that can be the case in a therapy room it can be a case in a business conversation too in my experience there's nothing to me inherently about capitalism that fosters meaningless. I think there's certain models, let's say.
Dan King:
[15:34] That we experience in how to do business, this super rushed transactional kind of quality to it. But it doesn't have to be that way. In earlier businesses I had, I was following those models. And in this one, I do less and less. And there's something beautiful about it. And so I hear you. And I think that in any context, I think we have this ability to try to transcend. I'll go back to Gerard here, we have an opportunity to try to transcend mimetic models.
Patrick Cleveland:
[16:04] Sure, sure. Absolutely. I think that like for us as entrepreneurs, we are, I mean, just in Western culture in general, right? Like we're the few, the small that get to have these discussions and be able to have that experience and the freedom of being an entrepreneur. I think what I was talking about more is like the general population clients who like are questioning the American dream or like the notion of like okay always um uh preparing for this life you know alan watts always talked about this you know that like you're you're preparing for this life that's supposed to happen later right like elementary school junior high high school college like okay life is gonna begin you know over here when it's been going on all the time right which is a form of a mimetic desire in and of itself just to create a structure like that you know where you're desiring this life to be later and i and i think a lot of young people are like okay so then i go to college i I get the job and then, you know, I work until I die, you know, like, and I think a lot, you know, there's that there's not a, there's not a lot of, you know, spiritual purpose, meaning, you know, sort of the old, you know, tribal meaning of initiation, recognition. It's just, it's just that, you know, and I think a lot of young people have been questioning that, you know, they see their parents maybe, you know, not so happy or like struggling or like, oh, like, what was this? They see the career life as not so rosy and shiny anymore and that's where I think the meaning piece comes in
Patrick Cleveland:
[17:33] Yeah. I'm like helping them. Okay, I get that this is what you're seeing. How can we work together to create a narrative, a story that is going to give your life meaning in the context and the resources that you have and in what goals you're trying to pursue?
Dan King:
[17:47] Yes. And maybe part of the way to think about it is that in the present moment, which, you know, a good therapeutic relationship can bring us into a deeper connection with presence, with this moment right now. You point out that so many people are of a mindset and society creates structures that make us think about this tomorrow that never quite seems to come. Preparing for the future, I think was the phrase you used. One of the great things about therapy is it can create presence. So what about right now? Right? What about right now? What can we do in this moment? So rather than being stuck in this future that may or may not come or, you know, who knows what the future is. We all have the present. That's something that we all have in common. And there's so much power, so much spiritual experience that's possible in the present moment. And there's just so many structures of our society that take us out of the present moment.
Patrick Cleveland:
[18:40] Yeah, no, absolutely. You know, back to back to the, we were talking about mimetic desire. One thing that in creating that presence in therapy is, you know, some of those young folks might come in and be like, you know, I really want to do theater, right? I want to major in theater, but my, my parents say I should, you know, major in business and then, and then, and then you can help them, right? Cause that's a kind of a influence mimetic desire right there, right? Like your parents are trying to tell you what you should want or what your dream is or whatnot. And then you can work with that person to help them navigate that decision.
Dan King:
[19:13] Yes, yes. That to me sounds like a pretty interesting way to think about how to build a therapy practice where people are given an opportunity to enter a truly different space than they're in in the everyday, right? They're taken out of, at least for a brief moment, they're given an opportunity to truly reflect. And when we integrate some philosophy in there, people are thinking about some of the big questions maybe in a different way. and so that to me sounds super important so it's good you're doing it.
Patrick Cleveland:
[19:44] Thank you. Thank you. It's interesting you say that because because the way I built it and this is different than a lot of other owners. I did model it sort of I built it exactly how I would want it to be if I were to join a group practice. And so, you know, I grew up in East L.A. I grew up in police brutality and and and oppressive systems and all this sort of stuff. And so, so I never liked authority. I never liked being told what to do, you know? And so I kind of, I always tell the people that join my group, being part of daybreak is like having your own practice, the closest thing to having your own practice without having to do the marketing and the, uh, insurance billing and hounding people for credit cards. So, you know, so I kind of sell it to them that way. And I, and I don't, I rarely even interact with them. Like if everything's going good and You know, I'll call them once every other month, maybe, hey, how are you doing? How's it going? You know, but I don't have meetings.
Dan King:
[20:43] I love it.
Patrick Cleveland:
[20:44] We'll have like a Christmas party, you know, and maybe a lunch in the summer or something. And if they want more stuff like that, we can do that. But yeah, I don't. I give them freedom and autonomy. I'm a big believer in that, you know, because that's what I would want. I wouldn't want, I don't want my boss all up in my stuff, especially as a therapist. And once again, this goes back to the music approach, right? Which music is a big part of my life. I also do music. And I think it was Jimmy Iovine, right? One of the big producers. He said that you, same thing, you give the artists the tools that they need and you leave them alone. Hmm. And that's kind of my approach too with the therapist. You give them the tools, I give them the space. I'm there to train them and help them if they need it, but they're free to do their own thing.
Dan King:
[21:27] And so at the beginning when you were telling me about how hiring was an important way to set the tone, an important way to handle the quality control issue that first prompted you to even begin the practice in the first place.
Patrick Cleveland:
[21:39] Yeah.
Dan King:
[21:40] It sounds like a big part of that is one of the values that you screen for is, are people going to be comfortable in a really autonomous space? Because not every clinician will be.
Patrick Cleveland:
[21:49] Yeah. Yeah. And most of them are. And I think one of the other things I screened for in the beginning is like in our job, like on Indeed, it says something like, you know, if CBT is your main focus, like do not apply, you know, like, like, like, so it's like anything, but like, if you are interested in anything else, like humanistic, mindfulness, narrative, psychodynamic, If you are of any of those schools of thought, you know, please apply. Right. And we're rare, like we're already a minority in this sort of manualized CBT world, you know, so it's it's it's hard and easy at the same time to find people who gravitate to the message. You know, I mean, because, you know, when you're a niche, it rules out a lot of people instantaneously, but it also attracts those people that are in alignment as well.
Dan King:
[22:35] Well, that authenticity is vital both to attracting clients as well as clinicians. You're going to build something that's sustainable and you've got, I think, 15 or 16 clinicians?
Patrick Cleveland:
[22:45] 17 right now, yeah.
Dan King:
[22:46] 17 clinicians. That's enough clinicians where... For them to stick around, they've got to believe in the authenticity of what's there, right? The organization starts to take shape beyond its founder. And you've deliberately set up an organization such that you're maybe a little less involved. You're less, you're not micromanaging the way perhaps some other practice owners are. So part of what is sustaining, what keeps 17 clinicians there working is there has to be something real and authentic about it. That energy has to jive with them.
Patrick Cleveland:
[23:18] Sure. Yeah, no, absolutely. And I think I have a clinical director. She's been with me for a lot of years and she recently sort of promoted and, you know, given her that role. And she's just way better at fostering those relationships, you know, with the therapist than I am. Like I like spending my time on like thinking about marketing or thinking about like, you know, business development and things like that. Like that's what I prefer to do and and she's really good at nurturing relationships and and fostering that those other things you know so it's a good balance whereas before i think it was too much autonomy right like i think i had some turnover because it was too much like yeah you know like like it was like we call it a leading from the back i think people call that leadership style right you're like just all right guys go ahead you know i've had it and i think i think i was too much in that so now it's a little bit better.
Patrick Cleveland:
[24:12] There's a little bit more, you know, a little bit more support and involvement with her style.
Dan King:
[24:16] So it's good. Awesome. Awesome. I love what you have built and I love how true to you it is. I'm curious to know as we come towards the end of our time together, what is fun for you when you're not working? So, you know, you built a meaningful business and you have some great people working for you. So you have some time to do other things. What is fun for you when you're not working?
Patrick Cleveland:
[24:39] I'm playing with my son. I have a five-year-old son. So playing with him, that's super fun. And I do music. So I make beats. I DJ and also do hip hop. So those are kind of like my hobbies. I'll go hiking. I love being out in nature and yeah I'd say those are the those are like my fun activities outside of running the business yeah so
Dan King:
[25:00] Patrick I appreciate you so much and I think there's lots of insights and really really cool philosophy for other practice owners to ponder so thanks for jamming with me.
Patrick Cleveland:
[25:09] Yeah man no you're welcome good to be here
Transcript: therapist autonomy in group practice with Patrick Cleveland
“I create a space for change to emerge.” — Patrick Cleveland
Read the full transcript
Dan King:
[0:00] Hello, everyone. Daniel King here again with another episode of Your Group Practice. And today, I'm looking forward to a juicy conversation with Patrick Cleveland, LMFT and founder of Daybreak Counseling Center, which is in Long Beach and Cerritos, beautiful Southern California. Patrick, how are you doing?
Patrick Cleveland:
[0:19] I'm good. Thank you. How are you?
Dan King:
[0:21] Oh, my. I am embroiled in way too much work, but I'm relying on you to be the fun part of my day. Can you live up to the billing?
Patrick Cleveland:
[0:28] We'll see, man. I'll try my best, yeah.
Dan King:
[0:30] There you go. Patrick, what got you into opening a group practice? Why did you do that?
Patrick Cleveland:
[0:35] Well, it's the, I mean, I'm sure this story's been told a lot of times on your show, but just I could only see so many clients myself. And my goal was not to do group practice. I really enjoyed being in private practice, having my own office, and I really, really enjoyed that. And that was great. And then someone said, an associate called and said, hey, I really like your website. Like, can I come, can I come, can I work for you? And they said, okay, well, yeah, you can take Saturday. And then someone else called and said the same thing. And she took Sunday and that's kind of how it started. And then I just kept getting calls from clients who had bad therapy experiences. That was kind of the impetus for growth or like to start a group was just that continued, you know, conversation. Because at this time, I didn't have a practice manager. I was doing all the intakes. I was answering the phone. And so I would constantly get these, you know, calls from people who had a bad therapy experience. And it was usually one of two things when I went to therapy and my therapist didn't say anything and it was really awkward and weird. Or the more common one, which was I went to therapy, they gave me a bunch of homework that I didn't want to do, and I didn't get to tell my story. And that really, you know, would bum me out to hear that. So then that really let me know that there was a space for humanistic, person-centered, psychodynamic therapy where the focus was on the client and letting them lead and tell their story and not, you know, the more sort of manualized approaches that are being taught in graduate schools today.
Dan King:
[2:03] So since you had a bunch of therapists with an impetus to join you that they didn't think therapy was doing being done well out there, how do you ensure
Dan King:
[2:12] that you're providing something higher quality? How do you actually solve that problem?
Patrick Cleveland:
[2:16] Mainly in hiring. So I look for therapists that share the same vision and the same goals and values that we do. And, and yeah, unfortunately, that's a really hard thing to track, you know, like, like, sometimes I'll joke about that with the therapist on my team, you know, I'll call them up and I'll be like, hey, you know, you're doing a really good job. You know, your retention is good. But the healing just isn't there. You know, like your healing level, like you need to heal more, you know, which is totally stupid and silly. Like I'm just joking with them. And then we all kind of bust out laughing because it's this factor that like, how do we really track that you know and so it's a mystery you know i think um it's the way we track it more is like and i and i always tell them this too is like unfortunately it's like in not hearing anything bad you know like only the only time it's hard to track things going good if you're not doing like surveys and sort of like you know that's you know doing client surveys i guess which which i don't do and i don't believe in so if we're not getting signs that things are going bad like client retention is bad, or we're getting complaints, clients are dropping like flies, then we tend to believe that things are going good. Yeah. So I know probably not the answer most people want to hear.
Dan King:
[3:28] Why don't you do client surveys? Why don't you believe in them?
Patrick Cleveland:
[3:31] It just it just feels intrusive. And it feels like one, I'm not too big on goals either, like having goals, like like the idea of a treatment plan and goals and all of that documentation, treatment plans, all of that I see as an aside. Like I see it as something that we have to do because the licensing board tells us to do it. Like if I, if I had my way, I would never do a treatment plan. I would never have goals. I would never write progress notes. That's how I would do it if I could do it my way. You know what I mean? But you know, this is the way we have to do it. So, you know, yeah, to me, therapy is more of an art, like rather than this scientific thing where we have goals and we're like tracking outcomes and things like that. It's like People come, they tell me what they want to work on, maybe in the first phone call, first session, and then they come for as long as they want, and I don't... You know, once in a while, if I feel like things are stagnating, or we're not doing anything or going anywhere, I'll kind of ask like, hey, how was you know, kind of check in? Hey, how therapy is going? You know, you know, something like that?
Patrick Cleveland:
[4:35] Is there anything else you want to work on? You know, I might if I get that feeling, which isn't which is pretty rare, or, or ever, but I guess that maybe that's why I don't particularly believe in client surveys. And then that would just be and like I said, before, I hate paperwork, you know, so that would be more paperwork for meaning that I already that I already don't like that I'd have to do more of, you know? yeah
Dan King:
[4:55] Paperwork either but we might be the wrong business both of us so i'm curious then if for you therapy is more art than science what are some of the drawbacks of the scientific approach to like results measurement and an obsession with making therapy more scientific are there are there real drawbacks you see to that.
Patrick Cleveland:
[5:14] Back to the outcome right like to get the outcome like it's almost like this you're focused on the end goal instead of the process and and it's it's like the idea of the philosophical approach of like the therapist is doing the work or I'm going to do something to you to generate this outcome versus I'm going to create a space where something can happen where the thing that you want can happen and it's a less is more approach so I guess outcome wise like or like the downside to that is one the therapist can be too preoccupied with their agenda you know like I have an agenda to have this outcome so they can have like all these interventions in their head and like, oh, this is how the session is going to go and, and all that, which kind of ignores the subjectivity of the human being and their experience and the what something mystical and magical that can emerge here because you got so much, you got so much in your head there, you know? Yes. In terms of like what you think it's going to go. So like,
Patrick Cleveland:
[6:11] There's an old Buddhist proverb about this, like the student goes to the master and says, how long will I take to reach enlightenment? And he says, I think he says 10 years or something. He says, well, how about if I try really hard? And then he goes, well, 20 years. And he goes, well, how about if I try even harder? And then he goes, well, 30 years. You know what I mean? Like, in other words, if you have one eye on the outcome, you don't have your both eyes on the process. And so I think that can be a downside. You know, the big research is that the therapy relationship is really what is the biggest factor in change. And so even people who are sort of in those camps, they tend to, from what I know, like get good outcomes as well. But that would be another downside, I guess, would be the way it would affect the therapy relationship. Those phone calls I got, those phone calls I would get from people saying, hey, my therapist didn't let me tell my story. I got a bunch of boring homework I didn't want to do. So that could be another sort of... You know, downside of, you know, you think you're doing this thing, but really the client wants something else, you know, but they're just following your lead because you're supposed to be the expert. So it can, can cause all these sorts of weird mismatch problems.
Dan King:
[7:21] One way to think about what you're saying is that super important relationship between therapist and clinician. It's easy for the therapist to get into their head and it's easy for them to try to impose their sense of how the sessions should go. The reality is human life and healing are such complex forces. We don't really understand exactly how people heal. We don't really understand the complexity of life. And so by just showing up
Dan King:
[7:47] with some humility and purely seeking to create a space, we can let the mystery unfold as it's meant to.
Patrick Cleveland:
[7:54] Yeah, I like that a lot. What's coming to mind too is recently, I'm gonna be volunteering doing free therapy at Homeboy Industries in East Los Angeles, which is a gang recovery program. Father Boyle there, he has a similar approach, you know, they're asking him like about outcomes and whatnot. And this is what drew me to them, too, is we have a similar philosophy of, you know, how do you do gang rehabilitation? You know, what do you do to them? What are you as an older white male, you know, help these Hispanic gang members? And he says, I don't do anything. I create a space for change to emerge. And that clicked. I was like, oh, yeah, that's us. Like, that's exactly what we're doing. you know, is like, Like it's a less is more. It's a marathon, not a sprint. Change happens when people feel safe, you know, when they have a relationship, a trust. And that's when the, you know, that's when things happen. That's when the good, that's when the real therapy starts to happen rather than this sort of evidence-based or outcome-focused therapist who is constantly doing and filling the space with, you know, worksheets, homework, talking. Sometimes silence is the best intervention.
Dan King:
[9:05] One of the things I've come to believe is that the sort of energetic connection between people can be so healing. When we seek to control it, even just thinking about an outcome in your head sometimes can create this almost kind of energy of control. And I think that's felt subconsciously. It's felt at deeper levels by people. And there's ways in which, I mean, I'm not a therapist. I used to be a coach. In working with owners of therapy practices, I can see how in super vulnerable moments, you know, in my case, we're investing in their business. We're talking about a very deep partnership. The energy of it's easy to sort of impose my agenda on the moment. And it's easy to, as a business person, think about all of the goals that your investors or that the larger institution that you operate within. It's so easy to be motivated by those goals. and it's not necessarily that I think we should reject them completely, but there is something so powerful about
Dan King:
[10:04] the authenticity of allowing someone else's truth to emerge and being guided by that. It's easier in a way. It's more relaxing for me.
Patrick Cleveland:
[10:14] Yeah, no, definitely. Um, I listened to Rick Rubin a lot, who's like, like a music producer. And once again, like just his approach to art, don't force anything, don't push anything, you know, let it flow naturally, let it emerge. Like I really I really like that or like I've heard Dr. Dre and Pharrell talk about the moment you get into a studio and you even have the thought of, we want to make a hit song, everything goes to shit. And no hit song ever come that way. We're going to make a hit.
Dan King:
[10:49] Have you heard of, in your study of French philosophers, have you come across René Girard? Does that name ring a bell?
Patrick Cleveland:
[10:57] Yes, the name does ring a bell.
Dan King:
[11:00] So he's become famous. He's dead. He became famous for mimetic theory. And I bring it up here. My crazy mind is bringing it up here because mimetic theory is a theory of human desire. It's about why do people want the things they want? And what he would have said was that most of the things we think we want, we don't truly at a deeper inner level actually want. These are imposed desires. So we see people in the world who model certain ways of being, and those models plant seeds in our head, plant seeds of desire. We see someone who, you know, we see the rapper with the champagne and the really cool car, right? And we want those things. Had we not seen a model, we wouldn't want those things. Whereas the deeper work of life, he would say, I think is to get in touch with your internal truer desires separate from all the models that you see around you. And so in therapy or in a business context, we're almost, you could sort of say that we're spreading mimesis, we're spreading mimetic content by imposing our agenda as opposed to enabling people to be in touch with what is true within themselves.
Patrick Cleveland:
[12:13] Absolutely. You know, one of the reasons I did a second master's in philosophy and one of the reasons I did that was because I felt like a lot of a lot of questions, a lot of a lot of things that people take for granted in the mental health world, like what is the good life? You know, how ought we to behave? These questions I felt like were taken for, you know, what is happiness? What is meaning? I feel like a lot of those questions were kind of taken for granted in mental health circles, which was at the time at least a real drive towards like be positive, you know, like positive thinking and that sort of backdrop to,
Patrick Cleveland:
[12:48] you know, cognitive behavioral therapy. You know you're you know you've got negative thoughts and you know those need to change you know and and and and that is like a uh sort of a zeitgeist you know or like an ethos at the time and still is to some degree but just those yeah those kind of questions about this sort of influence to be that way or to think that way or like oh this is the way which you know really is it though you know and and are there other ways of being or other answers to these questions that that's like at least in the therapy world, they kind of take for granted sometimes,
Dan King:
[13:21] I think. Yeah, yeah. There's so much potential for philosophy and therapy to interact. And they generally, I mean, is your experience that they're not interacting that much?
Patrick Cleveland:
[13:31] My experience is they interact all the time, you know, that people come in with really profound spiritual questions, existential questions. You know, especially right now, there's a lot of talking around about, you know, the meaning crisis, right? Like that a lot of people are not feeling a sense of purpose a sense of meaning the sort of um spiritual vacuum that that capitalist system provides not not not that i have anything against capitalism but but it does focus on the dollar and the product you know primarily and leaving out the the spiritual component of human life you know and and because that's like the main focus and i and i get that but that does leave a spiritual vacuum in terms of like, well, why else are we here? And what else are we doing here? People wanting a greater sense of purpose. And so... Yeah, I feel like those questions come in the room a lot, you know, of like, okay, what are we doing with our lives? Why are we here? You know, I feel like I get that from a lot of younger folks, especially.
Dan King:
[14:31] One way I might think about that is that just like in the therapy room, mimesis can be a powerful force, can be a very powerful force in capitalistic context too, but that doesn't mean that it has to be. So if I show up in a business context modeling other people, modeling the way they are, instead of bringing my authenticity to the table, then maybe capitalism can be meaningless and maybe it can contribute to people feeling purposeless. But maybe there's also just like in therapy we can can just like we've talked about here you know your view is there's a less is more approach which i generally i think operate the same way and i might even sort of add in when we remove inauthentic we remove certain inauthentic aspects of self what we're left with is really interesting and energetically powerful that can be the case in a therapy room it can be a case in a business conversation too in my experience there's nothing to me inherently about capitalism that fosters meaningless. I think there's certain models, let's say.
Dan King:
[15:34] That we experience in how to do business, this super rushed transactional kind of quality to it. But it doesn't have to be that way. In earlier businesses I had, I was following those models. And in this one, I do less and less. And there's something beautiful about it. And so I hear you. And I think that in any context, I think we have this ability to try to transcend. I'll go back to Gerard here, we have an opportunity to try to transcend mimetic models.
Patrick Cleveland:
[16:04] Sure, sure. Absolutely. I think that like for us as entrepreneurs, we are, I mean, just in Western culture in general, right? Like we're the few, the small that get to have these discussions and be able to have that experience and the freedom of being an entrepreneur. I think what I was talking about more is like the general population clients who like are questioning the American dream or like the notion of like okay always um uh preparing for this life you know alan watts always talked about this you know that like you're you're preparing for this life that's supposed to happen later right like elementary school junior high high school college like okay life is gonna begin you know over here when it's been going on all the time right which is a form of a mimetic desire in and of itself just to create a structure like that you know where you're desiring this life to be later and i and i think a lot of young people are like okay so then i go to college i I get the job and then, you know, I work until I die, you know, like, and I think a lot, you know, there's that there's not a, there's not a lot of, you know, spiritual purpose, meaning, you know, sort of the old, you know, tribal meaning of initiation, recognition. It's just, it's just that, you know, and I think a lot of young people have been questioning that, you know, they see their parents maybe, you know, not so happy or like struggling or like, oh, like, what was this? They see the career life as not so rosy and shiny anymore and that's where I think the meaning piece comes in
Patrick Cleveland:
[17:33] Yeah. I'm like helping them. Okay, I get that this is what you're seeing. How can we work together to create a narrative, a story that is going to give your life meaning in the context and the resources that you have and in what goals you're trying to pursue?
Dan King:
[17:47] Yes. And maybe part of the way to think about it is that in the present moment, which, you know, a good therapeutic relationship can bring us into a deeper connection with presence, with this moment right now. You point out that so many people are of a mindset and society creates structures that make us think about this tomorrow that never quite seems to come. Preparing for the future, I think was the phrase you used. One of the great things about therapy is it can create presence. So what about right now? Right? What about right now? What can we do in this moment? So rather than being stuck in this future that may or may not come or, you know, who knows what the future is. We all have the present. That's something that we all have in common. And there's so much power, so much spiritual experience that's possible in the present moment. And there's just so many structures of our society that take us out of the present moment.
Patrick Cleveland:
[18:40] Yeah, no, absolutely. You know, back to back to the, we were talking about mimetic desire. One thing that in creating that presence in therapy is, you know, some of those young folks might come in and be like, you know, I really want to do theater, right? I want to major in theater, but my, my parents say I should, you know, major in business and then, and then, and then you can help them, right? Cause that's a kind of a influence mimetic desire right there, right? Like your parents are trying to tell you what you should want or what your dream is or whatnot. And then you can work with that person to help them navigate that decision.
Dan King:
[19:13] Yes, yes. That to me sounds like a pretty interesting way to think about how to build a therapy practice where people are given an opportunity to enter a truly different space than they're in in the everyday, right? They're taken out of, at least for a brief moment, they're given an opportunity to truly reflect. And when we integrate some philosophy in there, people are thinking about some of the big questions maybe in a different way. and so that to me sounds super important so it's good you're doing it.
Patrick Cleveland:
[19:44] Thank you. Thank you. It's interesting you say that because because the way I built it and this is different than a lot of other owners. I did model it sort of I built it exactly how I would want it to be if I were to join a group practice. And so, you know, I grew up in East L.A. I grew up in police brutality and and and oppressive systems and all this sort of stuff. And so, so I never liked authority. I never liked being told what to do, you know? And so I kind of, I always tell the people that join my group, being part of daybreak is like having your own practice, the closest thing to having your own practice without having to do the marketing and the, uh, insurance billing and hounding people for credit cards. So, you know, so I kind of sell it to them that way. And I, and I don't, I rarely even interact with them. Like if everything's going good and You know, I'll call them once every other month, maybe, hey, how are you doing? How's it going? You know, but I don't have meetings.
Dan King:
[20:43] I love it.
Patrick Cleveland:
[20:44] We'll have like a Christmas party, you know, and maybe a lunch in the summer or something. And if they want more stuff like that, we can do that. But yeah, I don't. I give them freedom and autonomy. I'm a big believer in that, you know, because that's what I would want. I wouldn't want, I don't want my boss all up in my stuff, especially as a therapist. And once again, this goes back to the music approach, right? Which music is a big part of my life. I also do music. And I think it was Jimmy Iovine, right? One of the big producers. He said that you, same thing, you give the artists the tools that they need and you leave them alone. Hmm. And that's kind of my approach too with the therapist. You give them the tools, I give them the space. I'm there to train them and help them if they need it, but they're free to do their own thing.
Dan King:
[21:27] And so at the beginning when you were telling me about how hiring was an important way to set the tone, an important way to handle the quality control issue that first prompted you to even begin the practice in the first place.
Patrick Cleveland:
[21:39] Yeah.
Dan King:
[21:40] It sounds like a big part of that is one of the values that you screen for is, are people going to be comfortable in a really autonomous space? Because not every clinician will be.
Patrick Cleveland:
[21:49] Yeah. Yeah. And most of them are. And I think one of the other things I screened for in the beginning is like in our job, like on Indeed, it says something like, you know, if CBT is your main focus, like do not apply, you know, like, like, like, so it's like anything, but like, if you are interested in anything else, like humanistic, mindfulness, narrative, psychodynamic, If you are of any of those schools of thought, you know, please apply. Right. And we're rare, like we're already a minority in this sort of manualized CBT world, you know, so it's it's it's hard and easy at the same time to find people who gravitate to the message. You know, I mean, because, you know, when you're a niche, it rules out a lot of people instantaneously, but it also attracts those people that are in alignment as well.
Dan King:
[22:35] Well, that authenticity is vital both to attracting clients as well as clinicians. You're going to build something that's sustainable and you've got, I think, 15 or 16 clinicians?
Patrick Cleveland:
[22:45] 17 right now, yeah.
Dan King:
[22:46] 17 clinicians. That's enough clinicians where... For them to stick around, they've got to believe in the authenticity of what's there, right? The organization starts to take shape beyond its founder. And you've deliberately set up an organization such that you're maybe a little less involved. You're less, you're not micromanaging the way perhaps some other practice owners are. So part of what is sustaining, what keeps 17 clinicians there working is there has to be something real and authentic about it. That energy has to jive with them.
Patrick Cleveland:
[23:18] Sure. Yeah, no, absolutely. And I think I have a clinical director. She's been with me for a lot of years and she recently sort of promoted and, you know, given her that role. And she's just way better at fostering those relationships, you know, with the therapist than I am. Like I like spending my time on like thinking about marketing or thinking about like, you know, business development and things like that. Like that's what I prefer to do and and she's really good at nurturing relationships and and fostering that those other things you know so it's a good balance whereas before i think it was too much autonomy right like i think i had some turnover because it was too much like yeah you know like like it was like we call it a leading from the back i think people call that leadership style right you're like just all right guys go ahead you know i've had it and i think i think i was too much in that so now it's a little bit better.
Patrick Cleveland:
[24:12] There's a little bit more, you know, a little bit more support and involvement with her style.
Dan King:
[24:16] So it's good. Awesome. Awesome. I love what you have built and I love how true to you it is. I'm curious to know as we come towards the end of our time together, what is fun for you when you're not working? So, you know, you built a meaningful business and you have some great people working for you. So you have some time to do other things. What is fun for you when you're not working?
Patrick Cleveland:
[24:39] I'm playing with my son. I have a five-year-old son. So playing with him, that's super fun. And I do music. So I make beats. I DJ and also do hip hop. So those are kind of like my hobbies. I'll go hiking. I love being out in nature and yeah I'd say those are the those are like my fun activities outside of running the business yeah so
Dan King:
[25:00] Patrick I appreciate you so much and I think there's lots of insights and really really cool philosophy for other practice owners to ponder so thanks for jamming with me.
Patrick Cleveland:
[25:09] Yeah man no you're welcome good to be here