Yet Another Career Pivot of My Own

I’m aware that there are multiple chapters in my life where I craft a “why I left” missive, and as the pattern-seeker that I am, I wonder about it. Do I abandon things when they get hard? Nah, if anything, I stick with them too long, turning something sweet into a bitter taste in my mouth. Do I get bored and jaded? Yes, to some extent. The bureaucracy and hypocrisy of large systems – where I intentionally sought refuge – suddenly seem only driven by money and the entrenched patterns of the patriarchy. Like a lover whose most appealing feature seemed to morph over time into the most irritating quality any human ever displayed.

To get the nitty-gritty of this latest shift: at the end of September 2024, after three years working for a large EAP (employee assistance program), which was also dressed up as a mental health startup, I gave up the W2 life for full-time private practice. Side note: if you want to know the name of the company where I worked, go ahead and PM me and I’ll tell you - it’s not my agenda to do an expose on the inner workings of the company, but I’m also not hiding it. I left there with a healthy respect for the organization and the people who remain.

This change comes due to enormous privilege. My partner carries the health insurance for us through a benefitted, W2 position. I would not have made this change - at least not until I reached retirement - without that shelter.

I left because I want to step away from the cookie-cutter, frenetic pace that defined the company where I worked. I called it the Chipotle of mental health care. A step up from McDonalds, but fast food nonetheless. Sure, there was some efficiency in the robust digital library of videos, audios, exercises, and articles that covered therapeutic concepts, tools, and theoretical orientations. And I don’t want to belittle the efficiency of that bank of resources, the short-term approach to care, and the streamlined approach that went with it. The company was founded on the principle of making mental health care more accessible, and it delivered on that front.

But ultimately, the work felt rushed and formulaic, and - in some ways - dishonest because the clients were told they had a generous allocation of sessions annually (not universally true - some employers bought only a handful of session for their employees, but most went big and allocated up to 20-25 or even 50 sessions) while practitioners (therapists and coaches) were instructed to minimize the number of sessions. There were actually parameters (example: 4-6 sessions for clients with mild symptoms, 6-8 for clients with moderate symptoms, and 8-12 sessions for clients with severe symptoms). Of course, we could override those numbers using “clinical judgment,” but there was no getting around the fact that metrics such as the average duration of an episode (a cluster of sessions) were gathered alongside many other numbers that evaluated our proficiency as clinicians. And this process of categorizing clients as mild, moderate, or severe was invisible to clients as was the pressure that was on clinicians to wrap up care. To be fair, there were some advantages to this model in that it massively reduced a dependence that clients sometimes develop around therapy and equipped them with skills (a bit of a “teach a person to fish rather than catch them a fish so they can eat on that day” model). And the company was a for-profit business with venture funding that someday will run out, so there was a real need to get to profitability. But here’s the thing: another layer of nuance at the company was that there were financial incentives (at the time I worked there) for therapists to “graduate” clients once they showed clinical improvement. Yes, I received a not-insignificant amount of money each time I wrapped up with a client who demonstrated clinical improvement (which was calculated using an intricate algorithm).

Okay, to sum up: I got tired of running on the treadmill where the corporate behemoth set the speed (far too high) and created a mirage for clients (which behind the veil had some motivators that didn’t sit well with me). And despite all of that, I still found integrity and extraordinary clinical care there. Gifted and devoted and authentic people are still there, and I adore and respect them.

The tone of my final consult group – my cherished group of intimates who gathered where I confessed my doubt and brought forth my most stuck clients – that tone had grief around the ending of remarkable alchemy that forms into a bountiful meal where many can feast with revelry and nourishment for years. But the tone also had a schism, one where two of us were diverging and moving into private practice, taking a calculated risk to venture out on our own, with the metaphorical shingle in the form of a website. Those staying under the shelter of the umbrella of the company hinted at the road ahead, perhaps inadvertently underlining the uncertainty we faced as we headed out into the wilderness without a guide, discovering potholes (and potentially black holes) on our own. Perhaps they gave emphasis to that point to shore up their decision to stay, and perhaps I even imagined that subtext, overlaying the dynamic with my own worries and jealousies. Whatever the source of my tetchiness, I felt itchy in that meeting, eager to move forward yet reminded of the exquisiteness of our gathering and its brevity, never to be repeated, only held in the glow of memory now.

I feel gratitude to that company for my blossoming under its shade. The infrastructure of that sweet consult group and a solid foundation created by my clinical manager, whose counsel I held dear and leaned into often. My therapeutic style morphed, shaped by the container of the startup in utilitarian ways. I have a hefty toolbox and easily flowing scripts to engage with clients from the initial contact to the wrap-up. I have literally hundreds of data points around approaches, timing, and nuanced dials on my console to support people as they create habits they covet and gently set down those they’ve outgrown.

But the time is ripe. Something sacred in me was wilting on the vine at that company, an ownership and even an embodiment of how I work and who I am that is a sprouted plant whose roots are clumped into a pot of soil that is the mental health startup I just left. I’m busting out of that literal and metaphorical container, and my roots are suspended now, liberated yet tossed on the flagstone patio above the newly tilled soil that I’ve prepped, ready to go into the ground and find new water sources, new nutrients, new territory where I can spread and venture forth. I’m scared and exhilarated at the same time, my body humming with energy and tension.