Fear Is Where You Start From

Recently I was having dinner with some colleagues, who were discussing the state of mental health and managed care.  When these conversations start I sometimes begin to sit back, because I anticipate the worst.  I expect that there will be some insurance bashing, and then discussion of how their salaries have shrunk, and how unfair the current system is, maybe a smattering of how better things used to be for our profession and concluding with uncertainty about how much longer they can stay in business.  I expected this conversation to go the same way, and was preparing to decide whether to try to advocate for another, more empowering perspective.

I was pleasantly surprised.

The conversation did indeed start with the understandable concerns of therapists trying to grapple with the seismic shifts in our careers and businesses.  But then one of them began to talk about how he was planning to change the way he did business.  Others expressed curiosity about the things he was trying, and I finally offered a couple of ideas.  When they found out that I provide consultation on building & maintaining your therapy practice, they were 100% enthusiastic and eager to hear some positive perspectives.  They were able to hear my opinions of some tough truths, that we had bought into the managed care model because we were reluctant to market our businesses and have difficult conversations with patients about payment.  No one was defensive at all, one even invited me to come talk with a local group of colleagues.  At one point they made a joke about my “secrets” for success, and I told them I am not one of those people who holds back secrets to hook people into working with me, and that they could find a lot of free info on my site.

“I was kidding about having a secret,” one told me.  “You don’t have a secret, what you have is a strategy.”

The Buddhist teacher Pema Chodron writes in her book of the same title, about going to “The Places That Scare You.” The goal of the Tibetan Buddhist practice of tonglen, or taking and sending, is to reverse the normal cycle of human existence.  Rather than seeking out things we desire and avoiding suffering, the meditation practice of tonglen asks us to imagine inhaling and taking in the suffering for all sentient beings and exhaling happiness to send it to all sentient beings.  Whether you believe in the mystical qualities of this, the principle is a useful one in that it teaches us to break the instinctual habit of trying to holding on to the things we like and get rid of the things we don’t.  A version of this is going to the places that scare you, rather than running away from them.

The clinicians I have mentioned above are well on their way to maintaining and vastly improving their private practices, and its got nothing to do with me.  They have realized that fear is real, and that it often is mistaken for the end of the line.  They get that it is the opposite.

Fear is the place you start from.

People who deny that things are changing are in my opinion in for a rude awakening.  They deny the way our profession is being challenged, the importance of emerging new technologies, and the evolving practice of psychotherapy.  They deny the things that would evoke fear in them.  This is not unique to therapists of course.  Ironically, we often work trying to help patients see the devastating impact on their lives of repressing anxiety-provoking truths.  Then we turn around and do the same things to ourselves, hoping that this change in  economics or technology is “more of the same.”  Folks in this group are in pre-contemplation of fear, they haven’t even gotten that far.

Then there are clinicians who have gotten that things are really changing, and they are terrified!  They are paralyzed and miserable, commiserating with others and talking about the way things were in the past and how much better they were then.  They see the point of fear and they think of it as the period on a life’s sentence of struggling.  This is the end of our careers, we can’t learn to use technology, therapy is a dying art form.  They give up, and go out of business in a lingering dwindling sort of way.

Fear is not the endpoint.  Fear is where you begin. Fear is where you get going and hire a coach, research and write up a business plan, take a workshop on business development, marketing or integrating new technologies.  Fear is the start of renovating your practice.  Yes there is a lot of suffering in the world, let’s get going and reduce it.

Epic Therapists know all about fear. They aren’t fearless, there’s a lot to be worried about.  Many businesses fail, money needs to be spent to make money later, there are long hours ahead and no structure but the one they give themselves.  There is a lot they don’t know, a lot they’ve never learned to do to run a business, known expenses and surprises.  But Epic is running toward that dragon, knowing this could be an epic failure, being afraid… and then doing it anyway.

Epic Therapists have learned the concept of “nevertheless.”  I am scared that my business will fail, nevertheless I am starting it.  I am afraid that I’ll rent an office full-time and not be able to find patients, nevertheless I am going to rent one.  I am afraid I’ll sound inauthentic or greedy if I talk about my business to a colleague, nevertheless I am going to talk about my business.  I am afraid no one will want to pay my fee, nevertheless I am going to set a firm “bottom line” fee for myself.  I am afraid that I won’t be able to keep up with the changes in healthcare or technology, nevertheless I am going to make a strategy.

My last post about having a secret headquarters was fun to make, and it was also serious.  We need to have a time and a place for strategizing.  We can absolutely have fun doing it, but this is serious business.  There really are things to fear in healthcare, building a private practice and starting a business.  We need to think carefully and plan, and then we need to begin.


  1. Excellent post! I recently started in private practice and the beginning was terrifying but nevertheless I have had more terrifying initiations, this one wasn’t even as bad. Wait this makes me Epic, right? I like that 🙂 But I would have never done it without opening myself up to getting advice and help from different sources. It’s been a great learning experience so far!

    • Mike Langlois, LICSW says

      Elivita, I christen you Epic Elvita, grats! I am sure you will do very well in private practice, because of your comment about opening yourself to advice and help. I can’t tell you how many colleagues talk about going into private practice without being willing to spend a dime on coaching, career counseling, supervision, advertising, marketing consulting, etc. You will blow by them if you keep on being willing to ask for and purchase help.

  2. Mike,

    The importance and ability to recognize and adapt to change is critical to one’s ability to survive in this world of “where change is a constant.”

    Your wonderful post and the lessons it teaches brings to mind the wonderful book called “Who Moved My Cheese? An Amazing Way to Deal with Change in Your Work and in Your Life” by Johnson and Blanchard.

    I highly recommend to anyone having difficulty with adapting to change to read this book. It is basically a parable in which you have four different mice and each one has a different attitude or viewpoint towards life. The amount of cheese available starts declining i.e., change starts occurring (this could be seen as change in your life or work) and you are shown the different reactions the four different mice take to these changes and the consequences of their actions (be it sticking their head in the sand, so to speak or searching for new sources of cheese).

    The book really drives home the point that one needs to constantly be on the alert for changes on the horizon and essentially come up with alternative strategies, as you are recommending for epic therapists.

    • Mike Langlois, LICSW says

      Ah, “Who Moved My Cheese?” That brings back such great memories. An old supervisor of mine gave me a copy of it back when our department was restructuring and nobody was happy about it. I definitely try to keep an eye on the Cheddar and search out new sources whenever the internal whining begins..

  3. Noel McDermott says

    Love this Mike, as always very clear and helpful.

    I guess the future always involves some fear as it’s unknown. I managed to overcome my fear of flying on aeroplanes by reframing it as excitement. Currently I am really, really, really, really excited about the future 🙂

    Lovin it

    In regards to use of tech I’m with you, we need to embrace it. Here’s an attempt by me, which I hope you don’t mind me sharing? ‘why are the wolves white mr freud’ http://bit.ly/l8Gi1D

    kind regards


    • Mike Langlois, LICSW says

      Noel, thanks for linking to your blog, the latest post conveys your real, real, real, real excitement, and I hope others read it. And I liked the references to my pal Susan. 🙂

  4. Great post, Mike. I”m glad you had a conversation with colleagues who are ready to grow. Change is inevitable. Fear is part of the process. I”ve been in business for 6 years and still have fear about staying profitable and doing it “right.” But the lights are still on and my family is still fed. Fear drives me a bit and there’s nothing wrong with that. Gone are the jobs where people had “security.” This is true in all sectors of the economy. No one gets a gold watch for 50 years in the company anymore and no health care provider can sit back and ‘just see clients.’ We live in a different time and that’s ok, too.

    • Mike Langlois, LICSW says

      Thanks Susan, yes it is important to keep this in perspective. Success can be such a slippery concept when one is in a pessimistic mood, which is why Epic therapists need to have a guild of supportive and positive colleagues, like you. 🙂

  5. Mike! YES! You are so right here – There are ways for mental health professionals to move safely and strategically into the world of social media. And, those who don’t, I suspect, are being left behind. It’s no longer enough to throw up a static website. Potential clients want to know that we are accessible and engaged with our clients and our communities – online and offline. I am forever beating this drum when I’m talking to new professionals about how to build a private practice.

    And, I have to admit that I am tech-phobic and tech-challenged. So . . . if I can learn it, anyone can learn it!

    Thanks so much for a much-needed post! Your blog ROCKS!

    • Mike,

      Great article. When I started my practice I didn’t even have an office. I rented one or 4 hours a week and convinced myself that I would get those 4 hours filled. I have never worked so hard in my life as I did trying to do just that. I told colleagues, asked for referrals, talked with doctors who had referred to me – anyone who had referred to me. I made flyers and introduced myself to everyone in my building; gave them a stack of business cards and a flyer. I made an appt. for coffee with them to learn what they did, how I could help them and in 6 months I had enough clients to rent an office full time and my business never stopped growing. I too, love to teach people how to build a practice. I find it is oneof the most rewarding things I have ever done. I could go on and on and write a book…maybe I will!

      Again, great article – keep them coming. Judy

      • Mike Langlois, LICSW says

        Hi Judy, thanks for the condensed version of your story. And you have me rethinking the sub-leasing 4 hour block strategy for consultees. I admire your embracing the aggressive networking and marketing that building a practice requires. I am sure that you convey this in your consulting and coaching, and that’s the sort of colleague I refer prospective consulting clients as well. 🙂

    • Mike Langlois, LICSW says

      Thanks Tamara, and yes, there are ways to move into Web 2.0, and heaven forbid we have fun with it. I find that so many of our colleagues only think of Facebook and Twitter as mysterious liability magnets. And yet with the exception of one MD in RI, I haven’t heard of anyone even reprimanded for using social media in health care.

  6. Right on, Mike! Fear is a great teacher. We must must must grow and change, adapt and adopt, and keep move forward. Fear can be a friend along the way if we listen to it asking us to re-examine assumptions, take more strategic risks, embrace new challenges — lest we be stuck in a dying paradigm.

    It can be fear, when we are poised at the top of the snowy mountain, as we look down at the steep drop, imagine falling and feel the rush of anticipatory out-of-controlness.

    Or it can be exhilaration, an exercise in trust, and the chance to grow our own self-confidence and determined belief in our abilities.

    Hey! I should be posting this on my own blog!! LOL


  1. […] great post on social workers embracing innovation over at Mike Langlois’s Gamer Therapist blog. My favorite quote: “Yes there is a lot of suffering in the world, let’s get going and […]

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