Episode 17 · 44 min · Apr 29, 2026
Anxiety as Information: Moving Beyond Management Toward Understanding
with Madeline Maldonado, LCSW-R
Madeline Maldonado spent the first several years of her clinical career doing anxiety treatment the way she had been trained to do it: psychoeducation, cognitive restructuring, exposure work, symptom tracking. The approach worked often enough to feel credible. It also failed often enough, in specific and patterned ways, to make her curious about what was being missed. The clients who got better with standard anxiety protocols were, she noticed, a particular kind of client. The ones who didn't were not less motivated or less intelligent — they were often more so. Something about the framework itself was not matching their experience.
The reframe she eventually arrived at — anxiety as information rather than malfunction — did not come from a single theoretical source. It came from accumulated clinical observation, from the body of work in somatic and interoceptive psychology, and from a growing unease with how anxiety treatment had come to be organized almost entirely around the goal of reduction. Reducing anxiety, she came to believe, was sometimes the right goal and sometimes a category error. The difference depended on what the anxiety was actually communicating.
For the majority of the high-functioning anxious adults she works with, anxiety is not, at its core, a disorder of the nervous system. It is a disorder of attention — a learned pattern of directing awareness toward threat in ways that have become habitual and exhausting. Working at the level of symptom management addresses the consequences of that pattern without touching the pattern itself. Madeline's clinical approach asks clients to do something more counterintuitive: to develop, incrementally and with considerable support, a relationship of genuine curiosity with the signal their anxiety is sending, rather than a relationship of urgent management.
In this episode, you will learn:
- Why treating anxiety as a problem to eliminate often perpetuates the cycle
- How to distinguish adaptive anxiety from pathological anxiety in clinical assessment
- The role of interoception in understanding a client's relationship with anxiety
- Why symptom management approaches sometimes backfire in high-functioning anxiety
- What it looks like to help clients develop a curious relationship with their own anxiety
Welcome back to Therapist Voices at Reach Link. My name is Jessica Hurwitz and I manage our network of therapists. Today, I'm really excited. We have Madeline Maldonado with us. She's an LCSW and the president and founder of Minnette LCSW Psychotherapy Services and the executive director of Minnette Foundation, both of which we're going to learn a little bit about. And I'm especially excited to have Madeline with us because we're talking about something that is going to appeal to all of you. It's the stuff that you don't learn in grad school that for some reason no one wants to teach us. It's the whole business of having a practice, having a consulting practice as a solo provider. So, Madeline, thank you so much for being on with us. I think you're going to be able to shed some light on a lot of really helpful things.
I suspect, I may be wrong, but I suspect that a lot of the things that you're going to share with us may come from what you've learned along the way kind of maybe by accident that you can share with everyone as a mitzvah, if I will, as a good as a good deed. So, thank you so much for being here. Tell us a little bit about yourself and how you got started in the field in general. Jessica, thank you for having me. I'm very excited to to speak to you and everyone here listening today. So, I got started in this field uh what year? We're in 2026, so this would be 26 years ago. I started uh figuring out what I wanted to do with my life and career. But prior to even that, I had already as a child been very attracted to I guess social service needs. You know, I I remember being a young child, 8 9 years old, and already noticing things in the neighborhood where I grew up in New York City that maybe another eight-year-old wouldn't notice, I don't know, but I really was observant about, you know, hey, why is that person on the street asking for money?
Or, you know, why is that person without a coat and it's winter? And I would always ask those kinds of questions, and my father, God bless him, would always tell me the truth, you know, in a nice, child-appropriate way, but he would tell me that person doesn't have money, that person is poor, that person needs help. That's why we give them money. And so as a child, I think I already had that foundation of really wanting to help and being able to see things going on that hurt me as a human being. And then fast forward to college, I had been studying engineering. Uh that's what I thought I was going to do with my life, and I had done three years of internships with the MTA, and I had a wonderful internship in Brooklyn, and I really am thankful that the owner was honest with me. He told me I had very good work ethic and I was talented, but I talked too much to be an engineer.
So at that point, I said, I think he's picking up on something. hope you said thank you. Well, you know, I I I thought it was a little bit of like a of an insult at the point, you know, like I took it I took it like, oh wow, you know, he doesn't like me, but I think it was the opposite. He saw me as I liked the work, but I I was more into the people. So I would, you know, do the work, but in between, I'd want to talk to the engineers about their lives and ask them all kinds of questions, and that's not what that profession does. And so I started to really pivot and say, what do I really want to do that goes with this passion that I have for wanting to talk to people, to connect with people. And my advisor in college, she suggested I try an internship at um Bellevue Hospital. So, I did an internship at Bellevue Hospital in the city.
And I was in the HIV AIDS unit. And I would go from room to room just talking to people who were recovering from whatever illness they were having. And I just fell in love with it. I was like, this is exactly what I want to do. I am like enthrall stories. I'm honored that they trust me, and it just clicked for me. And she explained to me that what I was doing was called social work. And so, I started to change, you know, my my name my major my trajectory to go towards social work. And then, of course, I went to graduate school and got my degree in this and had more internships, but I feel like it was an evolution. Where I kind of always knew I wanted to be in some kind of human service-related field, even though I had talents in technical things. So, thankfully, I followed my heart and my passion because otherwise, I think I would have been a terrible engineer.
Just bothering people, talking about their feelings all day. I think that's so amazing though that that person I mean, that that person could have easily just as easily not told you, you know, I think this might not be for you. You really like people. You really want to know about people. That's amazing. That that person could have have really changed the they did really change things for you. You could have just as easily gone along your path in in that field. And shout out if they're listening to that person for for where you've ended up now. We need people like that to call out our strengths. And that's not it's not that common. Well, if you are listening, we're we know it's you and we're thankful because now we have Madeline with us. So you finished school with your degree in social work, is that right?
Yes. Yes, I have a masters in clinical social work. And then what came for you after after school? Did you know what what specialty you wanted to go into? Did you get into a practice with others? What happened for you first? Well, I always knew I wanted to start as a therapist and so as soon as I graduated, I I went right into a mental health clinic and I worked full-time as a therapist, but it was an interesting time. When I graduated, it was a year well, actually not even a year. Let's say 10 months or something before the 9/11 terror attacks. So I came out of school and I started working at a mental health clinic and right away our country was in in crisis and New York in particular because that's where the attacks happened and that's where I was practicing. And so we were inundated with referrals for clients who either had been in the World Trade Center or lost people in the World Trade Center.
And then sadly, there was a a plane that crashed in Queens. I think it was American American Airlines jet couple of months after September 11th. So that was another tragedy particularly for the Latino community because that plane was headed to Dominican Republic and a lot of people in New York in Manhattan and in the Bronx and Queens lost family members. So those clients, some of the the family members of those people that passed away or were affected ended up being clients as well. So I feel like the term baptism by fire was my experience the moment I I started in this field as a therapist. Like I really had to I had to grow up. Had to grow up quick. With with a definite tragedy and that I I suspect, although I'm not assuming, but I I bet that shaped a bit of the clinician that that you are today and that you were post post that time.
What type of clientele were you seeing at that time? Were you kind of seeing a mix of of people in different ages or did you have a specialty at that point? I started um because it was a community mental health clinic, uh you are required to work with all of the types of clients that come to the clinic. You're not really given a choice in terms of who you work with, who you don't. The The encouragement is for you to try to at least become proficient at seeing all kinds of people with all kinds of different problems. And um so I had clients that were I mean they could have been my parents. Which you know, at at 20 24 years old, I was like this is a little weird me giving advice to somebody that could be my mother or my grandmother. But again, I I realized I had to grow up fast and kind of see myself um in terms of my professional identity and and really solidify that outside of who I felt I so was as just Madeleine.
And and I think that was probably something that they didn't explain or train us about in graduate school. You know, really the importance of professional identity and and holding on to that because you may be a lot younger than your clients or you may be working with clients where you feel like they have more life experience than you or you know, something like that and and you still have to be able to be effective in the work that you're doing with them. I worked with young children as well, which was interesting because I never wanted to work with children at that point in time. And of course, you know, you don't want to and you get 15 of the kids on your caseload. And and you know, all the hyper little impulsive, aggressive little boys. I was like, "Oh God, I don't want to go to work."
I had them all. I had them all. They knew. They knew. They knew. I think they they just were like, "We're going to make sure that she really knows if she doesn't want to work with kids and it's not just saying that." But that's what I I think so many people, even people that I've had on the podcast so far and then combined with just therapists that I know, I feel like everybody that says they started off or had experience in community mental health in a clinic of sorts, have said that it was the hardest thing. It was so challenging, but it shaped me. It introduced me to all all different types of clients, ages, presenting issues. Just like you're saying, kind of no preparation, just getting whatever whatever is there and and I've also heard a lot of people say that's where you really learn to write some very in-depth notes Yes. and documentation.
And I think just from what I've heard people say that that's really very much shaped a lot of people into the clinicians that they've been able to then to then become. Yes, I I agree 100%. Um you know, the the field has changed a little bit in terms of, you know, when I graduated, you didn't see a lot of therapists talking about going into private practice right away. Particularly, you know, a few years out of school. It just I I can't recall a single friend or colleague talking to me about that stuff when we were in our late 20s or mid-20s. Um now, I think with the rise of social media and so many um therapists who are online kind of like, you know, exposing a little bit about what they do and also glamorizing it to some degree. Um you have new graduates kind of just wanting right away to have their own private practice.
And I am so for people having a private practice, a business, if that's what you want to do. But, you know, we'll get into this more obviously in this discussion. I think that you have to be ready for what that entails because it's not glamorous. I can tell you that. And the the training that you get as a therapist in a community clinic is, I think, the best version of boot camp. You know, how we we it's in New York, these are popular, the boot camps to get in shape. You know, if you're like if you haven't been doing your workouts all winter long, you get into that spring boot camp. And in 90 days, they'll get you back into like a workout mentality. You know, like you'll look good. These boot camps work. I've done them. So, I I think community clinics are like the boot camps for new therapists because you learn how to work in a streamlined way.
And you you know, you you're working with people who possibly are in crisis. You're working with the wide range of DSM-5 diagnoses. So, you know, you can't just get used to this habit of everybody's mild and just an adjustment disorder. No. You know, my first client of the day is schizophrenic, followed by bipolar, followed by post-traumatic stress, followed by ADHD, followed by the nice old lady who's just lonely. I'm not sure what's going on here. Like and this is all day long. And and and what I loved about the community mental health clinic model though is that you are surrounded by other therapists who, you know, iron sharpens iron to use that uh saying. There's a clinical supervisor, there's clinical director, there's possibly a psychiatrist or psychiatric nurse practitioner. So, when you have all these people together, there's always somebody to go to and consult and just bounce ideas off of and learn from.
And I learned medication from psychiatrist. And although I'm not a prescriber, it just came from a lot of medica- a lot of conversations where I would ask and say, "How do you know which antidepressant to start with? You know, just how do you know that this antipsychotic won't work? Why are injectable antipsychotics better than the pill?" I would ask those kinds of questions. And they don't They would always say like, "Are you going back to school?" I'm like, "No. Medical school is not for me. I don't like the sight of blood or guts or anything like that. So, but I'm I really wanted to understand. And that's what a community or a group setting allows providers to have. And private practice as a solo provider does not allow you to have. I I'm glad to hear you talking about this because I was just I was speaking with I had a guest on a couple days ago that is a a play therapist.
And I when I was in grad school got randomly placed in my internship in play therapy, which was like my fifth choice of one through five. And I remember, you know, while I got such a great experience, which I didn't plan, but I remember seeing all of my um my my peers that I was in school with going on to community mental health centers, whether, you know, some were in psychiatric hospitals, some were just in different settings, but they were getting such It sounded very intimidating, but at that point in my career, I wanted all of it. You know, I wanted the most severe, you know, every everything. I really was wanted to be immersed in the symptoms and and the acuity and all of that. And I do always feel like I missed a bit of an opportunity that my my peers did have even though it sounded awful for them at the time, you know, being I remember them being called in on weekends from their supervisors saying, "You didn't do this note properly.
You need to come back in." And I remember thinking, "Oh, I just get to play with these kids. That's unfortunate for them." But I do always feel that I missed out a bit on that foundation that you don't get in school regardless of how how advanced your your scholastic education is that that you're describing here. That's really a full You're going to get whatever you get, and you have to be able to pivot, and that's what the whole point is. And I think that's such an important foundation. And anyway, enough about me. I want to know more about then from there, you went to find out something very important, which we've touched on a little bit in this conversation already that we do not We're not prepared. We don't know how to work in private practice the way that many of these perhaps younger, newer to the field clinicians think they're going to Okay, jump in.
I've got a private practice. I've got a biller perhaps even. I know technology cuz I'm young. I get it. What was that like for you? Cuz I know then that's what you really went into into specializing in. What was that like for you? Did you fall into that? Well, I'm I'm actually going to segue into responding to that but with something that came into my mind when when you were saying about jumping into, you know, private practice, I think it's important to to name this because so many of us like carry in the world of therapy, we carry this as like a, you know, shameful like secret. A lot of us are very intimidated by the DSM-5. Prior to the five, it was the four and the three. That's how long I've been in practice, but people are terrified about that manual. They're even terrified about the small one, you know, the the the one you keep on your desk.
The condensed one. one. And and, you know, when you really, you know, I've supervised enough therapists to know where I've had to say, "Are you nervous about diagnosing?" And, you know, the ones that are kind of like, you know, "Yeah, yeah, I don't feel I'm great at it." Well, then we need to work on the skill. Because there's no way you can practice independently if you don't know how to diagnose properly because number one, it's your legal liability that's on the line, you know? You are responsible just like a doctor is responsible when they're putting a diagnosis. You are responsible. And and you cannot ethically just under diagnose or diagnose the few diagnoses that you're comfortable with because, you know, those are the ones you like. Like you actually there's a science to this, a system to it.
And and we have to get better at it. And and so, you know, I wanted to to just kind of say that because I think that that's the first thing, the the supervision. And and the quality of the supervision and training that you've had kind of sets the tone for how challenging it's going to be to have your own practice. Because you have to make every decision pretty much on your own. It's your practice. No one's telling you what to do. So, my first private practice experience was actually in my late 20s. I I was part of a group practice named Hispanic American Consulting in Yonkers, New York. And it was started by a former co-worker of mine at that first clinic job. And so, she called me and said, you know, I know you may not want to come work with me full-time, but I like how you work. What do you think of doing a part-time, you know, private practice but under me so I will pay you.
I said, you know what? I think I could do that. You know, I'm in my mid-20s. I could use the money. Why not? And so, that was my first foray into private practice because although it was under her her business, I still had to do all my own notes, fill out all my billing submissions. I had to call my clients, schedule my clients, and my clients no show or canceled. So, there was a lot that I started learning like, oh, I'm responsible. There is no no one else I can put this on. Whereas, like a community clinic, hey, I'm sick. You just call like the admin assistant and she'll call your clients. Not in private practice unless you happen to have an administrative assistant. So, you better always have all your clients' phone numbers with you. I learned that at 26 years old like, you know, this was before I had a cell phone.
So, I would have like a little piece of paper with client initials and their phone number so that I would know if I was sick or something and this is how I reach these people because there was nothing electronic either. So, it wasn't like I could log on from a computer. I didn't even have a home computer at that age. So, you know, I'm I'm dating myself now, right? So, Madeline, you were in a period where you're working at this at this practice with someone that was trusted to you which by the way not I know not everyone is in that situation where they they can go to work for someone that I liked how they said, I like your work. I know your work and I like your work cuz these days, not necessarily what everyone's hearing and you might just be another number. Um so, you didn't have phone numbers, you did it was a different day and you're really hustling to to get your clients what they need.
How long did you work did you work there for? I was there 7 years. Part-time. Yeah, so I had a full-time job. Part-time. Yep, I had a full-time job. Um that's when I started doing more of um like uh supervision. So, I I had a full-time daytime job where I mean, I had first been like a program coordinator for a a program that did um workshops in the community and then I would became a clinical supervisor at a hospital. So, I had um you know, responsibilities all day long 9:00 to 5:00 in those roles and then I would race to go to my private to see my clients at 5:45. That was the you know, and every 45 minutes I had a client until 8:30 at night. And I also worked Saturdays, which I hated. I hated working Saturdays. I did. I did. It was only 9:00 to 2:00, but so I I can always empathize with people that work Saturdays and hate it.
I'm like, just make sure you have an end date. I'd rather work till 10:00 at night during the week than work a Saturday. And it's so interesting cuz you know, some people would say the total opposite and then some people would say exactly that. It's so and that is a quick pivot why I think virtual counseling has totally opened up some differences some different um opportunities for people that providers and clients alike. So, I was not picturing that this whole time that you were working at within this private practice. I wasn't picturing that you had this full-time job doing counseling. So, you were doing all of that and you're probably learning, I imagine, at the same time in in the private practice all the stuff that goes into it, which again, we are not taught in grad school. I know, I think more in recent years it's kind of brought up a bit more the business of psychology, if you will, I guess.
But, so what did you learn? Did you learn a lot from your friend, your colleague, when you were working there in terms of how to have a practice? I did. And in fact, you know, because this was before we had access to all this technology, which does make running a practice a little bit easier. You know, billing has gotten easier since we do electronic billing. Let's, you know, let's just call it that. It is a little easier now to go into portals online and get information. So, yes, that has helped. But, I I just remember, you know, from back then, she would always tell me the importance of making sure that everyone submitted all their billing claims on time because if the insurance reimbursements were towards a late, that impacted her being able to pay the bills. And, you know, I had an understanding back then that there's not an unlimited fountain of money.
Like, you're the owner. So, if you have people working with you or if you're working for yourself, your landlord doesn't want to hear, you know, if you have a space, an office space, they don't want to hear that, "Hey, I my my insurance company hasn't paid me. I can't pay you your rent." They don't they don't want to, you know, Con Edison in New York, the electric company, they don't want to hear that you can't pay the light or whatever it is, you know. Your staff does not want to hear that you can't pay them because your checks were late. So, the timeliness of every night, we we wrote out our billing things and got them done every single night. And so, that kind of discipline where you know, it just you couldn't deviate from that. You have to build that. You know, you have to build that discipline muscle because no one's going to tell you what to do when you work for yourself.
But you will pay all the consequences for your decisions. The buck starts with you and stops with you as they say. So I learned at a young age, you know, you need to be responsible for yourself or you won't be able to make money doing this. And a lot of people I would imagine in that first those first couple jobs aren't necessarily thrown into that that lucky learning learning situation that you were in to understand all of this. What what came after after you were there? Where what came for you next? Were you in more of a private practice situation where you where you started using these tools or what happened for you? I actually took a a personal detour. I moved out of state. I got engaged and I was living in the in the Midwest for a period of time and I segued into that only because it well, I segued into sharing this part of my journey only because again, being a really good therapist, I think requires being comfortable with people of all kinds.
And I think that especially as a virtual if we're doing virtual therapy now, what has been lost for some therapists is that if you haven't had a whole ton of experience with people face-to-face in an actual physical setting, there are just some things that are a little harder to to read like you know, body language and you know, I could tell like with clients postures what was happening sometimes, you know, and especially with clients who were from different, you know, cultures or racial ethnic groups, I learned to pay attention and to ask questions. And clients also would notice things about me that, you know, I I find it amusing, but it's something that I think we've lost a little bit with the virtual therapy. You know, like clients, for example, who see me in real time, they're like, "You talk with your hands and boy, do you like long nails and jewelry."
Cuz they see me, you know, doing a lot of this, which I can control on a screen. On a screen, I could be doing all of that right now under where the camera can't see it. So, I can come across as very perfect and paused, whereas in person, you know, you're like, "Oh, wow." Or you'll see me spinning my little ring and my bracelets jangling them. It's a human tick. We all have one. I love that you're saying this because I feel like so often we're talking about, "Oh, the all the pros of a virtual counseling." And there are so many, but I really think this is very important to call out that, you know, we're seeing each other from here down. You know, like you're it there is a vulnerability I don't want to say manipulation because it's not an intentional situation, but there there are things that people are that you are able to hide that even if you're not intentionally hiding them, that that people are not able to see.
So, I really appreciate that coming coming out because we're always, myself very much included, talking about how great virtual counseling is. And it is, but this is really important to share. This is really important to notice. There's again, who knows what's going on. You could I could have a dog down here. I don't. I wish I did, but I don't. Um and in a session my client would know that. So, anyway, So, when I came back to New York um after about 5 years in the Midwest, I jumped right back into managing uh a community mental health clinic. And that is where I made the decision internally that I was going to have my own um clinic practice eventually. Not because I thought there was anything wrong with this community clinic. It's still there. I mean, I'm I'm friendly with quite a few people who are still working there.
Um what I saw working at that clinic was the things that I would want to keep and then the things that absolutely I would never want to have in my own clinic practice. And you know, I I saw how we treated staff, how we um treated the clients. I saw the the regulations that we were not in control of. You know, when you're a community clinic, you're licensed by the state and the city. So, you have to play their rules. You have to play everything by their rules. I mean, down to you know, if you can hang curtains in the waiting room. Not allowed. Fire hazard. Bye-bye-bye-bye-bye. Which is why private practice offices look so different. And it's not you know, because people purposely want community clinics to look like trash and private practice to have leather couches and area rugs. It's because that stuff is not allowed, says the city and state of New York.
Okay? So, I really just realized like I want people to to be able to come to a place where they don't feel they're at the mental clinic. And and especially for communities of people that looked like me, sounded like me, that came from families like mine, immigrant families, you know, black and Latino people. I wanted a place that, you know, it didn't say mental health clinic right on the awning. So that when you open the door, everybody on the street could see you were walking in the mental health clinic. I mean, just let's start with that. You know, what I wouldn't want to walk into a mental health clinic today except to work. That's the only way I'm walking in, you know, because it's it's off-putting. Yeah. Yeah, it's off-putting. It signals to the world that something wrong. with Right.
Even with stigma changing and and being being different, at the end of the day you still you're human, you are not necessarily going to want to shout to the world, "I'm walking into my mental health clinic or my mental health hospital." However, whatever they're calling it. You just and you don't have to you don't have to have to feel that way. Yeah. Yeah. And, you know, I also really wanted staff to also feel that they could relax. You know, all these regulations also, you know, for example, we were never allowed to wear sneakers. We had to dress corporate. Now, I like to dress nice all the time, but my staff, some of them were like, you know, is it okay if I wear sneakers? Nope. It's in the HR handbook, no sneakers. No sleeveless tops, like you're wearing right now, Jessica, no sleeveless tops.
This would have been a problem. I would have had to tell you, Jessica, you can only wear that top if you are going to put a cardigan or a jacket over it for your sessions. That's a violation of our dress code. So, I wanted our staff to just feel comfortable. You know, if you wear sneakers, if you're the type of therapist who gets on the floor with kids, come to work dressed appropriately for that type of work. You know, if you're the therapist that wants to wear, you know, 5-in heels and dresses, come to work like that. You know, if you want to wear, I don't know, what what I you know, when when I had therapists, for example, who were part of the LGBTQ community and they felt like they wanted to express themselves in a certain way. And I you know, again, I'm dating myself. This was, you know, before companies being more tolerant.
There were there were rules around, you know, how male and female genders should present in the office. And and I wanted to kind of do away with some of that so that the actual clients that we were trying to serve could feel comfortable seeing therapists who reflected them, too. You know, everybody doesn't want to wear a blouse, slacks, and pumps, you know, as a female. And as a male, everybody doesn't want to wear collared shirt and khaki pants and and loafers or dress shoes to the office. So, just even even small things like that, I I started saying, "How can we make something that is accessible to this community that I love and that they're proud of going there and that if this is a home for them." And so, that's where the idea kind of started. But, taking that idea from just an idea to reality was probably, I think, one of the hardest undertakings of my life.
And I will, uh you know, say say as a Uh-huh. Okay. As a side note, I'm I'm very blessed. I have an amazing um business partner and co-founder, Mary Tavares Garcia. She's also an LCSWR. Um she's Latina like me, Dominican background. So, we have a lot of similarities in training. And and we could help each other with some the things uh that needed to be done. But this was still work for four people. And and it was the two of us to start this clinic. And when we decided that we were going to do this, it was the beginning of 2020. We all know what happened in March of 2020 with the COVID-19 pandemic. So we had just sent our paperwork to New York State to get our name incorporated and get permission to have this therapy business and New York City shuts down and goes into lockdown and quarantine.
And that could have been enough to derail the whole thing. You know, but she she has a great disposition and she said, "Well, we'll just keep working on this and when New York opens, we'll be ready to go." And it took about two years of fighting through the red tape because the red tape trickles everywhere. It wasn't just getting the approvals from the state. It was getting the credentialing from insurance. So to get credentialed as a provider in a group, oh my god, some of these insurance plans will take about a year. So it is easier if you're starting as a solo practitioner because now we have platforms like Alma or Headway or all these other things. But even with those, it still could take 60 to 90 days. And and in that time while you're waiting to get credentialed, you now have to start coming up with a business model.
Because let me say that one more time. This is a business. And your business is therapy. And I think when you come into this business as a therapist, you are looking at your interactions as you know, I just need to see clients. That's about 30% of the work if you're a business owner. The other 70% really is running a business. And you can't drop one thing and only focus on the other. You know, so so figuring out how you're going to see your clients and manage a business. Are you going to only be in person? Are you going to have a location? Okay. Um how much money do you have available to fund this business? Because to be fully transparent, we did not um have any loans. We did not have um any kind of seed money. And we wanted to have seed money and and a loan, but you couldn't get one during this time.
You just couldn't. So and for those of you listening who are like, well, you know, I have good credit, getting a business loan when you don't have a business that's been running, it it sounds really illogical. But the first thing they'll ask you for is proof that your business has been successfully running in order for I mean, you go to Chase, Capital One, Bank of America, all the big banks, they're all going to say, "No." Even with good credit. Because you don't have proof that you have a business that's been running for a couple of years. So you either are going to have to rely on savings or you're going to have to rely on credit, your own credit. So we kind of, you know, did a mix of both, but I can tell you the first 2 years of a private practice, you are bleeding money and and just trying to keep your head above water.
Because as soon as money comes in, it's going right out. And you know, you you already owe the money that's come in. So the money that comes in, you already owe that, whether it's to pay for your electronic record system or to pay your biller or to pay, you know, whoever's assisting you with phone calls. So as soon as you see that check, uh it's already for something else. And you will not be able to pay yourself this big salary that you may be thinking that you will. It takes time to build to that, and it's uncomfortable. It's uncomfortable. So, my advice for people who want to start a private practice is unless you have a lot of money saved that you could make it a year, year and a half until you start generating consistent income or you know, I mean, if you're lucky enough to, you know, have a partner or someone that can, you know, pay the main bills you need to just understand that it's going to be very tight financially for a period of time.
And all of us online who are smiling and glamorizing this field are not going to say that, of course. But the reality is it's you're not making a lot of money in the beginning. You know, you're you're lucky if you break even. And there are months where you don't break even and you got to dip into your savings or dip into credit cards to make it work until you're known. Because that's the other thing. Everybody thinks, well, I'm I started my business, the clients are just going to start running to me. No, they're not. They're not. And I mean, when I started my business, I had already been in practice 19 years. If anybody should have had people running to them, it should have been me. They were not running. And and Mary also has that many years. They were not running. You know, we had some people that were like, great, I'll start telling people about you.
But you also have to become a master at marketing. And and and sharing that you have a a practice and that you're taking clients. And every What do you do? What's your website? Hi, another expense. And getting a website done is not this magical process where somebody comes in and creates your website. You actually have to collaborate with them to create this website. So, that's more work that you will be doing, and you have to pay someone to do this unless you are a master at this kind of stuff. And even if you could do it yourself, a lot of what ends up happening is you have to delegate some things because again, remember, you have to see clients. You got to generate your business is seeing clients, so you have to create revenue. And then you have to also create things that create more revenue.
So, a website, a social media presence. You got to get out there and network and and meet other professionals, you know, doctors maybe, school personnel, people who could send you clients. So, you literally have to promote yourself. This is not anything that we learned how to do in graduate school. This is business 101. This is not social work or um psychology or mental health clinical work 101. We don't learn this at all in school. So, no one taught me this. This was all learning from just tripping and saying, "Well, we're not getting enough referrals. What are we going to do? You know what? I'm going to print some flyers and start calling people that I know and going to this number of schools this week and showing up to doctor's practices and I'm going to get on Instagram and do lives and I'm going to, you know, tell all my therapy friends, "Can you recommend me?
I have, you know, I have a practice now." It This is where, like I said, for a year and a half to years, you are just treading water. It's not glamorous at all. If you care deeply about mental health, whether as a therapist or someone seeking support, this message is for you. If you're a therapist listening and you're looking for more flexibility, more balance, or a way to expand your impact, ReachLink is growing. We've been building a community of thoughtful, dedicated clinicians who want to make care more accessible through telehealth without losing the human connection that matters most. With ReachLink, you can work from anywhere, set a schedule that fits your life, and let us handle the administrative work so you can focus on what you came to do, help your clients. And if you're looking for support, at ReachLink, we believe mental health care should meet you where you are, in how you feel, and in how you live.
Whether you're navigating stress, burnout, relationships, or major life changes, you don't have to go through it alone. With the ReachLink app, you can connect with licensed, experienced therapists through secure, convenient telehealth sessions from your space on your time. No commute, no waiting rooms, just real support when you need it. So, whether you're ready to start therapy or ready to offer it, ReachLink is here. Download the app or learn more at reachlink.com because better mental health should always be within reach. And so, you don't know that you are about to be not only a wonderful therapist, that is what you went to school for, Yes. but also a marketer who, chances are, someone who's gone to school for therapy, unless they have some very diverse background, does not have a marketing background, doesn't have that skill.
No. The technology these days, especially, that you need, the administrative staff that you might likely eventually need to have to delegate, all those things. And I I always say that therapists these days are expected to be so much more than just a therapist. And I think that every year that goes by, that intensifies so much. And and it's amazing to see so many therapists like you that are able to roll with the punches, that you've dealt with this, you know that this is just another thing, another specialty I've got to, you know, have under my belt. Do you Are you available? Do you ever help people that are that are starting out in a practice? Do you ever advise people? Is that something that's part of part of what you do at all? Yes. Um actually, one of the motivating factors um to to launch our clinic for me and for Mary was we had this vision of wanting to give back to therapists, to young therapists.
Um a couple of years back um in 20 2020 or 2021, I co-authored a book called Latinx in Social Work, Stories That Heal Communities. And I co-authored this book with Tell me again, sorry. Madeline, tell me the name. What was the name of the book? Latinx in Social Work. With this book, I had joined a collective of about 20 other social workers who uh we each shared uh our our story in a chapter. And my story focused on um basically, how to navigate this career. It was like a blueprint for how to go from being a therapist to going into management to then being able to go into into private practice. And what I learned from this process was how many young mental health professionals, whether they're MSWs or MHCs or psychologists, really were looking for people to to share with them that blueprint.
They were looking for mentors. So, last year, we we well, actually, December of 2024, we launched volume three of that same book. And it was the mentorship edition. So, I also was in that book and again shared more tips and and strategies regarding how do you do this, you know, from from individual provider to a business? How do you do this as a business? And I I have a lot of people who always reach out wanting to either get mentored or to come work with us for that reason because Manet Psychotherapy trains therapists. That's part of what we do. If someone is new to the field, we will give you a shot. We will train you. And if someone has been in the field 10 years, but maybe they just don't have the confidence to start a private practice or or they don't feel that they have the skills yet to go into private practice, we will work with you and train you.
And for us it's a success when someone says, you know, I've worked with you a couple of years. I think I'm ready to launch my practice. We'll celebrate you. We're happy for you because it means you were a success story. What what we envisioned teaching you worked. And now you're going to go out there, get your own practice, and help more people because this is the this is the end game for us. You know, there's not enough therapists considering all the people that need help. There's not enough therapists to fulfill that need, especially therapists who speak other languages like Spanish, especially therapists who are experienced with multicultural communities. So, the goal is to make as many therapists as we can because the demand is overwhelming. And there are people that are on waiting list for 6, 7, 8 months in the Bronx where I have my clinic.
That's how long it can take to get a therapist, especially a Spanish-speaking therapist. Wow, so people people are really lucky. This is an amazing thing that you're doing, that you are making available to budding therapists or not even budding therapists, therapists that that are established, that really need your support. Natalie, I know that you I think you guys recently went through a bit of a rebranding. Tell us a little bit about that cuz I think it might be really exciting. Yes. It is exciting. We actually decided to to rebrand and and kind of solidify what we call the Manet ecosystem. So, the Manet ecosystem, the way that we envision it is the minds, the voice, the impact. And what that means for us, we see psychotherapy as being the mind as in in this ecosystem. Psychotherapy is about healing a person's mind, healing their emotions, but it takes place in an office, in a setting.
You know, even if it's virtual, it's still in one particular setting. The voice is what we're doing today, the conversations that we're having about mental health, about how to expand this field and get more therapists in it, how to help therapists become better therapists. So, all of these types of conversations, that's the voice. And then the impact, for us, we decided to create our long-term impact by launching a nonprofit 501c3 foundation, the Manet Foundation, but the impact really is, how do you move healing and this work from just clinical therapy rooms, whether it's a private practice or community clinic or hospital, how do you move it from there into the actual community, where you're really making an impact in how people live day-to-day, so that they don't need to constantly be in therapy just to navigate this world or their experiences in this world.
So, that is that is our rebrand and we are extremely proud of it because we are, like I shared a moment ago, we are training future therapists. We also take graduate students as interns. And in the time that we have been in in practice, we have graduated 16 graduate students. We have helped them graduate. We have been their second-year internship. And all of these therapists graduated and are licensed now. So, they're out here in the world making an impact. And you know, we also work with mental health counselors who have their limited permit and they're working on getting their full licensure so that they can also be independent. We work with them as well. We train them and and we give them that experience of different clients from all walks of life within a structured setting. So, we teach them, this is how you do the billing.
We do have a biller, but you have to fill out and organize your invoices every every week so that you know how much money is coming to you. And yes, you have a electronic record system, but you need to do your notes consistently. And your notes should look like this because when you least expect it, somebody will be auditing you. Whether it's an insurance company or a patient may need records for something, a lawyer may reach out. You don't want to become a nervous wreck because of something like that. Like there's a way to document so that you know, okay, yeah, this is fine. I can send this. Uh training. We do a lot of trainings um from HIPAA to ethics to clinical trainings on all kinds of DSM diagnoses because we don't want people to be scared of clients. You know, trauma-informed therapy.
What is that? Well, this is how you do trauma-informed therapy. This is how you do cognitive behavioral therapy. This is how you do um dialectical behavioral therapy. And it's not that you have to become a master at all of these things, but if you at least have a sense of some of the skills, you can see if you can work with a client that can benefit from this. And it may end up being a fit. And if it's a client that needs something much more structured and intensive, then at least you have the skill to say, "You know what? I think you need an intensive DBT program. Let me connect you to that." Or, you know, maybe you need a specialized, you know, treatment in in this instead. But we have to at least not be afraid to assess and diagnose. So, that's really, you know, where where we feel that we are doing things differently and and trying to change what mental health looks like, particularly in in, like I said, the communities that we're in, which is the the Bronx, New York.
Well, all New York state, but physically we're located in the Bronx. So, something that I feel like has been kind of full circle in our conversation is I I feel like we've kind of gone back to your roots, almost, with, you know, I know we talked so much today about making counseling accessible and how important that is. And that will never that work will never be done. It will never be accessible enough. But we've certainly come a long way. It seems almost as if you're making being a therapist more accessible. Um, you make it seem less scary, less overwhelming, less of an undertaking, which I mean, I don't know about you, but I remember when I finished grad school, I had that whole imposter syndrome of I had no idea what I'm doing. I don't send anyone to talk to me. I don't know. I've got my own issues.
I don't know how to help anyone. You are fostering that education that people have gotten and you are providing this service that should probably be paid for, that I would pay for as a therapist, um, to to people that have just kind of stumbled upon your services. And that's a very good deed, to say the least. Thank you, Jessica. I I absolutely see this work as full circle. Um, you know, Manet Psychotherapy and and having a clinic and now in a now a foundation, it is a love letter to this community. You know, I I love New York City. I love the Bronx, you know, I am deep down. I wasn't born in the Bronx, I was born in Upper Manhattan, but I am a Bronx girl at heart. Um, and I proudly say that because I really think the people in the Bronx are very resilient. I love everyone in all the boroughs, but there's something very special about the Bronx.
Um, and also because the people in the Bronx face some of the most difficult, um, systemic issues that we see in terms of housing and poverty and illness and high rates of, um, joblessness and and and poor housing opportunities. So, when you see that despite all those things, people in these communities are still fighting, you you're inspired by that. And I'm inspired by that, you know, like I see these children and I'm like, I was one of these children. Who knows if somebody looked at me one day and was like, you know, she's she's going to be, you know, no one in life. And then years later, I came back and I'm doing something for this community. And and I think that I also want to come back for my therapist community because I did have people when I first started out who really made me feel like maybe this wasn't going to be for me.
And and like you said, people complicate it. You know, for a long time, I think there was this kind of stereotype that therapy was for people who, you know, could do therapy like on the on the couch, psychoanalysis. And and there wasn't a place for us who wanted to do more, you know, boots on the ground psychotherapy. You know, I'm like, I I want a couch in my office where I could lay down. That's not realistic for most of the clients that we see. You know, people are dealing with some problems. They don't They're not going to lay down and relax to talk to you, even if you have a couch. So, let's get to work, whatever it looks like. And and I I think that I want people that come from where I come from, who also have that same desire to help these communities, to feel like you can do it. To to silence that imposter syndrome voice and and to say, "I can do this, too.
I know it's going to be hard, but there's a blueprint. Madeleine and Mary are showing me how to do it. They'll actually train me hands-on if I need it. And then I can feel confident to launch my own and develop a specialty." You know, over the years that I've had therapists who have supervised go One has a creative art therapy One went into um EMDR. Um One just recently told me that she's going into like uh immigrant issues. So, I'm like, "Oh my god, this is wonderful." Like, "I now know where to send also people that maybe they come to my clinic and No, I'd rather you go to her practice. I I We trained her. We know she's good. She specializes in this." So, it's we're creating a network, like a real-time network of people who are culturally and and competently trained and have the heart for this work.
So, it it's absolutely full circle. Thank you for noticing that. Absolutely. And I Everything that you just said then was its own full circle. Um Your inspiration that you've referenced is its is in itself inspiring to me just sitting here with you. I imagine to anyone who listens to this. You're you're wonderful. I am so excited to get your name out there even more. I'm sure it already is. I really want people to we're going to make sure everyone knows how to get in touch with you. So I hope your inbox is open because I've got so many people that have just popped to my mind that would benefit so much from someone like you who wants to give back and doesn't just want to give back, wants to also continue to help guide and shape to the point where you're able to refer to these people. It's it's such a give and take.
So thank you so so much Madeline Maldonado, LCSW, you're incredible. Thank you. President and founder Minnette Psychotherapy Services executive director of Minnette Foundation. We'll have more information to come on the notes after the episode. Thank you so much for being here with us and truly for everything that you do. Thank you Jessica. It was such a pleasure. You too. Talk to you soon. Thank you.
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