This episode’s specialty spotlight is Behavioral Health! Brandi Sinclair is a licensed professional counselor and founder of Heritage Counseling & Consulting, a center focused on the total wellbeing of patients. Brandi joins us to share her collaborative and intentional approach to therapy, and the unique model she has created for counseling success. We discuss the stigma of mental health, the state of the industry post-COVID, the impact of collaboration, and the challenges with insurance reimbursement for mental health services.
Heritage Counseling & Consulting is located in Texas and you can learn more by visiting https://www.heritagecounseling.net/.
Listen to the full episode using the player below, or by visiting one of the links below. Below is the episode’s transcript which has been edited for readability. If you have any questions or would like to learn more, email us at firstname.lastname@example.org.
Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues, simplified through real client stories and real world experiences. Creating simplicity in 3, 2, 1.
Brad: Welcome back to another episode of the Legal 123s with ByrdAdatto. I’m your host Brad Adatto with my co-host Michael Byrd.
Michael: Thanks Brad. As a business and healthcare law firm, we represent clients in multiple sectors and multiple specialties, especially healthcare.
Michael: This season, our theme is specialty spotlight where each episode we’ll visit about some of the nuances that can be found from a business and healthcare perspective in the various practice specialties.
Brad: Michael, why do you look sad today?
Michael: I read a story, Brad, and I know it’s gonna make you sad and so I’m feeling sad. In fact, I’m feeling so sad that I brought a licensed professional counselor in studio.
Michael: Because you’re not gonna do well with this. Just please don’t shoot the messenger.
Brad: Is it about the Saints?
Michael: We [00:01:00] would’ve cancelled if it was about the Saints. No, there’s been a recent change that threatens Elvis themed weddings in Las Vegas.
Brad: Oh, my dreams are all crushed. I was gonna get remarried again to my wife by Elvis.
Michael: Yes. Well, apparently, Brad, the company that controls the Elvis brand sent cease and desist letters to multiple Elvis themed chapels in Las Vegas. These letters order them to stop using the King’s likeness in their weddings.
Brad: This makes no sense. Elvis weddings have been going on in Vegas for forever.
Michael: I know. I know. Well, and there’s been a ton of publicity about this because the Las Vegas wedding industry has only recently started to rebound from the pre-pandemic levels. I saw a quote, one particular chapel owner who said that 95% of their weddings are Elvis weddings.
Brad: So, why is this all of a sudden happening now? Did COVID cause this? [00:02:00]
Michael: We don’t really know. The owner is called Authentic Brands Group and they acquired the Elvis Presley intellectual property rights in 2013. Well, at least that’s what Siri told me. I saw another quote from an article noting that the massive amount of revenues from publishing and licensing rights for Elvis just continue to this day. In fact, I saw that Graceland netted over 12 million in merchandise and memorabilia sales in 2019.
Brad: Yeah. I’m wondering how strong of a case they’re gonna have against these chapels. I don’t wanna get too legal, but Elvis is a pretty massive name.
Michael: I know and name or lightness laws can vary quite a bit. Nevada actually has protections for live performances, which is of course why there’s been a lot of celebrity impersonators in Nevada.
Brad: So what I just heard is, Brad, will you impersonate [00:03:00] Elvis?
Michael: You’re losing focus, Brad.
Michael: Okay. Some of the critics of these cease and desist letter. Have kind of drawn the parallel to trademark trolling.
Brad: When you said that, why did you look at me and say trolling.
Michael: Slow down. We’re not calling you a troll, Brad.
Michael: Plus you’re a self-declared Hobbit.
Brad: It’s true. What are these trademark trolls? What’s this referencing?
Michael: So trademark trolls, they may actually have a right to a name and then they actually are just going out and searching for others to use a name, which actually for people that police their marks, that’s normal. However, for them they’re not trying to shut it down. They’re just looking to scare people and get them into paying a settlement or licensing rights.
Brad: Yeah. It gets really messy, real fast.
Michael: Yeah and it actually gets more complicated when you’re dealing with a celebrity, because if they become an icon or a cultural symbol I think we can all agree, Elvis has arrived.
Brad: Oh, I thought you meant [00:04:00] icon celebrity.
Michael: Well, they’re more likely to be considered fair game for works of, quote, artistic expression. So the first amendment becomes a very strong argument at that point when someone becomes so famous, it actually ends up working against the name and likeness owners.
Brad: So I’m trying to figure that out. So today’s guest, she’s an Elvis impersonator.
Michael: Oh, Brad. Okay. She’s here to comfort you.
Michael: And you can only dream our guest today is a licensed professional counselor. Actually, many years ago, we first met her when she worked with my wife, Stephanie and I in our pre-marriage counseling. No, Brad, we did not have an Elvis themed wedding.
Brad: Okay. So what I just heard is our guest has dirt on you. I think I might, change the questions I was gonna ask her, but first, Michael, let me ask you this question. How much did you pay her under the table to make sure she would not tell Stephanie to run for the hills?
Michael: Very, very fair point, unfortunately. I had to sweat through the pre-marriage [00:05:00] counseling process and pray that Stephanie would not make that choice on her own. Thankfully there’s confidentiality to these pre-marriage counseling conversations, and I am definitely not waving that privilege for you to get more information to use against me and make fun of me.
Brad: Okay. Well, if we’re not having a guest here today, what’s going on here?
Michael: We’re having our guests on today because of the specialty spotlight theme, Brad.
Michael: You got distracted by the Elvis conversation.
Brad: I did. I did.
Michael: And the news.
Michael: And we get to learn about licensed professional counseling.
Brad: All right, perfect. Let’s bring her on.
Michael: Okay. Our guest today is Brandi Sinclair. Brandi founded Heritage counseling in 2004. Brandi is licensed as a professional counselor and has been in private practice for many years. Has over 20 years of experience. She is a graduate with a bachelor of arts and psychology and a master of arts in clinical psychology from Southern Methodist [00:06:00] University and is a prolific speaker. Brandi we are so glad to have you, welcome.
Brandi: Well, I’m so glad to be here with you guys. You guys are hilarious.
Brad: Well, I appreciate that. I think I am. I’m not sure about Michael, but yeah I think she said I was hysterical is what I heard.
Michael: And he’s also saying that we might need some kind of business marriage counseling.
Brandi: Well, I can certainly help you with that. I do a lot. I work with a lot of executives and interestingly, a lot of attorneys. Not sure what that implies.
Brad: Yes. I could see that. Well, we’re gonna have to put you on the spot right here. I mean, given everything we just talked about, especially with your role in the premarital counseling, have you ever had to counsel someone, right before they went to get married by Elvis?
Brandi: I don’t believe I’ve ever counseled anyone that was planning an Elvis wedding.
Michael: I feel like Elvis weddings probably tend to be more spontaneous. [00:07:00]
Brandi: Perhaps they are and perhaps a lot of alcohol is involved and I doubt very seriously if most of those people are getting pre-marital counseling.
Brad: I wonder if, afterwards, they could have your card after they get married. If they needed to have counseling.
Brandi: You know, that could be a really great marketing tool. We could just put our cards at all of the Elvis wedding facilities and then perhaps that would drive some business.
Brad: There you go.
Michael: Oh, good. Well, we are so glad to have you here and kind of the whole behavioral health sector is just booming these years and everyone I talked to, including you, Brandi, we know there’s just a lot of need. I’m sure COVID had a lot to do with it as a propellant, but I’d love, to start, to have you kind of introduce your specialty. Introduce professional counseling to our audience.
Brandi: Well, professional counseling from my perspective is a fantastic career. There is such a high need right now. [00:08:00] In our field, there are lots of different licensures. There’s licensed professional counselors. There are licensed, social workers. There are licensed psychologists and psychiatrists. So different kinds of people provide different kinds of services for our practice. We are a fee-for-service and we have both licensed, psychologists and licensed professional counselors. We see a variety of different kinds of people, but basically what we’re doing is we are, treating the mental and emotional health of our patient and client base.
Michael: That’s great. Talk a little bit about how there, with all these different disciplines, or licenses that are kind of in your field, how do y’all work together? Do y’all, for example, work together on the same patient, or do y’all have your own lanes that you tend to stay in?
Brandi: Well, it really kind of depends on the practice. In our practice specific, we are an [00:09:00] extremely collaborative practice. A lot of family systems work. So we have people in our practice who can do marriage counseling. We do, child and play therapy and adolescent therapy. We treat grief so we could work with lots of different people in one family actually. So we, in our practice have a very collaborative effort. We do, neurofeedback, and we can provide psychiatry services. So we have a very diverse practice and we have lots of treatment modalities and we can work with lots of different kinds of people. So a lot of collaboration in our practice statistically speaking, there are lots of practices that have multiple therapists in there, but they don’t have the same collaborative approach. We also work with physicians. We work very, very [00:10:00] closely with physicians and that actually is probably our largest referral base other than you know, patient-to-patient referral. We work with these physicians and we work with psychiatrists who are not in our practice, too, taking really great care of our patient population.
Brad: So it’s interesting. So patient presents themselves and then y’all decide who would be best to help work with them based on that collaboration
Brandi: We do and in fact, we have a large support staff and admin staff and the admin staff take our calls and do their very best to place each individual patient with the right therapist, depending on, the style of therapy that they practice, depending on what the patient need is. That also is a little bit unique to our practice because in many practices, if you take the call, you get the client. So we’re very intentional about placing each person with the right therapist.
Michael: I’m guessing that there probably, I could see [00:11:00] circumstances where a psychiatrist, as you mentioned, would refer to you, and then vice versa, where you would have someone that you would think needs to be referred to a psychiatrist.
Brandi: Yes. We have a really strong, referral process, coming both into our practice from physicians and psychiatry and even other therapists and then we refer out and we have a person that specializes in our office in referrals. So in other words, they’re looking at the different kinds of inpatient facilities for mental health and addiction, troubled teens. We do a lot of referring out. We’re also looking for the right psychiatrists. So if the psychiatrist that we work with is not the right fit, then we’re looking for an even better placement that might be in the case of a child, a young child that needs psychiatry help.
Brad: Hmm. So now we’ve been talking about patients, but what is one of the biggest challenges that you have in your specialty when you’re [00:12:00] handling those patients?
Brandi: Probably the biggest challenge that we have is getting people to call us before they are in such a crisis state.
Brandi: You know, mental health still has a lot of stigmas associated with that and so we just wanna encourage others to consider treatment well before you’re in a state of crisis. This is another thing that we do with our physicians. We try to educate them on doing a good job of finding out what the mental and emotional condition of each one of their patients is and treating that before it gets to a place of crisis.
Michael: Did you notice a difference with COVID on the crisis?
Brandi: Lots and lots of differences. There’s a lot. We’re gonna be seeing a lot of residual, negative, emotional, and mental health issues based because of COVID. Lots and lots of things going on there.
Brad: So [00:13:00] I grew up in my family, my grandpa was a psychoanalyst and so when you hurt your arm, my dad was an orthopedist, so you would go see an orthopedist, right? A lot of people, they don’t know that when something’s strong, you’re having trouble with it and you can’t figure it out, you think you’re supposed to do it yourself and my family, you were like, oh, go see someone about that and so I was one of those rare families that was a normal part of the outcome that you should be saying that cause it’s just like when you hurt your arm, you see someone, you can’t figure it out and you’re troubled by it. You go see somebody, a therapist to help you through that process. I learned later in life, I was rare in that sense, but hopefully, with COVID a positive outcome is so many people are getting into this field right now. I mean, so many people are reaching out for help and maybe it’ll take some of that stigma away from it.
Brandi: Well, I hope so. I think that collectively the field of mental health is growing and has become more palpable. It’s always had such a stigma associated [00:14:00] with it and you’re correct, Brad, it’s that thinking of, I’m supposed to be able to handle this on my own and if I seek help in the mental or emotional field then I’m weak and I can’t do it on my own. I think a lot of people also fear that medication is going to be the line of treatment and that’s just not the case. What we do is, we do in our practice specifically, we’re very heavy on cognitive behavioral therapy. We’re eclectic in a lot of ways. We have lots of different theoretical treatments, and programs, but a lot of cognitive behavioral, behavioral therapy and basically what that means is examining how you think about the world around you and yourself in it, how you react to those things. When you go to counseling, it’s assessing those things and figuring out what the trouble areas are, and finding new ways of managing so that you get a better outcome.
Brad: That’s awesome.
Michael: Do you think the patients have, a lack of understanding? It sounds like, you kind of [00:15:00] alluded to this, where they think it’s gonna be necessarily medically or prescriptive medicine as the treatment. Do they have an understanding of what actually goes into getting counseling?
Brandi: I think a lot of people don’t. In fact, I think some people think that you go into a counseling office and lay on the sofa and it’s a somewhat dark room and there’s a person sitting in a chair kind of behind you, writing on a tablet, hoping that you figure it out while you’re lying there. It’s completely different from that. I’m a very interactive therapist and I have homework and it’s more of a vivacious event and a collaborative effort together of figuring out how we can create change.
Brad: So if a patient presents themselves and they’re like, I want the red pill or the blue pill, whatever it is they believe is going to solve their issue, is that someone you’re like, I’m not sure if I’m a good fit for you?
Brandi: That’s exactly correct. It doesn’t mean that a pill won’t be necessary somewhere down the road, but if the pills, what you’re looking for [00:16:00] psychiatry is the stop that you need to make.
Michael: Yeah. Interesting. Well, so, there’s also a business side to your specialty and, like any business, most professional counseling and all of the behavioral health tends to still be small businesses. I’d love to kind of hear your perspective on the business challenges, kind of from that side of things in your specialty.
Brandi: Well, we’re very fortunate because we have a large administrative staff that helps us with the business part of our business. Statistically speaking, counselors do not have good business acumen, which is kind of a challenge in the field because we’re very trained in our own area, but the business area falls by the wayside. Unfortunately, it’s expensive to have that help, but, I think it’s a really necessary part of being successful. [00:17:00]
Brad: Yeah, I can agree with you on that one. We have seen many lawyers who are really good lawyers. How many other types of physicians are really good at being surgeons, but, the business side of it slips away from them.
Michael: What’s your favorite part about the business side or parts of it that you enjoy as a counselor?
Brandi: I really love the business side and I would say when I got started, I thought I had some business acumen, but I learned pretty quickly as we grew that, I was not as skilled as I thought I was and so hiring good people was necessary. I enjoy the people’s development of our practice. We have quite a few therapists and, it’s really nice to do the people development on the backside, not just the client care on the front side.
Michael: Yeah, I would, I bet that y’all are very well equipped for healthy conversations.
Brandi: Well, we try and we do a fair amount of bantering like the two of you do, which I think is really helpful for us too.
Brad: Does [00:18:00] the bantering ever get outta control where someone says, I know you’re trying to use that technique and it’s not gonna work cause I’ve trained on that technique.
Brandi: I would say that occasionally it gets a little out of control, but you know, we have to offload some of the energy that comes to us from our patients and clients. So I think that that bantering is pretty healthy actually.
Brad: That’s probably fair. I mean, I know that we get a lot of feedback from our clients that sometimes we wish we wouldn’t get, but that’s part of your job in the sense of bad things happen to them and they tell us about it, but no one else is supposed to know about it and I think that’s probably something that you guys actually hear every single day. How do you all handle that then, stress wise?
Brandi: That’s a really great question. In our field collectively self-care is critically important.
Brandi: From my perspective, I think collaboration is the key. From the very beginning, I, did not want to practice in a solo office. I wanted to have other professionals [00:19:00] I wanted to have different treatment modalities and different perspectives. We have a weekly meeting where we debrief and it’s an opportunity not to share names and circumstances, but for us to address challenges that we may be having with the patient or client and for us to talk about the impact of what’s going on in our day to day with other clinicians who are, slightly skilled to help each other.
Brad: Yeah. That makes sense. I mean, the word collaboration is a word that rings true with us too, just because the area of law that we are in gets so complicated, the number of days that we get together and talking about that is crucial for us, for our growth. Mostly for Michael’s growth cause he’s so immature, but, it really is something though that I think, you said something that I’ve said all the time, I could not imagine being a healthcare attorney and practicing on an island by myself. The ability to walk down the hall and talk to other people and collaborate or get a group together and collaborate is a huge part of that and I do think it does help mentally too, [00:20:00] cause you’re not alone when someone, you hear this over and over again. Yeah, but that’s not correct.
Brandi: Yes and, I love the collaborative aspect of our field and I think it’s necessary order for you to keep your skills up. It’s one of the reasons why people really love working for us or with us.
Brad: Yeah. So we’ve talked about patients we’ve talked about the business, what type of business, healthcare compliance challenges do you face in this specialty?
Brandi: Yeah. We don’t have a lot of healthcare compliance challenges because we are a fee-for-service practice.
Brandi: I’ll tell you the a great challenge though, is helping our patients and clients get reimbursement for the insurance. We had a really interesting thing happening during COVID. My staff did some research and started working with insurance companies to get approval for out of network payments even though people may have had, their policies, may have had high [00:21:00] deductibles or may have not had that as an option. So that was a really nice, it was a really nice benefit that we got to see happen, but typically the management of the insurance companies and getting reimbursement, helping our clients get a reimbursement is probably the greatest challenge.
Michael: Yeah and it’s pretty common, just as an observation in your field, for that responsibility to be put on the patients. They’re kind of on their own to just kind of seek reimbursements for whatever benefits they have.
Brandi: Well, that’s another benefit of working with our practice is that we have an administrative staff who has a lot of skills in the insurance reimbursement area so you have a little bit of help there. There are lots and lots of therapists. In fact, I would say maybe over 50% of therapists are fee-for-service currently. So the patient, if you are a solo practice, you don’t have the time to help your patients and clients get [00:22:00] information to help them get that reimbursement. In our practice, we have staff that he really helps you to try to make that work out.
Brad: That makes sense.
Michael: Have you experienced any challenges, just working with others who may have different licenses and are there any kind of compliance or business obstacles that you face going down that road?
Brandi: Yes. The great obstacle that we have had is bringing psychiatry into our practice. We feel like it’s a real necessary part of our success, but when you’re not licensed at the same level, it presents a business challenge and so we’ve hired this really great team of attorneys called ByrdAdatto who have worked hard to help us, find ways to manage this.
Michael: Yeah. I’ve heard about them. There are all these rumors going on, but not quite on par with Elvis weddings.
Brad: Yeah, I think I’ve heard of them too. I think the last question I want to [00:23:00] ask and if you can’t answer, it’s fine. We were talking about reimbursements and it dawned on me. Did Stephanie Byrd reach out and ask for reimbursement for you not counseling her better, that she should not have married this guy? Or is that something you cannot answer?
Brandi: You know, the rules of confidentiality definitely apply here.
Brad: Okay. All right. I thought I had something there.
Michael: Once again, time flew by. We are so grateful to have had you on the show. What we’ll do next is we’ll say goodbye to our awesome guest, Brandi Sinclair, and we’ll go into a commercial and on the other side, we’ll do, our little legal wrap up. I’m really grateful that you were on today.
Brandi: Thank you so much for having me. You guys are a real lot of fun.
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Brad: Welcome back to Legal 123s with ByrdAdatto. I’m your host Brad Adatto my co-host Michael Byrd. Now, Michael, this season, we have been working really hard to find this specialty spotlight and, wow, we had some amazing guests so far and each time we have a new guest, we’re like, wow, this person’s even more amazing. Nothing against our other guests, but Brandi brought in a lot of information that’s very unique because of her background and it’s not your typical medical practice stuff that we learned from her really from the behavioral side, it’s a lot of nuances that a typical practice does not face.
Michael: Yeah, we tend to have a lot of medical focus [00:25:00] conversations with physicians and the conversations flow from regulation from the medical board. It’s important to realize that every licensed professional discipline out there, whether it’s professional counseling, dentistry, medicine, etc., they all have their own kind of licensing requirements and things that flow from that. Brandi brought to light something that is a really big part of behavioral health, which is you have professionals of multiple licenses and license types trying to work together and most of them don’t. They’re independent of each other.
Michael: Or at least substantially independent of each other. So trying to figure out how to set up a business on our end, as attorneys, so that they’re working together [00:26:00] compliantly and also, trying to create as seamless of an experience for the patients is quite challenging. It’s very state driven.
Michael: We’ve talked before about the management services organization model that ends up being necessary and behavioral health quite often, even when it’s all professionals that are owners, because you’re trying to figure out ways where in some circumstances, Texas is a good example, a physician and a licensed professional counselor can’t co-own a business that practices together, but there are ways to do it. It’s just interesting in the sense that integrated medicine and many disciplines, including behavioral health, are growing over the years and recent years in particular yet the laws haven’t tended to catch up as to how everyone can play together in the same sandbox.
Brad: Yeah and [00:27:00] we’ve talked about the court practice of medicine a lot, but the court practice of my mental health is also something that it goes back to the same level, which is can non, and this goes back to it, can an MD and someone who is a behavioral health person, can they co-own a business together. Every single state, believe it or not, is different in that role too and how that works and how even someone who’s not a licensed professional, just your entrepreneur, how they can work with them. So to your point, the MSO model does come in play a lot of times so that the collaboration with the Haitian feels normal, but there are a lot of moving parts of the background on inside the MSO model. So they can be fully compliant. Again, that’s a really good point to take away. Any other final thoughts, Michael?
Michael: That’s it.
Brad: Yeah. So my final thought is, audience members, if you’re [00:28:00] watching live, Michael did not break into his Elvis impersonation. If you have never seen it, it’s amazing. Riley, don’t you think? Riley’s nodding her head. I’ve never seen Michael do that, audience members. Okay. No more kidding. Guess what? We’re going to move on to next Wednesday, we have another specialty spotlight with guest Jay Burns. Outro: Thanks again for joining us today and remember if you like this episode, please subscribe make sure to give us a five-star rating, and share it with your friends. You can also sign up for the ByrdAdatto newsletter by going to our website at Byrdadatto.com. ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does it establish an attorney, client relationship reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views [00:29:00] expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues.