00:00
Libby Andress has been a practicing psychotherapist since 2004. She has worked and trained in New York City, Boston, South Florida, and Philadelphia. Libby has advanced training in psychoanalytic psychotherapy with a focus on adolescents and young adults. Throughout her career, she has worked in community mental health centers, inpatient psychiatric hospitals, and private practice settings. She opened her own practice in 2018 and currently sees patients in person in Philadelphia and virtually in Florida.
00:27
Libby, welcome to the show. Thank you. Thank you for having me. Yeah, awesome. So let's get started. Tell us a little bit about your background and why you wanted to become a psychotherapist. I guess really what it was is I had a pretty rough teenage life and actually saw a therapist when I was 14. And that really helped me be less depressed and less anxious. And I just wanted to help other people get the same help that I did.
00:56
Yeah, yeah, makes sense. And so tell us a little bit about your journey in terms of education. What did you have to do for training? Sure, so first I got a bachelor's of social work at BU and then I moved to New York City and went to Fordham University. I got my master's in social work and then after that, I did a three year training in New York City for the psychoanalytic psychotherapy training.
01:26
And then just as part of your licensure, every two years you have to take like CEU credits and things like that to keep things relevant. Makes sense. And then how do you decide on the therapeutic modality? I just, I really am interested in patterns of behavior and kind of why people do the things they do. And I think a lot of people create a lot of things that they've been through in childhood and try to correct them through other experiences in life.
01:56
just having people having that awareness of their family background and maybe how that's affected them and working through some of that, which is what psychoanalytic therapy is all about. Gotcha. So what does a typical session look like? Like an initial session or? Yeah, so like, let's say I wanna get some therapy.
02:21
What's the process like with your practice? So usually the first two sessions, it's normally gaining background information if they've had therapy before, if it was successful, talking about what their goals are, and just trying to really find out what they're looking to get help with. And usually, I can kinda cater my modalities.
02:51
to what that patient needs. So whether it be a psychoanalytic or cognitive behavioral, it really depends on the person. Sure. And is there anything that the patients can prepare themselves for before the therapy session? Usually it's just an intake form they fill out. I also offer a 15 minute consultation for free over the phone. So to kind of, before they come in, get to know each other a little bit and what they're looking for and if I may be the right fit. Sure.
03:20
Sure. Are you able to talk about maybe a therapy session that's gone like a ride, like, you know, it just didn't work or it became a little bit of an awkward situation or even a dangerous situation? Not so much dangerous. I'm, the first thing that popped in my mind is couples. I am not, I do not enjoy working with couples. There are people that are trained, but.
03:46
Usually, in my experience, people come in as kind of a last ditch effort. Usually one person wants to be there and the other one doesn't. And then it's a constant. And I say to them, why don't you do enough of this at home? Why don't you get something done here? And even sometimes I would ask them to drive separately because on the car on the way home, they would be still at it. So I just that's just the one area that. Yeah.
04:15
I don't specialize in it. That reminds me of a funny scene in a movie and I can't remember which movie it was, but basically the guy bribes a therapist to take his side prior to the session. I bet that happens. So tell us a little bit more about like the, you know, the demographics of the patients you worked with. Are you know, are they more younger? And then also like, what are some of the typical issues? And you know, you can talk about it in terms of themes.
04:46
So initially I really started first starting out was working with mainly children and adolescents. But then now I see more adults. I think COVID really had a big effect on that because young children really need like tools and tangible like play therapy. Right. And COVID we couldn't really do that. Yeah, yeah. I mean.
05:13
I noticed too, just like with the kids in the neighborhood and just like kids of like family friends and school friends that a lot more of them became anxious, depending on what age they were. So after the pandemic was over and things started opening up for some reason they were a lot more just worried about things or socially distant.
05:38
With adults, that wasn't so much the case. Like either you drank too much or you put on some weight or you watched a little bit too much TV. But typically, like for, I mean, especially for me, things just went back to normal once things opened up. I wasn't, I didn't really indulge in anything. And obviously I didn't get anxious or anything like that, but I did see a noticeable difference in children. Yes, and even now, like that era,
06:07
and adolescents and young adults now that went through that, they kind of missed two years of important social development. Right. So, and a lot of the adolescents I was seeing were having a lot of online friends, some positive and negative and TikTok of course, and just glued to their phones even more. So I think that really, COVID was a very difficult time for teenagers. Yeah. And that, I mean, this is a great segue into social media.
06:36
And there's a lot of, you know, just negative results from constant social media use. And it's happening more towards, you know, young girls. They're being more adversely.
06:52
affected in a much negative way than boys. Can you talk a little bit about the social media on young people's brains? Sure. I think especially for girls, females, a lot of negative body image issues have arisen out of it. You're supposed to look a certain way or use this product to look a certain way, so there's a lot of pressure to...
07:20
follow some of those influencers. Yeah, absolutely. So what's your stance on like...
07:30
banning TikTok or limiting, you know, use of these apps. So I know, I think Australia just banned social media for anyone under the age of 16. China has always banned the use of TikTok for entertainment purposes over there. They use it for education. What's your stance on it? I feel that even TikTok, I think you're supposed to be 16. I'm not sure of the exact age.
07:55
But I think a lot of the teenagers I see have ways of getting around that. Like they'll use their friend's phone or they'll find a way. It's just so hard because you can't monitor the content because there are positive things on there. You know, there's body positivity and ways to think. But then again, you can't block out all the negativity. So I think it's a very complex issue. Yeah. If there was a way we could.
08:23
somehow like monitor and separate the content.
08:29
to see that I think for teenagers, it's like their phones are their appendage, an extra appendage. So it's just so hard to take that away from them. Yeah, personally, I would definitely ban TikTok just completely, you know, in the US. I think it has such a negative influence. I know there's obviously other things that you can watch like, you know, Facebook and Instagram Reels,
08:59
is just a little bit more addictive. It's very dark too, they don't have dark content. 100%. About self-harming and like pro eating disorder. Yeah. Yeah.
09:14
them. Yeah, I don't have TikTok either. And actually it's banned in our house. You know, and my wife and I go back, go back and forth about the use of phones, right, at an early age. And it's, you know, there's good and bad, you know, with it. So obviously the good is you're able to reach them when you need to. They can reach out to their friends. So there's a lot of positive things about.
09:38
having a phone, but then also the negative is like you can't monitor them, you know, 24-7. And so then what's the right age of like allowing them to have a phone? And if you look at when kids get a phone nowadays, sometimes it's as early as like fourth grade. Even kindergarten. Yeah. So it's crazy. And there's a huge problem with schools and kids I work with because schools all have different like rules about it. Yeah. Some are very flexible, others like you have to put your phone in like a
10:06
one of those where you can shoe rack that goes over the door when you come in the classroom. One thing when I lived in Florida, I was working with the families of the Parkland shooting in 2017. So I think in the Florida public schools, it's been a big argument about, because parents want access to their children at all times of the day because of safety reasons. Yeah.
10:31
So it's been hard to ban the phones there, but here in Philadelphia, I think they do a much better job. Yeah, yeah, I think it's a more balanced approach here. I know what the school that my daughters go to, essentially they can't use the phones, nobody can use the phones during the day, right? It's only in the morning before school starts and then after school is over. Is other than being able to...
10:59
you know, have access to your kids, whatever you want. Is there any other positive things you see about cell phone use? Some teachers will use like the phones in the classroom as a study aid. I don't know if you ever heard of the app Kahoot. It's almost like, it's a game, but it's kind of like asking quiz questions to prepare for a test or so everyone would take out their phone and so some teachers use it or also for assignments, like they have apps for.
11:27
they can see what the homework is. Sure. Yeah, absolutely. So just going back to, you know, your practice and then dealing with patients. Are there common misconceptions from patients about their being in general?
11:50
about their own therapy or just? Yeah, like, you know, do you see like minorities that are against it or maybe like kids that are against it? We already, you know, you mentioned couples, you'll have usually one person in the party that doesn't want to do it. So what are like some of the misconceptions about just getting therapy in general? I think some people see it as.
12:13
which it is because it's a business but like transactional, like I'm paying you to give me advice. Like you're not authentic or you don't really care. But that's not the case with me. And I think we're not taught in school how to really deal with money. So it just feels strange helping someone and then asking for them to pay you. So I think some patients when it comes to like the money issue have a problem.
12:44
But, and sometimes with an adolescent or child, same thing, like one parent will be all for therapy, let's get our child help, and the other parent will be like, how is this gonna help? Like we've already had the conversation with our child. Yeah. So then the child is getting mixed signals from the parents. Right. And then you kind of see where the bigger problem is. Right. Makes sense. So.
13:12
And then, I mean, what about minority communities? I know in some communities, getting therapy is a sign of weakness. So do you kind of get that? I work with a lot of clients from originally, like South America and Miami. And yes, a lot of...
13:32
older generations from countries in South America feel like problems should stay in the family and you shouldn't be telling an outsider a stranger, whereas like the younger generation doesn't feel that way. So sometimes like parents of children won't be encouraging of having their...
13:54
child seek therapy. Right. Because it's something that stays in the family. Right. Do you think there's differences of how they see it when it comes to like male skin therapy versus females? I think maybe in the past, but I think I have probably almost as many male clients as I do female. Okay. Wow.
14:18
No, I mean, that's good to know. I feel like as a minority myself, a lot of problems you kind of just deal with on your own or maybe amongst your friends. You don't really get outside help. You don't go to your parents. It was something that if you're a guy, you just dealt with it. Right? Yeah. And I know this is a different generation. People have different viewpoints at this point.
14:48
Yeah, I mean, I think getting therapy, maybe 20, 30 years ago, was definitely a sign of weakness, especially in my community. I don't know about overall, but I would say for us, you didn't hear too many people doing it or, you know, it was just something that was more on the fringes of healthcare. Right. And I think men in general, like, it's, you're...
15:09
told to like suck up your tears and be strong. And I see coming to therapy as a strength because you're actually admitting what's going on and you're asking for help for it. Yeah, yeah, absolutely. So talk to us about some of the self care that people can do to better their mental health. Exercise.
15:30
eating right, all the same things you do for just being healthy in general. And I think trying to kind of in between sessions, try to keep being self aware and insightful by journaling or doing different things to kind of...
15:50
prepare for the next session. Yeah. So let's dive into that a little bit more. So in terms of exercise and eating right, what would you recommend someone in terms of exercise, like how many hours per week? Yeah, if you can just talk a little bit more about that and then we'll talk about eating. Okay, I think it depends on the person. I'm not a medical doctor, but...
16:18
and people are driven towards different types of exercise. I find that a lot of my clients that do yoga and meditation, that's very helpful, like three days a week. Yeah, so I feel like meditation for me, and I was against it in the beginning, but it really helped me kind of just.
16:42
Re-frame the day because you know like running a business Your brain is all over the place Right and then physically like I personally go to different locations So my day could be really a lot of random acts a lot of different emails and phone calls new places so for me to just get back to That frame of mind of like, you know, just a little bit of more stability Meditation has really helped me out. I
17:12
We do it every day now. And then also walk. Do you do a sitting meditation? I do the sitting meditation. Yeah. And then I'm, so I use the Peloton app and I'm okay with the sitting, but I really love the sleeping meditation. Like for me that works. Is it the body scan? Yeah. So they'll have a bunch. So they'll have the body scan version, you know, version, then they'll have breathing techniques. They'll have, and then they'll have different themes. So like, you know, it can be about.
17:41
grief or just other aspects. So depending on what mood I'm in, I'll listen to what I think is needed at that time. In 2014, I took an 18-month course for therapists and meditation and mindfulness and how to bring that into your practice and for yourself. So for that training, I had to sit for 45 minutes twice a day, which was very challenging.
18:07
And then I also did two five-day silent retreats where you couldn't talk, but they were in beautiful places with nature. But I have brought that in, obviously, with my own life and with clients who are anxious. I think it can really help them ground themselves, be in the present moment, especially people with anxiety, because they're always thinking of the past or the future. So we sometimes do meditations in the session.
18:36
Yeah, absolutely. Tell me about the silent retreat. Like I've always wanted to do it. I haven't really had the time to do it. But so you go there for, you know, it was a five day session. It was a, it was, let's see, I've done three different ones. So they were, all of them are part of a training, but five of the days were silent. So basically there's someone guiding you through meditations.
19:02
And then you can do a lot of like walking meditations by yourself. And one was at the Omega Institute in New York. The other was in Massachusetts somewhere, if I remember exactly where. And also eating in silence, like mindful eating. And we weren't encouraged to even write anything down. Like you had to just... And are you in like a private room? Like you don't like have interactions at night with?
19:31
Anyone? You're with other trainees. OK. But they can't talk. No. And you're not supposed to make eye contact. But it really, the first, I'd say, two and a half days were very hard. And then I settled into it. And it was very peaceful. OK. So I think, obviously not to that scale of the silent retreats, but I think you can meditate when you're taking a shower or when you're brushing your teeth. I kind of.
19:58
between clients, I kind of see it as bookends. Like I'll kind of just take a breath and like collect myself and meditate a little bit before the next client comes in. Yeah. And that kind of helps me get through my day. What was the effect like after, not immediately after you came back from silent retreat, but like a month after? And then what do you tell like your patients about mindfulness?
20:27
I'd say I really had to push myself to get back to my regular practice because when you're there on site, obviously you have to do it and it's easier.
20:39
just trying to implement little things in my life, like mindful walking or anything, and that's kind of what I mentioned to my patients. I do recommend different apps for them, Headspace is one. Okay. Or I do have some recorded guided meditations with my voice that I might give them, to like 15 minutes, so things to practice. All right, very cool.
21:07
Alright, let's share a little bit and talk about the business side of your practice. So what made you want to go private in the first place? To be honest, I do take health insurance. Many therapists don't and I understand why. It was in 2013, I believe, a lot of the insurance cut rates for therapists and they would only offer.
21:36
20 sessions per year on the policy plans, and then we would have to appeal and get more. But there was an act that went through, I think, the end of 2013, 2014. Now most healthcare plans are unlimited, which that's huge for mental health. They actually recognize us as part of the medical community. Oh, that's good. But it still is, I was working in a group practice at the time, a group private practice of therapists, and...
22:05
I just couldn't afford to pay a percentage to the owner. So it was actually more affordable to go off on my own. And like I said, in school, they don't teach us any of this. So I had to teach myself how insurance works, getting credentialed, but I just really liked, I was able to do it. And you do have more control over your clients and who you see. And it's been a...
22:34
learning experience and it still is. So you started in 2018 going private, right? And then you see patients in person in our Philadelphia location of Medco Share and then also virtually for patients in Florida. Yes. Okay. So I moved from the Fort Lauderdale area to Philadelphia in 2020 during COVID and it just that time was...
23:01
was so stressful because I remember March of 2020 closing my in-person office and three days later fully online without any training of how to use telehealth or anything. And I think a lot of therapists felt like we weren't recognized as like first responders. I think they call us like the silent second responders because we were there helping everyone who was so anxious and we were anxious ourselves.
23:31
and I had more clients needing help than ever. And interestingly enough, the clients I already had that had anxiety and mental health issues coped with it better than new people that I had seen that never saw a therapist before. They never had panic attacks or anxiety. So it was just a very interesting time. But I think once things started opening up,
23:55
I would much prefer to see people in person. In telehealth, there's a lot of glitches and the wifi doesn't always work. And it's just, I always feel like the screen is kind of like a barrier. Where sitting with someone, you get such a more rich experience, like body language and you know how tall someone is. It's a lot more nuanced. And I'm trying to recall when we...
24:19
Matt, you did a tour of I think our Fishtown office. Was it in 2020? 2021? I was seeing it Dr. Ready for an ear issue I was having. Right. And I remember walking in the office and I'm like, I felt the buzz and the energy of the office and I'm like, I want this again. And, and I learned about the model and I think I've never seen anything like it. And I think it's just so great to have other
24:45
medical providers and referral sources and like I always liked working as an interdisciplinary team with other doctors. I think that's so important.
24:54
So I like the model that this practice provides. I think it's great. Yeah, no, absolutely. Yeah, thanks for saying that. And I think that was in 2021 then, because Dr. Reddy started with his NJT practice in Marlton around that time. And so you've had a full-time room with us for I think a couple of years now. Yeah, two years. Yeah, and it's very well-designed. It's very comforting. I'm always surprised to see how these rooms can be kind of,
25:24
change with the right decorations and furniture. Because you took a typical clinical room, we got rid of the exam table, you put a really nice couch in there, really nice artwork, so it's really cool to see. Yeah, with any space you can make it like a therapeutic ambiance. Yeah, yeah, absolutely. So talk to us about the different challenges of going private, and maybe you can start with,
25:55
in 2020 when you went all virtual, like what was the next step after that?
26:02
I think at that point I had a pretty full caseload of my same clients because people were very anxious and overwhelmed with COVID. But I really myself felt depressed and trapped almost and working from home is not for me. Yeah. So that's when I saw the opportunity and I spoke with you and I really wanted to be in person seeing clients again.
26:31
Absolutely. And just seeing other professionals and it just stimulates your mind and it just helped me so much. Right. So the patients were your patients from the group practice and then they kind of followed you or? Yeah, most of them did. Okay. Did you do anything for like marketing once you moved to Philadelphia? How did you attract new patients? So I had a website designed.
27:00
I also, psychology today is a very good resource for clients to log on and find a therapist. And I also, there's a couple of psychoanalytic institutes here, which I gave my name to and reached out to other psychiatrists, other doctors, other therapists, networking events. Yeah, amazing. And I know you met with Dr. Avang instead of our Fishtown office. So what was that like?
27:30
He's great. I had always seen research and articles about ketamine helping with depression. And I had a couple of clients that saw him and went through the process. And it was just amazing the change I saw in them. These people have been on antidepressants for 20, 30 years and it doesn't really work. And like six to eight treatments with the ketamine.
27:57
is a life changer. And people can talk about difficult things like trauma and things they've been through without that guard up. It just helps people to like, access it and kind of put it behind them so much faster. And it has a lot of the same effects as meditation, quicker. Yeah.
28:21
Yeah, so I mean, I think one of the biggest benefits of medical co-working is the ability to refer patients to other providers in the space. Right. I mean, because you usually only get that really in larger clinics or hospitals where it's like that's all built in. But once you go private, getting referrals is something that you actually have to work at. Yeah. It's visiting other other doctors nearby or whatever it is. But being in a Medco share space, you can network.
28:51
with other docs and that helps to at least get a few patients that way. And Dr. George as well, the cardiologist. Yeah. I get some of his patients who have panic attacks or they feel like they're having heart issues, but it's really anxiety. Yeah. So the two of them have been great. Yeah, no, absolutely. So talk to us a little bit about the management of your practice.
29:16
Right. So, you know, you're a solo practice. So you're handling or you're handling like billing, scheduling, everything by yourself. I have one biller that works for me for some outstanding claims that I haven't been reimbursed for. But basically, yes, I do everything myself. The scheduling, billing, obviously, note taking, marketing. I'm not very strong with like social media and and those things. Right.
29:47
And I don't know if I necessarily need to take that step, but I know a lot of therapists have social media accounts. Yeah. I mean, do you have like a full calendar of patients now? I'm pretty full, yeah. I mean, I have a few openings, but. But for the most part, you're full, and it's kind of like on autopilot.
30:08
I would like to get more inpatient people. That's, I'm sorry, inpatient can take that out. In-person clients, yes. Yeah. Because I just enjoy that so much more. Yeah, yeah, absolutely. What advice would you give to a psychotherapist that's looking to get started now with their own practice?
30:36
I would say to start with a group practice, because that's a good way of just seeing the flow of things and also seeing different clients because usually when you work for a group practice, the administrative assistant will assign the client to the therapist. So you can kind of see a wide range of people and see where your specialties are, what you're interested in. Okay.
31:02
And I guess to ask more business questions, if a newer therapist is trying to handle it on their own. Okay. So they handle all the marketing though, right? So like, if you're part of a group practice, they're basically just giving you the paychecks. Exactly, exactly. So I think to ask questions of what they do and what's accessible for them. Got it.
31:28
Are you able to talk about the financial aspect? You know, like what's the cost? And you can get rough estimates of like starting your own practice. Is it just the cost of the real estate or is there more to it? It's the cost of the real estate. It's the cost of the software and the billing programs. Also marketing.
31:53
For me, I was fortunate because I had the patients from the group practice and actually the office that I had in Florida was Right across the street. Okay, so I didn't have to do much. So for me, it was really the software the rent some marketing the website Okay So do you have like a rough estimation of like on a monthly like what someone should budget? I Mean every office space is different, right? I think Yeah, just about where you're looking what you're looking for. Yeah
32:24
Okay, great. This was really insightful. I think anyone that wants to either learn about being a psychotherapist or even the business side of it, I think this is a great podcast and interview where we kind of dived in to see what it was like. Where can patients find you? People can find me on Psychology Today or my website, which is www.psych.com.
32:52
libb And I'm very responsive to people. And if I'm not the right fit, I will find someone who is. Yeah, absolutely. And you're taking on new patients and you're basically you want more in person right now. Yes, and I take United, Cigna, Aetna, Blue Cross.
33:14
So pretty much all the major insurance panels. Yeah, and we're located in the beautiful Fishtown neighborhood. So anybody in the Philadelphia area looking for a psychotherapist, I recommend you, Libby. So yeah, thank you so much for joining today. Thank you.
