[Transcript] Episode 436: Neurodivergent Leadership and Fostering a Neurodivergent-friendly Work Culture, with guest Patrick Casale

 

Evan Dumas

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co-host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton, and we are Person Centered Tech.

 

Liath Dalton  

This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and electronic health record system to support you in growing your thriving practice. Therapy Notes is a complete practice management system with all the functionality you need to manage client records, meet with clients remotely, create rich documentation, schedule appointments and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user, go to therapynotes.com and use promo code PCT.

 

Evan Dumas 

Hello and welcome to Episode 436: Neurodivergent Leadership and Fostering a Neurodivergent Friendly Work Culture with guest Patrick Casale.

 

Liath Dalton 

Hello and welcome to another special episode of Group Practice Tech with guest expert, the wonderful Patrick Casale, of All Things Private Practice, Divergent Conversations and Empowered Escapes, and a group practice owner himself, Patrick, thanks for joining me today.

 

Patrick Casale 

Thanks for having me on.

 

Liath Dalton 

We are going to be talking about something that you have your own direct lived experience of, and is something that you really are effective at, helping to resource and equip practice leaders around, which is how to manage being a leader when you are neurodivergent. Being a practice owner, but also how to kind of intentionally curate affirming culture within a practice for, for those who are neurodivergent as well. So how, how did this, I mean, I guess I kind of already alluded to it by saying that is a direct and lived experience for you, but what, what would you share about your your own journey?

 

Patrick Casale 

Yeah. Um, so, I’m a late in life diagnosed autistic ADHD human being. I was diagnosed. ADHD, I’m 38 years old today I was diagnosed. ADHD, well, not today, like my birthday, but like as of this present moment, sorry.

 

Liath Dalton 

I was gonna say, what?! You’re podcast recording with me on your birthday!

 

Patrick Casale 

Surprise! I was diagnosed. ADHD, probably when I was about 33 years old, and then two years later, I was also diagnosed as autistic. The last three years have been quite the journey, and acknowledging those things and living that obviously, every day of my life. As a leader, I have to kind of zoom out and take a step back and see like, how does my neurotype, my communication, my preferences, all of it, impact how I show up? And as someone who employs staff, specifically, I would imagine, if I had to guesstimate, that 90% of our staff are either autistic or ADHD, how do we create a culture where people feel affirmed and supported and well taken care of as well?

 

Liath Dalton 

And what is that kind of look like in your practice? Or if you want to zoom out further and talk about how you support other practice owners and leaders in managing this.

 

Patrick Casale 

Yeah, so this is really like a two directional conversation, right? Because I do both. Not only do I provide coaching, leadership coaching for neurodivergent business owners, I also help implement culture within the workplace and supporting neurodivergent staff. So I will start with the leadership component. And I think it’s about really getting a good understanding of of your neurodivergence, of your neurotype, if you are autistic, ADHD, especially. Because that’s going to impact a lot of things, and how you show up. It’s going to impact your communication style, how you absorb energy, how you absorb and understand and process information, how you show up in different settings.

 

Patrick Casale 

And I know for myself as someone who, I would say that my autistic side shows up more in like meetings and things like that, because I’m very direct. I’m very black and white. And if you didn’t know me, or you didn’t know that I was autistic, you might think that I was rude, or very blunt, or that I didn’t care about other people’s opinions. Because I do struggle with, like, artificial conversation and small talk and don’t make a lot of eye contact.

 

Patrick Casale 

So if we’re looking at it from a neurotypical lens, it’s like, oh Patrick is really rude, or it’s like, oh Patrick is just from New York, and that’s how New Yorkers are. And some of that could be true, but then when you go a little deeper, it’s like, well, there are certain things that if I’m going to model how to unmask safely and how to ask for your accommodations that you need and deserve, then I have to be really authentic and true to myself too, and how I show up. And it’s really created an evolutionary process in terms of not only the work that I do as a leader, how, but how I support my staff and feeling affirmed and taken care of as well.

 

Liath Dalton 

And how much of your sort of experience of late diagnosis informs that approach? Because I’m imagining that, while we are both at a moment in time where it seems like there is far less stigma, particularly in the in the mental health space and the entrepreneurial space around neurodivergence and just sort of at large in our culture, but that there are still so many folks who aren’t neurotypical, who, who aren’t aware of that, and so have a unique set of challenges in managing their leadership and business. So how, how would you, are there sort of particular questions that you suggest people ask themselves or start with?

 

Patrick Casale 

Yeah. So I, as a human, like and before I knew any of this about myself, I’m still the same human that I was prior. I just have a very different lens on how I view the world. And what I’ve realized is, I’ve always been a leader, and it’s always because of how I’ve shown up in spaces as very authentic, very vulnerable, very real, always willing to be supportive to the best of my ability. And I have an ability to just see people, I think that you could call it intuition, you could call it whatever you want to call it. But I’ve always been able to really get the best out of people while also helping them see the best in themselves.

 

Patrick Casale 

And I think a big part of this, you know now, is like accommodations and realizing we cannot, I’m using generalized terms, but traditional workplace settings don’t work for neurodivergent people, and they never worked for me. So if I look at my time in community mental health, where I was maybe salaried and expected to be in a office setting for whatever hours, and didn’t matter how quickly I got my work done. Or when I was in middle management, and we would have meetings just to have meetings.

 

Liath Dalton 

Ugh.

 

Patrick Casale 

And I would say, like, it seems like we’re just having meetings just to have meetings. And I would say things like that. I did not realize, like, that was just my autistic side being like, what are what are we doing? Like, why are we not just getting to the point? Now, fast forward a couple of years, and the reality is, like, if we want to be an inclusive, neuroinclusive workspace, and we have to acknowledge all of us listening and participating in this, whether you’re neurodivergent or not, you are surrounded by neurodivergent people, whether you know this or not.

 

Patrick Casale 

So if you’re a leader and you want to create a neuroinclusive workspace, there are a lot of things that we have to revisit and kind of reevaluate. And I’m someone who really believes in, like, non-traditional types of thinking in terms of workplace culture. So we value people over profit, always have, always will. A lot of autistic ADHD people are very values driven. So if I stay true to my core, to my values, that’s my starting point, right? And that’s my why.

 

Patrick Casale 

And that’s what I would say to your question is like, get really curious and in tune and aligned with your values and your why. Because that has to be the foundation of everything that we do. So for me, it’s always autonomy, freedom, valuing people over profit, being culturally competent and celebratory. And if we can start there, then I can start building around that.

 

Patrick Casale 

This means that when we hire new staff, we send them a communication preferences form, and that means, like, I introduce myself, I’m autistic ADHD, this is how I communicate, this is how I struggle with communication, this is how I process information. I allow for all of them to do the same. Because what I don’t want to do is say you have to show up to staff meetings and you have to keep your video on because I need to know that you’re paying attention. That is not neuro affirming, right? So I want to ensure that if you could, if you are uncomfortable making eye contact, or you can’t process information on video, let’s make sure we accommodate that. Let’s make sure we honor that.

 

Patrick Casale 

I want my staff to feel empowered to ask for the accommodations that they need. We do quarterly one on one check ins, and I have several staff who will say, can we do our check in through text or through email instead of a video call or a voice call? And I’m like, absofreakinglutely, because one, I also hate video calls. It’s like this is exactly what a neuro-affirming culture should be, is you should be able to ask for the things that your system needs. And too many employers and leaders, in my opinion, believe that it’s a one size fits all approach, and that is just not something that works for neurodivergent people.

 

Liath Dalton 

Right. And how would you guide folks to kind of become informed about what they should be considering and keeping an eye out for and how to really let their team know that it is a safe space to ask for the accommodations that they need?Which I would imagine, in some cases, it’s offering examples of accommodations, instead of putting it out there of well, just tell me what you need as the starting point, that it’s kind of like a both and right, that you offer it and, and have to be very clear that it is truly welcomed and give them space to and, and that encouragement to actually name what it is that they need in particular.

 

Patrick Casale 

Yeah, so we have to walk the walk and talk the talk, right? Too often we just post like buzzwords on our websites, or like we’re an all inclusive, anti-racism environment, but we don’t do the work.

 

Liath Dalton 

Right.

 

Patrick Casale 

And that’s just simply not enough for people who are a part of our workplace culture, who identify within marginalized groups or communities. So same thing here, as I would say, if you’re doing anti-racist, anti-oppressive practice work, you have to do the work. If you’re a neurotypical leader, you do have to immerse yourself into neurodivergent culture. And that might mean like, paying, doing trainings, bringing in consultants and trainers like myself or other people who are out there doing the work of like, how do we how do we become more neurodivergent affirming. It’s about evaluating everything.

 

Patrick Casale 

So I evaluate everything from like our job hiring posting, to our interview process, our onboarding process, PTO policies, workplace environment policies, like that even includes seating, lighting, scents, etc, everything that impacts the sensory systems. I also ensure that we always have telehealth options for people, for those who just really struggle with being in person. It also means that nobody has the same work schedule, because nobody’s system is the same.

 

Patrick Casale 

I don’t sleep well. I cannot start my day before 10am. When I used to have to go to work at seven, 8am I couldn’t function. I would always struggle. And that was like playing catch up all the time, and it just didn’t make sense to me. Why do I have to be here at these hours if nobody else is here or we’re not doing anything, just because that’s the rule? I’ve actually hired people without ever seeing their face or without ever talking to them on the phone or on a video call. I’ve hired people directly through email, based on some conversation and some questions.

 

Patrick Casale 

So it really is about taking this, like black and white perspective of this is how we employ, this is how we hire, this is how we train, this is how we onboard. Taking that step back and kind of turning it on its head and saying we’re going to do things a bit differently. And that really does create a cohesive culture of people who are like, oh man, like, this is so different than what I’m used to. This is exactly what my system needs. It would be really hard to know what our systems need if our systems don’t need those things, though, right? So as an allistic or neurotypical human, it really is about doing the work, learning, growing and providing some continuing training and consultation.

 

Liath Dalton 

What are the sort of go to resources for folks who want to begin that, that process of becoming informed and really incorporating this in a meaningful way into their their practices?

 

Patrick Casale 

Well, you could hire me to come in and take a look at and evaluate all of your processes and procedures and do training for your staff and your leadership. There are other neurodivergent people who do the same. You could listen to Divergent Conversations, which is a podcast that I co-host with Dr Megan Neff, who, in my opinion, is one of the most intelligent, insightful resources in the neurodivergent community right now. I believe that the book Unmasking Autism, by Dr Devon Price is a wonderful resource. There’s a trainer and consultant named Lyric Rivera, they do neurodivergent affirming workplace culture training.

 

Patrick Casale 

So, like, the resources are everywhere. And I think that’s the that’s the big piece here. When people are like, I don’t know where to start. It’s like, just Google search, honestly, like, go into Instagram and just type these things in. Because we are seeing more neurodivergent, especially autistic ADHD advocacy, in like, social media spaces right now than we ever have before. So I think it’s important to do the work, and I think it’s important to just ask the questions.

 

Patrick Casale 

This means, like, a couple of my staff asked if we could buy some bean bags for the office so they could sit on the floor, because they’re more comfortable sitting on the floor with clients. This means that we are ensuring that we never have fluorescent lights on. We always have, like, dimmed lamps are things that are really sensory friendly and soothing. Lots of fidget toys and tactile toys everywhere. I’m playing with one right now. But that also gives your clients the permission to do it, so your clients don’t have to sit in your session and like, hold it together or, like, act as if they can’t stim or fidget or take care of their sensory system. It means that we have, like, weighted blankets, weighted pillows, things that will give pressure to our proprioceptive needs. It means that we have lots of ways you can contact us. You don’t have to call us to become a client. You can text us to become a client. You can do, so it is, again, just reevaluating these little tweaks that really make a massive difference.

 

Liath Dalton 

Right. And that’s components of accessibility and creating that safe space, both for clients and for team members at the at the outset, from the initial interaction and experience. It’s interesting, sort of connection, because recently I was was talking with another group practice owner whose entire focus is on disability and accessibility, and she was describing some of the changes in the way she runs her practice, both in terms of hiring and expectations, or not having the sort of typical expectations for what employees must do and how they need to present and so on, and also the same piece around initial contact from prospective clients. So I’m loving seeing the the synchronicity there. And I’m kind of curious how, how frequently you see that actually being lived out in in practices, versus you mentioned earlier, sort of the keywords and buzzwords that get put on job descriptions and practice websites. And so there, I think, is a presence, to to an extent, of sometimes those values being named, but not really lived out in practice.

 

Patrick Casale 

Yep.

 

Liath Dalton 

And how, how would you suggest trying to address or combat that, or prevent that from from being a dominant experience?

 

Patrick Casale 

Yeah, unfortunately, it’s definitely still very prevalent. I mean, we still, and I’m not trying to shame anyone who’s listening, but we still have a lot of, you know, group practice culture where, like, it’s pretty standard to say full time is 35 clients a week. Or you have to be in the office from hour this to hour that, or you have to dress this way, or, no, you can’t do telehealth, even though there’s no reason to say no to it. So there’s a lot of that. There’s still a lot of that. I think that we live in inherently an internalized ableist society. It’s ingrained in who we are as people. So I think it’s very, very, very prevalent. It’s probably why I get 200 to 300 job applicants a month because the culture speaks for itself. But I just have an auto responder on because I can’t handle it.

 

Liath Dalton 

That’s, that’s intense. But I I am curious to how the aspect of self disclosure, which you clearly really live, live out in, in what you do, how that’s kind of addressed in the practice, in your own practice, with your clinical staff, and and how does self disclosure for those who are neurodivergent, is, is that something that’s done really intentionally through through the practice, that sort of self disclosure part of the practice’s identity?

 

Patrick Casale 

Yeah, we definitely try to embrace identity first language. We definitely try to embrace self disclosure. We have a lot of folks who work for us who are either part of the LGBTQ community, BIPOC community, neurodivergent community, a lot of intersectionality and overlap. We always encourage self disclosure if people feel safe enough to do so. I’m never going to push someone to do something that would lead them to feel unsafe in the community because of identifying a certain way. However, the ones that do we put it on their profiles, they put it in their their about mes they put it on their directory pages.

 

Patrick Casale 

Like, for example, I’ll always introduce myself as autistic ADHD, because it’s again, self advocacy. And advocacy across the board is disclosure in real in real settings like that. So I’m just trying to model that it’s okay to talk about this stuff, it’s okay to identify a certain way. I also have an enormous amount of privilege, I don’t really ever feel unsafe doing so. But I think that’s important to note as well.

 

Patrick Casale 

But self disclosure and identity first language. I mean, I think that accessibility is relatability. And when clients who are marginalized and they’re struggling and they’re looking for someone who gets it, where they don’t have to share their story again and again and again with the nuance, and they see you, right? I’m autistic, I’m ADHD, I’m this, I identify this way. It’s almost like this relief, right? Because they may come and tell their story again, but they are not going to have to go into the nuances about the why, about the oh my god, every time I say this, someone asks me a million questions because they don’t understand, or they don’t get it. And I think that’s so powerful, and that’s, that’s a huge part of what we do.

 

Liath Dalton 

I love that, accessibility is relatability. It’s just a beautiful way to describe it, and I love seeing that that is, is how that shows up in in your practice, in your work. One, one thing I’m curious about with those directory profiles, do you have any particular directory services that you like, that stand out, that are oriented maybe around particular identities or populations serving populations where that relatability so you can find someone relatable?

 

Patrick Casale 

Yeah, that’s that’s a good question. I wonder if I’m about to get a cease and desist. What I would say is I don’t like Psychology Today because it’s very whitewashed and transphobic, and has been kind of like problematic forever. But of course, they take up the most real estate via SEO and Google search, so everybody’s on there regardless. I would say the two that I like the most are Inclusive Therapists directory and Mental Health Match. Ryan Schwartz, with Mental Health Match is really cool guy, and I had him on my podcast, and I really like what he’s created over there. I also really like Inclusive Therapists. And we’ll say Inclusive Therapists is a great directory, and that’s going to be one that’s going to really call you out on your shit. If you’re like, I’m going to join this directory because I’m anti-racist. It’s going to ask you, why. Who are you? Like, it’s very values driven, and it’s very much about protecting people who are a part of those communities. And I really appreciate the work that they’ve put into that. So I would say those are my two go tos.

 

Liath Dalton 

I love that answer, and don’t worry, I’ve been complaining about Psychology Today and their practices for years and and publicly so and have not yet gotten a cease and desist letter. But I mean, even just from a walking the talk themselves sort of viewpoint, the fact that they won’t do a Business Associate Agreement that covers their messaging when it’s handling initial contact, so not HIPAA copacetic, and they’re, they’re headquartered in the Cayman Islands, which I think you know, says, a lot right there.

 

Patrick Casale 

Yeah, yeah, for sure.

 

Liath Dalton 

But they are kind of ubiquitous, but it’s nice to see that there are alternatives that are, you know, run by therapists for therapists, and where there’s that really a difference that is reflected in in how it’s it’s managed, speaking of accessibility.

 

Liath Dalton 

Are there any sort of last little pieces of guidance that you would give a practice owner, a leader, in terms of what, if you’re going to do one thing, to take a progressive step towards being more inclusive in and intentional in studying your practice’s culture, to be anti-oppressive and affirming, what would what would you say to do?

 

Patrick Casale 

First and foremost, I think it’s anonymous feedback forms. Because a lot of our staff, despite our best intentions, may still not feel safe, depending on the power dynamics at play or racial dynamics at play. And I think it’s important to solicit anonymous feedback from your staff. To say, tell me about what you would like to see more of. Tell me what you would like to see less of. Do you feel safe here? What could make you feel more comfortable? What would make this a more accessible environment? And then really take that stuff to heart.

 

Patrick Casale 

A lot of people do not solicit feedback because they are concerned about receiving it. As humans, we struggle with critique and criticism, you know? I think I’m no different, but I also you have to be uncomfortable if you want to be a good leader. You have to lean into the things that people are trying to tell you, even if it’s subtly or subconsciously. So I do think like anonymous feedback forms, make a Google form, no name included, or just send out something that is anonymous and let people fill it out, and some of the responses are going to suck. And some of the responses are going to hurt, and it’s just an opportunity to grow and anchor in and just shift into a place where things can be a lot more affirming and a lot more accessible.

 

Liath Dalton 

I love that takeaway, and I do know that getting getting that sort of feedback is a pain point or fair point for a lot of practice owners, and understandably so, that’s like you say, human, human nature, but really centering how, how crucial that is, I think, is, is huge. So thank you for providing that, that takeaway, and I hope people will will take that to heart and incorporate that into their practice leadership.

 

Patrick Casale 

Absolutely.

 

Liath Dalton 

Thank you, Patrick, so much for joining me and and sharing your story and your work with with all of us the way that you do.

 

Patrick Casale 

Thank you so much for having me on Liath, I appreciate it.

 

Liath Dalton 

This has been Group Practice Tech. You can find us at personcenteredtech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast or click podcast on the menu bar.