How to Build Systems and Culture That Scale in Your Practice

In this episode of MI4Change, we explore how Motivational Interviewing can be applied beyond clinical work—into leadership, business growth, and organizational culture.

If you’re a:
 • BCBA
 • Business owner
 • Clinical supervisor
 • Therapist building a practice

This episode will help you understand how to scale your organization in a way that is sustainable and aligned with your values.

In this episode, Dr. Monica Gilbert shares:

 • Why processes are critical for scaling a business
 • How to define roles and responsibilities within your team
 • How to handle staff resistance and pushback
 • How to use Motivational Interviewing to build collaboration and autonomy
 • Why doing too much as a leader creates bottlenecks
 • How to create a culture of ownership and accountability

You’ll also hear real examples from a growing ABA and mental health organization and the lessons learned over 16+ years in the field.

Because scaling isn’t just about growth…

👉 It’s about building something that can thrive without you.

Learn more about Motivational Interviewing and explore on-demand courses at www.drmonicagilbert.com

Join the MI Academy for practical training and resources — and enjoy an exclusive 15% off with code MIFORCHANGE at checkout.

📲 Connect with me on Instagram: @drmonicagilbert

Transcript

SPEAKER_00 0:06

Hello, everyone, and welcome to another episode of Am I for Change? I'm your host, Dr. Monica Gilbert, and today we're going to talk about how to implement motivational interviewing to grow your organization, to really establish that organizational culture that will be everlasting and that will be a good one. Because no one wants to have a toxic organization, right? So come with me today and dive into this very important topic. And I mention it's a very important topic because compared to back in the day, maybe 18 years ago, and I know that I'm dating myself by saying that, but we didn't have so many ABA and mental health companies out there, private practices out there. So nowadays, it feels like everyone has their own private practice, which is good. The field is growing. People are building more of these entrepreneur skills. But we have to make sure that when we are growing, we are doing it in a way that satisfies our vision, in a way where we can still provide the best, most authentic services to our clients, and that we are guiding our staff and we are providing that care and supervision to them. So I'm gonna talk a little bit about how motivational interviewing can help not only in the conversations that you have with your staff, but also in building this organizational structure and culture that you're proud of. As an entrepreneur, and I can tell you about this firsthand because I've had my private ABA practice for it's going to be 16 years now in two weeks. I know 16 years is a lot. And a lot has happened in those 16 years. I have evolved, I have learned, and of course, I've had my challenges, I've had my oops moments, I've had my moments that I don't want to relive, but they're all part of the process. I also have my private practice in psychological services, crystal mind psychological services, which has been going on for a little over seven years already. So entrepreneur is what I like. I love psychology. I love working with clients, I love motivational interviewing. But another side of me is that business side. And the idea of growing is something that I've always been open to. I've always been looking to do. But I also want to grow in a way where it doesn't crumble. I want to grow in a way where we are not losing our values as a company, where I am not losing my vision of why I started to do what I do. So in order to keep that, you have to develop processes within your company. It's it's impossible for you to scale, for you to grow, for you to really reach that point where you can provide the most services that you're able to if you do not learn how to scale, if you do not learn how to trust others. And processes I have learned really in the last five years of my career are what's going to set you apart. What are processes? So everything has a process. For example, when you start working with a client, the first thing you do, if you're in the ABA world, you do an intake, you send it to the insurance, you recommend the hours, then you get the authorization back, you start working with a client, you staff with an RBT or an intern, and then you start the services. So that in its own, it's a process. So having something like that that can survive even when you aren't there is what organizations really thrive on. And that's how you make them grow. So I have learned to do that in my own organization where we have a process for everything. I think that the admin team in my private practice, they're sick and tired of hearing the word process because that's all I say. I always ask them, well, what's the process for this? And what do we do about this? Or let's build this process for this. And oftentimes it's a little, I'm sure, annoying. But also some staff tend to just naturally follow processes better than others. For others, it's a little harder to be structure. It's a little harder to perhaps learn a new process because that's the other thing. You have to change your processes because what's working now may not be working next year. We're always evolving so much. So that's something to keep in mind. And then what do you do when there's this pushback? What do you do when there's this uh determination of like, I don't want to engage in that process, or I don't think this process works, or I'm just gonna do things my way and not adhere to the process? Well, that's when motivational interviewing really comes in. So, how do you use MI in an organization? And I'll give you guys just like a really um uh just a framework that maybe you can use or you can just kind of see and and develop your own. You don't have to use what's worked for me. So, in my organization, for example, we have different people that do different things. Sometimes some of their jobs coexist together, sometimes they merge, and sometimes they're parallel, but then at some point they merge. So, what I have done is that I have had a meeting, and really the first thing is to define and make sure that you have identified what that job title is. I know that we hire and there's job titles, but sometimes it just kind of bunches up. And what tends to happen is that when you're when you're in an or when you have an organization and all of a sudden you have this peak where it grows, things change and people start like just acting out of inertia. They're like, we have to put out this fire and we have to put out that fire. And if you have a good team, everyone's gonna just jump in and do each other's job because you have to put out those fires. So the point here is not to get to a place where you are putting out the fires, and that's why these processes exist because you want to act proactively and not really just putting out the fires when they do happen, because then that creates chaos and burnout. So less focus on the symptoms, more focus on the systems. Um, and so going back to the processes, the first thing is you should identify clearly what each person's role is in an organization. And the way that I did it, instead of going in there and saying, okay, I'm gonna check and chat and chat GPT and put everything together and for ChatGPT to tell me what your role, what your role is, I did think of doing that because it would have made my life a little easier. But instead, I interviewed my staff. So I sat with each one of them one-on-one and I asked them, tell me all of the tasks that you engage in. And I had my marketing director help me with that. And they were able to tell me all the tasks that they engage in. Well, what are some things in your task or in your day-to-day that you don't think belongs into what you do? And what are some things that you think do belong to you, but someone else is doing? And those were some of the questions, the open-ended questions and the collaboration that we were doing with them. And there was also this evocation because when things, when the conversation got to the point of like, well, this isn't working, instead of me coming in or my marketing director coming in and saying, Well, why don't you try this? Or let's think about a fix for this, I put it back on them. Well, what do you think would make it work? What are some things that maybe we can do differently as an organization, or you can do differently, or or someone else can do differently? Let's brainstorm together. And those meetings went incredibly well. And I'll tell you what actually happened in those meetings. So our intention was different, and even me knowing about motivational interviewing, my goal was different. And what actually happened was even better. So I'll get to that in a minute. So the first thing is clarify everyone's role. They need to be aware of their role. You need to be aware of your role. And in having them jot down what their role is or what their the tasks are that are involved in their role, it allows you to see how well they understand their role. It allows you to see what their role actually is, and it just softens the whole process. So that was the first thing for them to identify that. The second thing was to sit down and think about well, your job starts here and where does it end? So, for example, if if you are receiving the call from the client and you are onboarding them and you are taking down their information, now, after you do that and you pass on the torch to the client relations manager or the program coordinator, well, that is where your job ends, and that is where her job starts. So identifying a clear start and end to everyone's job. And again, some people are going to just have um things that they're gonna be doing together. There's like no end, or maybe they have to jump back in after that. But clearly identifying that has helped tremendously. So, first is identifying what each and clarifying each person's task. Secondly, is identifying where does your job start, with where does your job end. And then it's sitting down. I sat down with my marketing director and we really looked at the whole scope of things. So zooming out and really looking at the organization as a whole and seeing how everything plays a part in it and what we can change or we should change, or maybe this should go here. Maybe the person that does the benefits and eligibility should also be doing the authorizations, and maybe this person can do that. Now, I will tell you because this happens to me, I try, I always orbit back to personalities and wanting for everyone to be happy in their job. And that is sometimes a challenge and something that I personally need to work on because you can't make everyone happy and people just have to work. Um, it's funny because I do things that don't make me happy in my job, but I just feel like I need to do them. So that's just a personal thing that in this process, this is one of the things that I wasn't really aiming for, but I was able to see in this process, I, as the owner of the company, I was able to see how much I was sticking my hands in things that I really shouldn't be sticking my hands in. First, because there's no need for it. Secondly, I am complicating things more by sticking my hands in it when I should allow others to do their job. So that was something that after this exercise, I was able to also identify within myself, which was very powerful. So after we were able to zoom out and see like who does what and what goes where, and going back again to the point of like what I tend to do, and I think sometimes we do that inadvertently in organizations. We say, well, this person really is not the best in, I don't know, like structure. So even though her task is to do all of these different things, since she's not really good with structure, I'm just gonna allow this other person to do it. That's a big no-no. That is a big no-no because then you are modeling or you are shaping your organization to fit that person's need instead of fitting it to what your organization needs. So we never want to think about this, but what happens if tomorrow this person leaves? Well, you just created a position based on their needs and not a position based on your organization. So that's just something to keep in mind. Now, what did I find out from this process? What did I learn? What was that unintentional lesson? Well, the first thing is that I was doing too much. So I had to back off a little bit because sometimes it can actually make things worse. And it also helped me reflect on everyone's role. It allowed me to reflect on the things that were missing. And this was such a powerful exercise. And when my marketing person and my marketing person has been working with me forever on motivational interviewing, so she's learned a lot of things. And she was actually the one that initiated these conversations with my staff member. So when she came in and she started to interview them, and I asked her, how was that process? And she said, Well, I just did what you've taught me. I just did what what you've preached, was which is just ask questions. And the magic didn't happen in that meeting. The magic happens after. And that's something that I always like to talk about because oftentimes we're in the session with the parent or with the staff or with the client themselves. And we are trying these skills and we're using motivation and all that, and and we just don't see it happen. Like in the session, we are not getting reinforced by all this output. And it's important that we remind ourselves that the magic happens after. What we do in a session is that we plant the seed. And I always tell my clients this I always say, therapy doesn't happen right now. Therapy happens when you leave my therapy office because that's really how it works. That's how you start, that's when you start reflecting. That's when you start thinking and processing about, you know, all these things that that happened. And it's truly magical if you are able to gauge and ask the right questions in your organization. So, what does this do? What does it do when you initially open up an organization? Now, mine was a little different because I've had it like my organization grew with me. Like it was a child when I was a child and it grew with me. So it's been through different molding spots. But when you already know about motivational interviewing and you open up your private practice and you just start with this culture, I'm sure that things are completely different. Um, because you're already opening with that. And it really shapes the culture of your staff. It shapes the culture of your therapist because you are building an organization that is around brainstorming together, that is around collaboration, that is around asking open-ended questions, that is around evoking, evoking solutions from everyone. Because you can be an incredible entrepreneur, but you can't do this by yourself. You cannot. And that's something that I've learned. When I was growing, there were points where I was able to wear every hat and I wore it well and I wore it gracefully, but it got to a point that I didn't want to wear all these hats. I wanted to also have my time with my family. I wanted to think about other ideas. When I was so in the moment about insurances and staffing and this, I'm not able to be myself. I'm not able to be creative and think outside the box. So if that happens, you cannot grow. So something really important to think about, because I know that sometimes as entrepreneurs, we get so obsessed with the process and it's hard for us to trust. And when we start trusting and when we start allowing others to sometimes figure it out for themselves, we can truly see the magic happen. So I hope that you found value in this session and that you're able to apply some of these concepts or some of these things to your own organization. Please let me know in the comments. Send me messages. I love always hearing about the follow-ups and what happens after you hear this podcast. If anything happens, maybe nothing happens after you hear it. But thank you so much for sharing this time with me. I'll see you in the next podcast. Thank you for joining me on today's episode of MI for Change. If you're ready to keep growing your motivational interviewing skills, I'd love to invite you to explore my MI Academy, where you'll find a full library of on demand courses designed to help you put MI into practice with confidence. You can learn more at www.drmonicagilbert.com. Until next time.