Minter Dialogue with Steven Buchwald
3 Key Points:
- Authenticity as Unveiling: Therapy and authentic living are ongoing processes of unveiling rather than fixed destinations. Authenticity means continual adjustment and reconnection with who we are at each moment, not arriving at one final self.
- Matching Patients to Therapists: A key theme that emerged was the critical importance of matching clients with the right therapist, acknowledging that therapeutic fit is often discovered through experience and can change as needs evolve.
- Limits of AI and the Value of Human Connection: The conversation examined both the limitations and opportunities of AI in therapy, maintaining that while AI can offer support during crises, the human relationship remains irreplaceable for effective therapeutic outcomes.
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Music credit: The jingle at the beginning of the show is courtesy of my friend, Pierre Journel, author of the Guitar Channel. And, the new sign-off music is “A Convinced Man,” a song I co-wrote and recorded with Stephanie Singer back in the late 1980s (please excuse the quality of the sound!).
Full transcript via Castmagic.io
Transcription courtesy of Castmagic.io, an AI full-service for podcasters
Minter Dial: Steven Buchwald, I am very happy to have you on the show. I, you know, I didn’t know you before, got a chance to sort of research you, figure out a little bit about you. The fact that you speak French like I do, fun and games. And you’ve been in a very interesting space, so we’re going to get into that. But before, as I always do, Steven, and beware, I ask, who are you?
Steven Buchwald: Nice. Well, thank you for having me. It’s a pleasure to be here. Who am I? Well, very loaded question. Naturally. But I guess we could say that I’m a human that is pretty much enjoying his human experience as a CEO of a management company. in the healthcare space, and I’ve been at it for over a decade now, and I’m having fun with it. It’s a very passionate space.
Minter Dial: Well, I’m going to be provocative, Steven, because you named your company a very particular name, and it argues that under the name, one must know who one is. The word is authenticity. Tell us about your choice of that. What— I mean, because that’s got to be— that’s a powerful word to use as a name of a company.
Steven Buchwald: Yeah. And so, there are 2 companies here. There’s Authenticity Management Group, which is the company that I’m the CEO of. And then there is a clinical entity called Manhattan Mental Health Counseling, and we’re managing the non-clinical side of it. And so, the choice of word for authenticity has very much to do with therapy itself. And in my view, therapy is a process of unveiling. and getting to the core of what one is about. And so, that process of unveiling is about being authentic to yourself and finding ways to live a very authentic life.
Minter Dial: Authenticity is, is a— I’m going to characterize it as a buzzword in the business world. We’re always talking about transparency, authenticity, And I always, I’m at this point now in my career and the number of conversations I’ve had, I kind of look at it and say, is there not an agenda behind calling for transparency? And is there not another reason why people are constantly looking for authenticity? How does that jive with you, this notion that everybody’s talking about it, Why is that?
Steven Buchwald: What do you see the agenda? What do you imagine that the agenda be?
Minter Dial: Well, that depends on the people calling for it. But if I say I want you to be transparent,
Steven Buchwald: sure.
Minter Dial: So, like every time when you just finished, when you point, right, there are the 3 fingers pointing backwards at me. And it might— my maybe cynical approach is to think that sometimes these calls for transparency come from an agenda perspective and perhaps from a lack of transparency on their own side. So, I’m just wondering where that fits in with therapy and all that.
Steven Buchwald: So, the way I look at it is more so, um, it’s so easy, um, like essentially you’re the easiest person to fool, right? And so, it’s so easy to live a sort of double life of having a face to others and another one to yourself in a way that you live a life that is not fulfilling, not fun, and is not representative of what you’re truly about. And so, an authentic life is a life that feels fulfilling, that feels aligned with what you truly care about, what you’re really interested in, what you really want to be doing. And, And so, that’s what I mean by authenticity. That’s kind of like what I have in mind. And I think that the process of therapy itself is a great way of aligning with that, being very, very clear about what brings you joy, um, what you actually want to be doing, you know, with the limited experience that we have here on Earth.
Minter Dial: Well, I’m writing a new book, uh, Steven. It’s called The Avatar Trap. And it is absolutely zeroing in on the gap between what we present and who we are. And my general thesis is to say that this gap has become too wide. And yet, as far as actually knowing who we are, you never really fully know who you are, at least not 100%. Yeah. As a lady who I was on my podcast said, she said, And I can’t remember her name, so that’s bad on me. But she said, it takes more than a lifetime to know who you are.
Steven Buchwald: Sure.
Minter Dial: How did you— let’s— I mean, maybe you can use that as a stepping stone for getting into the domain that you got into.
Steven Buchwald: Yeah. So, first of all, I don’t— I think it’s a process of unveiling, right? And it’s not like what you are is fixed in my view. And, and tada, you know, at some point you’ve found it, you figured it out. And so, you change, you progress, your interests are going to change throughout your life. And so, living an authentic life is very much about being in touch with what’s truly, you know, is present with you right now in that moment.
Minter Dial: So, you, in the oddness of your career, aside from being brought up in France, which is something we share, you also studied law.
Steven Buchwald: Correct.
Minter Dial: And you’re not a clinician as far as psychotherapy is concerned, but you’ve dedicated yourself to the operational side of it. Yeah. Why did you decide to invest your time in running this type of business? And maybe what did you initially misunderstand about this business before you got into it?
Steven Buchwald: So, I had a very fairly negative view of therapy before I got involved in it from a business standpoint. Very dubious. Did not think it would work. Did not think there was much of any value in it. Looking at it from a very I could only see the downsides. And I think that that’s—
Minter Dial: You mean like the lawsuits? Like any good lawyer, all the legal ramifications of not being good therapy, not getting good results, not satisfying expectations?
Steven Buchwald: More so, I think the way I looked at it was kind of like, if I remember correctly, it was more like, well, yes, you’re going to do those things that are out of alignment, but you need those identities, you need those parts of you. Otherwise, how are you going to get it done? I think that that’s kind of how I looked at it. Like, what am I going to be if I get rid of these parts? Then how am I going to get my motivation? How am I going to get to meet those or that objective? And so, I was like, I don’t want to get rid of X, Y, or Z because I need it, right? I’m attached to it. And so, I think that that’s the way I looked at it. And that’s kind of— so it’s not worth it. You’re looking at it from like a benefit trade-off perspective. And you just see the cost. What am I going to do if I lose that? Thankfully, I got to try it. And so, by getting involved in this business, I was motivated to actually try it out and try therapy and pursue therapy. And also for my own personal reason, I was kind of ready to try it. And it was truly a life-changing experience. It was extremely helpful in helping me live that very much authentic life and helping me essentially make more conscious decisions, right? And so, going back to sort of the that trade-off that I was saying, I was able to get rid of some parts, get rid of some things sort of standing in the way, and be able to also meet those objectives from a more healthy place, uh, and a more conscious place where I get to say, actually, this is important to me, I do want to do it, but I don’t need to chase it in this unproductive, unhealthy way.
Minter Dial: So, I’m going to level with you. I am someone who has done therapy, but I’ve always had and continue to have a little bit of reticence as to what it can actually do for me. In your selection process, you presumably had— I want to have somebody in real life where I can visit and have in-IRL conversations with somebody. Yeah. Choosing somebody with your experience now, both from an individual as a patient, quote unquote, as well as in all the operational work you’re doing, how does— what sort of advice do you have about actually trying to get the right fit to have that transformational experience that you had?
Steven Buchwald: Sure. So, it’s a good question. I can tell you what we do here at Manhattan Mental Health Counseling. to facilitate that. And so, that matching process is super important. And exactly sort of the experience you’re sort of hitting at is what I worry about. What I worry about is that somebody is just going to get a bad first experience with a therapist and think, okay, this is not working, this is not for me, I have nothing to get from this. And so, I think in some ways I got lucky personally that I was in the hands of a truly fantastic therapist that was able to really help me and have a really deep impact on my life. And so, the way we look at it is that truly we want to get to a place where we’re clear on what the client is about, what are the various preferences that they have, what makes them tick. Um, and gathering all of that information is going to help us truly get them into the hands of, you know, the right person, the, the best therapist for them.
Minter Dial: So, that’s from a, uh, a supply perspective. If I’m looking at the demand, the individual who’s listening says, shoot, I really think I need a therapist. What should I be thinking about? What do I need to be doing in order to get the right person? Because I mean, you said you had a little bit of luck, but I mean, at the same time, you presumably all had a chemistry. You sort of asked some questions. There are certain things that stood out for you, and then you just said, well, to hell with it. I need to have to only know 60%, and then I’m going to go for the rest. You know, some people need 120% total control as opposed to letting go. Right. What is it? What do you think it is?
Steven Buchwald: So, the reason I keep answering them from the sort of supply side, which is where I would go naturally now again, is that I think that you don’t know those things coming in. You don’t know what’s on the other side of the wall. You don’t know what’s actually going to help you, right? It’s not your field. You haven’t encountered it yet.
Minter Dial: Exactly.
Steven Buchwald: It’s hard to know what questions to ask. And to be honest, I don’t know that there are a lot of questions that you’re going to be able to ask to ascertain that. The best I can say is the way we look at it, again, looking more on the supply side, is truly getting a good sense of what the personality of the client is, getting a good sense of the type of issues that they’re struggling with. Is it more anxiety? Is it more depression? Is it more trauma? And that’s a big piece of it, right? And so, obviously, you know, one of the clearest pieces is going to be somebody struggling with, you know, childhood trauma needs somebody that truly has experience with that, right? And so, if they go to a therapist that all they do is anxiety and that’s pretty much it, they’re just— it’s just not going to work, right? So, those are kind of like the basics of it. You need somebody that specializes in the main thing that’s the issue. Now, the reality of it is that some of those issues get uncovered throughout the therapeutic process. And so, you might start out with, well, the main thing is anxiety, and realize down the line that actually there is more to it. And that’s fine, right? And so, that’s part of the journey that I’m hinting at, the unveiling. That’s And chances are that the therapist might still going to be the right person for you that you started with, or it’s possible that you would then be transferring to another therapist that has that special experience. And that’s fine too. It’s always difficult to make that transition because it’s truly about that relationship. And so, to move to another relationship, trusting again, getting vulnerable again, is a little bit of a process. I’ve done it myself. I’ve been in therapy with one therapist and then another and then another. It gets easier.
Minter Dial: For the patient?
Steven Buchwald: For the patient, yeah. It gets easier once you know truly what the value is. You know, it’s never, you know, I don’t know if you’ve you’ve been to the doctor and those sort of first visits are kind of boring, right? Like you don’t get to do anything, right? They just kind of go through an assessment that’s, you know, you know everything you know about, you need to know about yourself, right? You don’t learn anything during that first session. So, those are, you know, it takes a little bit of a little while to get through those motions. But once you’re clear on what the benefits are, then you can be a little bit patient with a
Minter Dial: So, I’m still going to circle back on this topic, but it brings up the other topic, which is how, as a business person, do you manage the handing over of clients for Manhattan Mental Health Clinics? Because you have therapists, and I’m going to guess that they have a book or a calendar, you know, their clients, and you’re going to say, well, you need to move from here to there. And usually as far as I’m concerned, I mean, the businesses that I’ve run in that kind of way, they have their clients and they get paid according to their clients. So, now I’m going to— oh, but this person, I’m a, let’s say, PTSD dude, and oh, but this person has just anxiety or another thing.
Steven Buchwald: Sure.
Minter Dial: They need to go to another one. Oh, I’m going to lose them. And so, how— I mean, that’s a very business type of question.
Steven Buchwald: Sure.
Minter Dial: In this, from the supply side. How do you manage that and encouraging people to say, no, no, this is not for me? I’ll let them go to there because I can do everything, but perhaps I should not be doing this person.
Steven Buchwald: Yeah. So, fortunately, we have amazing therapists that specialize on a variety of things. And most definitely anxiety, depression, trauma are very top of mind and things that we definitely specialize in. Suppose that trauma is the thing, then they’re going to be able to find an amazing therapist here within the practice. Now, it happens very often that we don’t have that specialty. And so, I’m thinking today of, let’s say, somebody that is going to need medication, and we just don’t do that. We do talk therapy only today. And so, in those cases, referrals is the way to go. And the way we look at it is very much so that we want to help people. And so, if we’re not it and truly what they need is medication, then there is no reason to delay. There is no reason to drag our feet. We want to help people. And so, that’s going to be the way we look at it and go for it.
Minter Dial: Well, presumably as the CEO, you still have the eye on the bottom line. Why don’t you hire a psychiatrist who can do the medication piece Surely you want to keep it within the home. I mean, these are types of business ideas that we have and having the grandiose idea of actually really helping people, which is what we’d all hope you’re trying to do. How do you resist the temptation from a business angle of not saying, well, let’s just, you know, I mean, you know, I’m going to again level with you.
Steven Buchwald: Yeah.
Minter Dial: I am a consultant. I speak. Someone comes to me and say, hey, Minter, do you know how to do this? I’m like, ah, of course I know how to do it. Never done it in my life. But of course, I can keep the client as opposed to, you know, what I should be doing is referring it to somebody who’s actually the specialist in this thing that’s going to make the client’s experience satisfactory. This is typically the kind of conundrums that individuals have in sharing the clients.
Steven Buchwald: So, so what we aim to do here at Manhattan Mental Health Counseling is truly to provide the highest level of therapy, the highest level of quality care. on an affordable basis. And so, we aim to be sort of therapy without compromise, where traditionally you would get, like I did in the past, amazing therapists that don’t take insurance, or therapies that do take insurance but are not so great. So, we aim to provide a solution that you don’t need to compromise. You can get therapy that’s truly amazing and effective and get to pay with your insurance. Now, we have about 100 clinicians at the practice. We don’t have 1,000, we don’t have 10,000. And so, we don’t need to conquer the world, right? There’s a lot of— and in fact, the demand for services far outweighs our capacity to provide them. So, it’s not even a question that we’re asking ourselves in terms of resolving all the world’s problems. We’re just trying to resolve what’s in front of us and trying to help people that are coming to us, whatever the solution might be. And for some of them, therapy is not going to be it, and that’s okay. What I care about is that if they come to us, we try to truly get them the best treatment possible. And sometimes it’s going to mean referring it to somebody else. And to answer the other part of your question, why don’t we do psychiatry? We, you know, so, you know, you know, essentially medication management, things like that. So, today on a licensed level, our clinicians are for the most part licensed mental health counselors. And so, they do talk therapy, and that’s what their license allows. They’re not allowed to prescribe medication. So, that’s the line in the sand that, of course, we cannot cross. We do have plans to eventually expand to psychiatry, meaning hire psychiatrists that can prescribe medication. But we have a lot of other important priorities that we’re working through. So, it’s not something that We are jumping to ready seconds.
Minter Dial: Well, so there are lots of things in there. One of the factors that the supply is not big enough for the demand today, and that’s true of pretty much every Western country. Hence my desire to talk to you, Steven, about this because it’s a fact that we talk about this world as being progressive, lots of progress, but why is it that there’s so much mental health disorder? solitude, depression, anxiety, allergies. There’s so many things that are out of here. We don’t have solutions for all these people. And the second idea that I was just thinking about, I have a lovely, great Indian food place right next door that doesn’t serve alcohol. And so, I think, I don’t mean to make a parallel between alcohol and drugs, but it’s like having a license to sell alcohol which allows for higher margins, business person that I am. Why don’t you get it? Why don’t you do it? And they said, well, we just prefer to stick to, we serve food and you can BYOB, bring your own beer, bring your own wine, and make that arbitration. You are in a business though, clearly, where everybody is looking for help. And the challenges that I see, and presumably you have better statistics about that, is that There are so many therapists that don’t even have a waiting list anymore. The waiting list is too long. The need is so big. In your mind, why is the demand so high today? And why is the supply so low? And what are you doing about the supply?
Steven Buchwald: Yeah, it’s a good question. I mean, that goes truly into the heart of societal issues. And it seems that as progress happens, and truly there’s some incredible technological breakthrough, particularly now in the age of AI, there seems to be new breakthrough every day. There is also a sense of disconnection. and a sense of isolation. And so, everything that you’ve said, I see it as well, right? And so, it’s almost as if we’re growing a little too fast in some ways and projected, you know, projecting humans into a reality that’s unfamiliar and destabilizing. And so, that’s kind of the way that I look at it. And so, I don’t think that those problems are irremediable, that there are solutions to it. And, you know, those sense of greater connection, those sense of, you know, living a very aligned and fulfilling lives is very much reachable. And that in some ways, the life that we live now is a life of being very intentional about what we expose ourselves to and what we don’t. And so, you— sorry about that. Let me make sure that my phone is turned off.
Minter Dial: It’s okay. That’s life. It’s the interruptions of life, Steven.
Steven Buchwald: Sorry about that. So, yeah, so, you know, looking at social media, for instance, It is something that can be very unhealthy, right? And very addictive and very, you know, what are you doing? You’re just scrolling at your phone. What is that?
Minter Dial: Comparing yourself to everybody else.
Steven Buchwald: Right. What kind of lived experience is that? It’s a little funny even when you look at it, like, you know, when you don’t see it in yourself so much, but when you see somebody else kind of sit there and just scroll, you can see there’s something really odd about that.
Minter Dial: If not sick.
Steven Buchwald: Right. And so, I think therapy can be extremely helpful in reconnecting and in getting to a place where you’re really able to make those conscious decisions, putting the phone away, Um, you know, choosing family time, choosing quality time. Um, and, you know, there’s tremendous advantage from using technology, but it doesn’t mean that we should be, you know, behind the screen all day and, and not connect with real humans.
Minter Dial: So, in that capacity, Steven, and I didn’t, to ensure transparency, look at exactly your offer at Manhattan Mental Health Consulting, but Do you do Zoom therapy as well as in real life? And what sort of data points do you have as to which one is— or is there a failing that actually happens because we’re in it, we’re in screen? I can’t see, you can’t see my toes tapping and the irritation I might have wiggling in my bum or something like that.
Steven Buchwald: Yeah. So, first of all, I want to go back to your prior questions about sort of the demand-supply imbalance. So, we don’t have a waiting list. And so, we’ve been really good at getting people seen really fast. People come to us and within 5 days on average, they get to see their therapist.
Minter Dial: I mean, if I could, I mean, the reality is when someone says I need to see somebody, it’s not like, oh, I’ll deal with that in 2027 or, you know, next year.
Steven Buchwald: Exactly.
Minter Dial: Something is happening now.
Steven Buchwald: Yeah. And that’s a part where, you know, we’re doing definitely a lot better than other practices out there where they can have, you know, 10+ days waiting time. We, you know, We’ve worked at that. We’ve wanted to make sure that truly people can be seen quickly. And I think that that’s a competitive advantage in this case and essential, right? Like people need help now. Now going back to your more recent question, can you remind me what it was again?
Minter Dial: Zoom versus in real life.
Steven Buchwald: So, yes. When COVID happened, up until then, we had offices in the city, in Manhattan, and everything was in person. The sort of silver lining from COVID is that we absolutely had to move online. And fortunately, we’re one of those businesses where you can actually do this online. And to our surprise, it was incredibly effective. It was actually working. And so, we realized that there’s actually some really powerful benefits from doing this very vulnerable thing from the comfort of your own home. And so, I think there is a trade-off. Certainly in-person has some benefits, but being able to do this like we are doing right now, connecting with people, that are not actually in front of you, but still being able to have some very deep, vulnerable conversation is real and actually is just as effective, if not more effective, than therapy. Because in some ways it’s easier to have those conversations a little bit more removed, right? It’s a little bit more safe. to, to get personal, to get vulnerable when you’re not in somebody’s face.
Minter Dial: So, I, I have no data on this, but it’s an area of interest. I have to imagine that there are qualifications as to whether someone thinks that the screen provides distance that’s safer, or being in someone’s arms is better. And, uh, I studied— I study a lot this notion of the female experience and the male experience. And I, I’ve, I’ve been— my zone of interest has always been on the, the interactions with artificial intelligence and psychedelics. Those are my 2 zones of interest and how women and men operate differently with AI. and with trips or psychedelic-assisted therapy, which are topics I want to get into. So, when you’re as a business person, Steven, challenge being, do you charge the same or differently between in real life and on the couch in my office? Because when you have the office, you have to pay for the rent. When you don’t have to travel, you don’t have to pay for commuting and the time that costs. So, there’s an efficiency component, there’s a pure cost component, and then there’s the efficacy component. And so, how do you, how do you guys approach that?
Steven Buchwald: So, so certainly when you compare apple to apple, because you don’t have those, those expenses—
Minter Dial: Or sorry, do you mean Samsung to Apple or just apple to apple?
Steven Buchwald: When you compare therapy in person versus—
Minter Dial: I was just kidding.
Steven Buchwald: And so, it is easier, right? You don’t have to pay those rent, right? You don’t need to pay the insurance in connection with the lease, right? So, there are less expenses in some regard. But if you want to be truly apple to apple, we have to also take into account the other expenses that you now have, like cybersecurity insurance and the Zoom licenses and all of those other things that allow you to do business online. So, there are some additional expenses that you’re not going to have because you’re not in person, but you are somewhere. And that somewhere has expenses. The way I look at it is truly about what is actually going to provide the best service to the greatest number of people. And certainly being able to work online is far more efficient and, you know, provides opportunity to scale because now you don’t have those sort of transaction costs, right, of traveling.
Minter Dial: Parking.
Steven Buchwald: Parking. And so, it’s easier on the clinician and it’s easier on the clients. No travel, no parking. And now maybe you do get to do more out of your day because you can be more efficient with your time. You have less of those kind of dead time. So, that’s the way I look at it. You can do more with your time, more productive, more useful use of your time.
Minter Dial: Well, and why I ask these types of questions, Steven, of course, is that majority of my interviewees work in business and most people who are listening are in business. And so, I’m always thinking about the ROI, the KPIs, and all that kind of good stuff, which is what this is about and how. So, for the last 15 minutes that we have together, Steve and I, I want to zero in on these other 2 topics that are of extreme interest. And let’s start with therapeutic AI because this is a topic that I’ve talked about a lot. I look at a lot. And the benefit of a therapy that is AI is that at 2:00 AM, I’m there for you. No friend, basically, and certainly no therapist who is a professional is available at 2:00 AM. To what extent, how do you view therapeutic AI and where are we today talking end of 2026 in therapeutic AI? Good, bad, indifferent. How do you approach it? What do you think of it?
Steven Buchwald: So, I’m very critical. And dubious that this is truly the best way to help people, to be honest. And so, what we know about therapy is that truly it’s about the relationship. And so, in a world where you sort of want to replace therapy by humans by therapy by AI, I I personally don’t believe that this is going to be a successful trade. I don’t believe that this is going to actually lead to better outcome and even the same outcome. And this is what sort of the evidence is pointing to right now, that doesn’t work. This is, this is not it. Um, so that’s sort of my view of kind of replacing it one-to-one. What I do believe is the sort of scenario that you hinted at is somebody’s at 2 AM, there’s no— the therapist is not there at 2 AM to help you, right?
Minter Dial: Nor are friends, by the way. No one answers telephones anymore.
Steven Buchwald: Exactly, right? Your friends are not reachable. And I think that that’s an important use case, right? And that’s where AI can be very helpful. within boundaries and in ways that— my concern is always going to be there. Is it actually going to be helpful or not? The worst-case scenario is the AI is giving you bad advice. That’s a concern. If they tell you at 2:00 AM, maybe you should use your drugs, maybe that’s the solution. You know, not great, right? And so, I think there’s definitely something to do here. And I think that the better way of looking at AI in the context of mental health is going to be sort of like a support system, right? When nobody else is available, somebody that you can dialogue with, that you can talk to, that can give you words of encouragement, Um, but I don’t think it, it needs to be a therapist necessarily. I don’t think it needs to be somebody that’s kind of like a licensed AI therapist. I think it’s more like, more like a friend than, than, than anything else.
Minter Dial: Well, I’m going to push back a second because I mean, if we’re talking ChatGPT or Perplexity or whatever, they are not devised to provide therapy. There are others like Empathic AI and other, Hume, who have been focusing on therapeutic AI with therapists doing the brief for the encoding of the therapeutic responses, which is very different than just saying, hey, if I speak to OpenAI, is it going to help me? And, and it, you know, it’s available at 2:00 AM, fine, but it doesn’t know diddly. And it’s programmed to be nice and safe, but it doesn’t have any therapeutic real understanding. So, if we sort of zero in on therapeutic AI that is designed by psychologists like my friend Bryn Lord or others, where they’re absolutely using psychological or psychology-based encoding, I think of them, like you say, a little bit like an assistant as opposed to the replacement of the therapist, and certainly better than nothing at 2:00 AM. Right. So, I push for that. And I think you’re right to think if I open up ChatGPT or, you know, whatever conversational AI that I have, it has nice elements to it. It provides companionship. But it doesn’t provide therapy. And the area that I imagine is completely off bounds is couple therapy. I mean, that is such a more specialized zone. And I wonder what you have to say about the difference between individual therapy and couple therapy as far as AI is concerned. I’ve never seen anything that’s good on AI. Sure.
Steven Buchwald: So, the challenge in my view about AI is that AI for therapy is probabilistic, right? You ask it 100 times the same question, it’s going to give you 100 times a different answer. It can’t be trusted, right? And so, that’s the challenge is that it needs to be trusted to actually help. And I don’t think we’re there yet in many ways. I think the way to go about it is to really have very narrow use cases. And for example, crisis de-escalation might be one that would be one of the first ones that, number one, there’s tremendous need for that.
Minter Dial: Like triage, like the triage. The call comes in, this is an urgent situation, I need somebody. To answer that one in, in the de-escalation process. This is urgent, urgent, 5-bell alarm, needs to be handled by somebody,
Steven Buchwald: right?
Minter Dial: Oh, you’re just feeling a little lonely, it’s 2 AM in the morning and too much noise going on around you, not as big a deal. I can handle some portion of the conversation.
Steven Buchwald: So, so the, the triage part We know it’s something that AI is fairly good at. And so, there’s fairly good evidence that it can do that part. The question is that can be tremendously helpful. The question is, does it get to a human on the other side? In those cases, does it actually do the triage for the truly emergent situation where they get the support that they need? But I think that’s very promising. I think that AI also responding themselves to crisis might be something that where there is opportunity, where de-escalating a client, helping the client go from, you know, 100 crisis to maybe, you know, 50 out of 100 might be something that where the AI can be useful. I don’t know enough about this, to be honest. But I think you need to go very narrow to get to a place where the AI is actually doing more good than harm in those very human issues.
Minter Dial: That seems fair. I mean, at the end of the day, from a legal standpoint, you end up being responsible for it. It’s your AI as part of your system. And the other thing that I’ve heard a lot in the medical field is AI can be really good at doing the admin piece, you know, getting rid of all the paperwork, insurance, and all that sort of muckety-muck.
Steven Buchwald: Yeah.
Minter Dial: That just kills everybody. Bureaucracy, paperwork.
Steven Buchwald: Exactly.
Minter Dial: All right. So, the, the last area I wanted to talk about though, Steven, was psychedelic-assisted therapy. And obviously that would be sort of in the category of a drug. I mean, c’est le cas de le dire, as we say in French. You know, what’s your opinion of psychedelic-assisted therapy? How do you view that from your standpoint? Obviously more from, you know, traditional psychotherapy, but I’d be intrigued because I think it’s a field of tremendous interest for me.
Steven Buchwald: Yeah. And so, we’ve actually got some really good evidence for some of them. in recent years that’s extremely promising. And there are some states that have allowed it. New York is more conservative. And so, to the extent that we have the evidence and that we know that it’s actually working, and I know, for example, that for severe depression, there is some fairly good evidence that some of these can work, I’m all for it as long as it’s done in a way that’s actually helpful and useful and is supportive of the experience. But the challenge with those experiences is that you don’t know what you’re going to get, right? And so, it can be— we have anecdotal experience from people having those illuminating experiences and being able to shed some very heavy baggage. And we have others that have some traumatic experience. You know, we— And so, I don’t know enough to know how do you promote one and decrease the other. And so, you know, that’s what I would want to look at. There is already a lot of companies out there that are doing it pretty well, right? And so, there’s ketamine-assisted therapy, there’s psychedelic-assisted therapy, And so, what I know about it is that, you know, there’s support during the experience, but there is not enough integration of the experience, right? And I think that that’s the critical piece. And so, that’s the part that really needs to be figured out, because if you’re going to have some experience that you don’t know how to make sense of them, then addressing them in therapy so that you get to coherence is going to be extremely valuable. But I look at it as like an essential piece of the puzzle, and it’s not going to be just the experience, but it’s the experience with the integration that can be extremely helpful.
Minter Dial: That’s for sure. I mean, I’m a psychonaut. I’ve probably taken one or other psychedelic maybe up to 300 times. So, I can say I’m practiced in the art of psychedelics. And I’ve spoken to many people who are practicing it. And in New York, I know ketamine is a legal item, not everything like psilocybin or, you know, and every state has different approaches, but I remain, particularly positive from an individual standpoint of the role that psychedelics has played in keeping my mind wired in its way, the crazy way. I mean, I played rugby for 18 years and had 7 concussions, and if I’m still able to speak with a way that more or less sounds lucid, I fundamentally believe that psychedelics has contributed to helping my brain not fuddy-duddy itself. Anyways, that’s where I go. Last question for you, Steven, and you can of course come back to that if you wish. But last question from a business standpoint with your work at Authenticity and the Manhattan Mental Health Clinics. You say growth should make the practice better, not just bigger. And growth is such a capitalistic thing. Everybody wants to grow. But so, often growth brings dilution. Growth brings things like cost savings and other things. Can you provide an example where growth improved care and maybe even bring a warning sign that would make you slow down even with demand waiting at the door, like the waiting list that we talked about?
Steven Buchwald: Yeah. So, So I love growth. And the fun part for me is that as you grow, some things break, right? Some process that would take, I don’t know, perhaps a couple of hours when you had 10 clinicians is going to take perhaps 100 hours when you have 100. And so, you need to find ways to be more efficient. And that helps you ask the right questions in terms of how do we get to serve more people? How do we get to be effective with our time? And so, that’s one piece of the equation is covering more ground, being more efficient. Another piece of the equation that perhaps some people are not thinking about as well or as much is the quality piece. How do we actually get to do this better? And these questions, in my view, go hand in hand. If you just look at the more for more’s sake, you’re missing great opportunity. And so, that’s the way that I look at it. As you grow, you have more capabilities to truly look at one problem and solve for all of it, not solve for one angle, the efficiency part, but solve for the quality part. And so, that’s been our experience so far where growing has helped us actually get better. And so, examples of that include, for example, measurement-based care. So, essentially we send assessments to our clients every 4 weeks, asking them essentially the sort of basic questions, helping them rate their own experience. experience that gives a very graphic view to the clinicians of how their clients are doing. And that actually improves care. It improves care in many ways because now it’s at the center of the experience. They’re going to talk about it in sessions. And, you know, is it actually helping you? I’m seeing that, you know, maybe the results are getting worse, but in therapy you’re telling me that it’s better. What’s going on? Let’s talk about it. So, it’s actually those discussions are going to actually improve care. You’re going to get to the core of the thing that maybe was still not clear or still in the dark. And the other piece is that the clinician is going to be able to visually see progress over time for all of their clinicians. And so, there is an arc, in my view, of improving around those 2 angles of being more efficient and higher quality. And in my view, higher quality is for us at least the very piece of the positioning that we are continuing to want to compete on. And I truly believe that that’s the best thing we can do, truly provide the best quality services. And that eventually helps us grow into a bigger company and that eventually helps us help more people.
Minter Dial: Wow. So, 2 thoughts. One is you introduce the idea of measurement. And in, in all of my interactions with psychotherapists, rarely has anyone said, what does progress look like? How do you measure that? Because, you know, it’s just like inside my head. Right. And just like psychedelic-assisted therapy, it’s a little complicated to really measure what’s the embodied experience, because everybody’s a little bit different. They come to a different context. And that’s the issue with psychotherapy. So, this idea of measurement, I think, is cool. And the second thing, Steven, that strikes me, and I think this is also part of your zeitgeist, which is that you have embedded a purpose in your mission. Yeah. And that presumably is shared throughout. Because if my goal is truly for every individual who comes through my door or in my Zoom to have a better experience, And it may not be with me, but with some psychiatrist or other area, then that, that also builds trust with your patients, your clients, as opposed to thinking of them as businesses, you know, making money. Because you talked about being accessible for a wider audience, and that presumably also scopes how you approach growth.
Steven Buchwald: Absolutely, yeah. So, clearly we are in the business of, business of helping people, right? And so, that’s the mission. And so, if you want to dig deeper into it, in my view, the mission is essentially number one, helping therapists become the best therapists that they can be, and actually helping clients meet their objective live authentic lives. And that’s the mission, right? And the affordability piece is a part of it where obviously if it’s not affordable, people can’t use it. And so, that’s been something that’s very important to us, being able to accept almost all the insurance that’s available so that we can actually be the service that people can use easily. And so, easy access is an essential part of the mission. Going back to your question about measurement, it’s not so difficult to do it because it’s not perfect measurement, right? We’re not being—
Minter Dial: You mean I’m not perfect, Steven?
Steven Buchwald: Not yet, not yet. But we’re going in that direction. And so, we don’t have perfect measurement about how the client is actually feeling, but we can ask them those questions. We have those standardized assessments like the GAD-7 that are going to ask those exact same questions in the same sequence every 4 weeks. And we can compare that. And now we can compare that easily and say, oh, there’s an improvement. It’s getting better, right? And we can bring it out to the client and say, hey, it looks like it’s getting better. Is it? Does that match your experience? And the client might say, no, actually it doesn’t. I don’t feel better. And so, that sparks those very interesting discussions. And so, the curiosity of the clinician is essential. Those discussions are essential to actually seeing what those assessments are not capturing. So, those measurements are not perfect. Nor are they designed to be. What’s important is that they spark those discussions.
Minter Dial: That’s glorious, Steven. It feels like a lovely space, spot to end. For someone who’s been listening to this, hopefully they’ve been captivated by it. I mean, the issue of mental health is such an enormous problem for so many people, if not for me, but for someone I know, a child, parent. How can someone Get in touch with you, understand what your offer is, and maybe even get a Zoom from London or Paris?
Steven Buchwald: So, it’s not quite possible today to do a Zoom from Paris or London because today Manhattan Mental Health Counseling provides online therapy for people across New York, and New York only today.
Minter Dial: So, everyone who’s listening to this, send this to some of your New Yorker friends.
Steven Buchwald: That’s right. That sounds about right. We are expanding though, so we will be expanding into Florida shortly and in a couple of other states next year as well, with a very strong focus on anxiety and depression and trauma.
Minter Dial: Makes sense. Well, there you have it, Steven. It’s been a great pleasure. Merci beaucoup. It’s been lovely chatting with you about this important topic that faces so many. And as I was telling you about in The Avatar Trap, It’s a topic that I’m particularly keen on looking at and addressing. So, thanks for all your work. Thanks for spending your time looking at trying to build a healthy mental health approach to help people out.
Steven Buchwald: Absolutely. It was a pleasure. Thank you.
