Daniel Fishburn: Leadership, spirituality, a nuanced perspective on treatment and recovery

From working with refugees in Houston and El Salvador to working in community mental health and the “NATSAP World”, Daniel Fishburn has dedicated his life to serving others.  He’s been a mentor, colleague and friend of mine for years, so I was super excited to have him on the podcast! 

Here’s a bit of what we covered in this episode:

• Pros and cons of for-profit vs. not-for-profit healthcare and treatment
• Human-centered capitalism
• The journey from addiction to recovery
• Spirituality in life and leadership 
• The stories we tell ourselves
• Employee retention vs. team development and the role of a leader 
• The concept of ‘no-self’ and how it pertains to leadership
• The good, the bad, and the ugly of NATSAP 

This was a super wide ranging episode -- hope you enjoy listening! 

Daniel Fishburn is a licensed clinical social worker, leader in recovery, and former CEO with a longstanding background in wilderness therapy programs and hands-on service to marginalized populations in the United States and abroad. He recently opened his private practice, DBF Counseling, in Asheville, NC. To learn more about Daniel check out his website: https://dbfcounseling.com/. 

Find us on the web:

• Advaita Integrated Medicine
• Green Hill Recovery

Transcript

Daniel Fishburn (00:00:00):

Get into it though. It's looking and sounding, right?

Tripp Johnson (00:00:02):

Yeah. So everything sounds good. If you hear yourself kind of fade out, just make sure, I guess make sure, but yeah, you should be good and you can move it around. And so you kind of need to, to readjust, but, uh, Daniel, I'm excited to have you on the podcast.

Daniel Fishburn (00:00:16):

Great to be here. It was a good time to spend time with you.

Tripp Johnson (00:00:20):

And I'm, uh, I guess for quick introductions, you were, you were one of the first people I really met in this field and I felt like open me, you know, welcomed me with open arms. You, like you said, last night when we were having dinner, I remember sitting out back at, uh Kanuga and talking about, um, you providing some mentorship to me and which I think you certainly have over the years and you know, more than just the professional side, just having someone that I can call that I really trust who's, you know, walked a lot of the same path and maybe a little bit ahead of me, uh, and someone good to just bounce ideas off of having a diverse set of experiences leading up to where you are today. So I'm excited to dig into some of that

Daniel Fishburn (00:01:03):

Excited to see where this goes. We'll see.

Tripp Johnson (00:01:06):

So could you just give me, give me your bio so I know some of it, but I really don't know. I feel like I kind of know from a little bit of community mental health to where you are today, but could you just kind of give me the whole rundown?

Daniel Fishburn (00:01:17):

Yeah, it's always an interesting question to answer because I've, I've often said, if you look at my resume, I always wonder why anyone would hire me because I stay somewhere for a couple of years and then move on. Um, but looking back at it all made a lot of sense and really started, uh, going into, I guess what I'd say is human services. When I was in college, just wanting to be of service and spent a good bit of time in Houston, working with refugees, which drew me into central America, um, you know, physically going down and, and, uh, being involved, um, with, uh, sort of left leaning groups in El Salvador in particular, which was a, quite a learning and experience of, of learning from a group of people about, you know, you go in and you ask them, how can I help you?

Daniel Fishburn (00:02:09):

You don't go in and say, this is how I'll help you. I have a better idea. And, and, uh, I think that lesson and, and how to be humble and look to the people you're serving to see what they really need, um, has kind of stuck with me. And, um, shortly after that, after the war in El Salvador ended a lot of us, you know, white skins, people who were going down, we're told, we don't need you anymore. It's time for us to go do our thing and you do your thing. And, and, uh, my thing was going back to working, uh, along the lines of social work and public health and doing a lot of community organizing, um, and, uh, actually did full-time human rights work, which was great. I actually got paid to do stuff that very often you just don't get paid to do.

Daniel Fishburn (00:02:54):

And, um, led me again to just the principles, social work, you know, macro and micro, uh, trying to make institutional change and also looking at direct service, which was reflective of where I was spiritually too. Um, and, and just try to figure out how can I be useful? How can I be helpful? Um, without too much detail, I, I worked for child protective services for a while. I worked with, um, the Dallas county health department and doing street outreach to sex workers and, you know, youth, uh, just kind of frontline work, learning a lot about public health, you know, and you know, the organizations of a health departments and a county and a state, um, and worked with street kids, uh, in a, in a nonprofit. And this is where I started to get this understanding that very often people running nonprofits didn't understand the business of things.

Daniel Fishburn (00:03:51):

They really had a great mission. They had a great plan. They had a great programming and had gotten a lot of funding, but didn't know how to manage it. And that was one of a number of programs I was involved in that went under. So I'm like, I need to go learn how, how do you run a business, right? Or at least understand, even if I'm not running it, how does that work? And I went to work, um, as a vocational case manager for a company that, that did workers' compensation work. And it was essentially, my job was to help somebody who'd been injured, get past being stuck and afraid of going back to work. I was saving money for the insurance company and for the employer, I was well aware of that, but it was also, it was good work because often these people were just stuck in fear.

Daniel Fishburn (00:04:36):

And, um, it was a well-run company. And I learned, and I became a manager and a director of a crisis intervention program and kind of moved up in that. And, um, then over time, uh, in doing that and some community mental health, I also, uh, even with a master's degree in social work, uh, even licensed found myself falling into addiction. Um, and it was, it was just, there was such an arrogance behind that tailspin that I thought I was at first above that happening to me, and then felt I must be beyond help, um, and, and kind of gave up so long story short, there spent a number of years just, uh, you know, disappearing from my family and my friends into that. And, um, this after having gone to grad school again, um, but I fortunately the state of Texas intervened and arrested me and put me in treatment.

Daniel Fishburn (00:05:37):

And, um, I had that experience and also found that I was not going to be able to be a social worker, maybe ever again, no one was going to hire me to do that. Having at least that's what it looked like. And, um, I waited tables and that was a great experience for a couple of years. And I just thought, I hope I physically can do this rest of my life cause I might have to. Um, but after a couple of years went back and this is a very common story. I'm sure, you know, went back and worked at the treatment center that I went through after I'd been gone for a couple of years. So it was very grateful. They gave me that opportunity. Um, but learned a lot about, uh, working in, uh, addiction treatment, working for a mission-driven privately run company and, and learned a lot about what to do and what not to do, and really started to understand, I think at that point that we, as a treatment program, weren't just serving our clients, but we were also providing the service of employing people.

Daniel Fishburn (00:06:40):

And we needed to look at our employees as people, you know, that we needed to treat with the same dignity and respect as we treated, uh, our clients. And that doesn't often happen to be the case, but I was going to say even in human services, but maybe even more so sometime in here. Yeah. And I, I, you know, I would see in the program where I was working, which again is very common, um, that they were built on a business model that I don't know was intentional, but just came to be over time that, um, with very low pay, they would employ former clients who would relapse. And then they would get to go to the program, you know, for a few weeks and then they'd get their job back. And I think we killed people doing that because it was always this, this very comfortable safety net of like, yeah, you can use again, not only will you get free room and board, if that happens once you're done having fun, you know, which would become hell actually, um, that, that, that, that cycle would repeat over and over, but it also kept, uh, payroll costs down because someone is so grateful, they feel like they owe you their life.

Daniel Fishburn (00:07:51):

Uh, they're not going to ask for much either. And, um, well, I think, you know, that program in particular has saved a lot of lives over time. I think it probably has hurt a lot of people. So it's one of these things where, you know, pay attention, learn, you know, don't do that thing that you notice this hurts. People don't do that thing if you're ever in the position to make a decision around that. Um, so I, I did that for a few years. I helped a couple of folks start treatment programs under understanding how, um, to get licensed, uh, how to get everything set up to do your policies and procedures really enjoyed doing that and having that expertise to offer. And again, trying to implement some of these things I've learned about how do you treat the people that work for you, uh, if you're really going to be mission-driven.

Daniel Fishburn (00:08:44):

Um, I D I had learned this important lesson, uh, because I'm sure that when I was in my twenties, I thought a nonprofit is going to be noble and pure, and a for-profit is evil and greedy. And there was this, this, they w they were always in my mind, polar opposites. And then, you know, you had government run agencies. It could be, it could be either, but, you know, we're also slower to move and to be creative. Um, and I learned that, yeah, a lot of nonprofits, uh, are, are poorly run and the people running them pay themselves a lot of money. So there's just as much opportunity for greed to seep in, and for that to affect services and the way they treat their people. And they, a mission-driven, uh, private company can actually do very good work. And it's just, it's a matter of how things are accounted for and how things are on paper.

Daniel Fishburn (00:09:38):

And it really has to do with the people who were in the positions to make those kinds of decisions, and, um, kind of started to tuck all that stuff away. When I was, uh, working in, in one of these, uh, these, uh, drug treatment programs, I was recruited to go work for a program that worked with young women, uh, in transition, most of them coming out of wilderness programs. And that's when I entered into the world of Nat SAP, um, and learned about educational consultants. Tell me, tell me back up. Cause some people might not know that's at the national association of, uh, of therapeutic schools and programs. And this is, uh, as a trade group, really of wilderness therapy programs, residential treatment centers, therapeutic boarding schools, um, all that kind of grew out of, uh, mostly I think wilderness programs essentially, uh, but tend to serve many of the same families, uh, with different levels of care.

Daniel Fishburn (00:10:39):

And I think the intention of having better practices, but also being able to, to market the programs and amongst each other, and also to referral partners like educational consultants and educational consultants, or essentially, um, placement specialists to get to know programs what's available. Some of them are clinicians. Some of them are parents of kids who went through programs. Um, they come from all walks of life and some of them are amazing and do great work. And some of them I've, I don't know if they thought, well, I could open a car dealership, or I know you can make money this way too. And it's my understanding that this, this began out of, and the reason they're called educational consultants, it was about placing kids in college. And as they started serving kids that had particular needs, um, especially therapeutic needs, they realized they needed some people who would specialize in those kinds of programs.

Daniel Fishburn (00:11:36):

Um, but it was a very different world than I'd ever known. And, and I, and I had to learn about both of those and got to, and going to conferences and, and just learned that, you know, like any human endeavor there, there's all variety of, of skill and hearts and ethic. And, um, it's just about getting to know people and having the relationship and working together to understand who's really going to have their client's interests at heart. Um, and so I, then I moved to Colorado just to get back I'm from Colorado originally. And my parents were, were struggling a bit with health, and I thought, I want to go back home and went to work for a program, uh, also in that side, but this time working with young men in a transitional program, up in the mountains. And, um, that, that was an amazing experience.

Daniel Fishburn (00:12:24):

I really loved it there. I had a falling out with my boss and I'm still confused about it a little bit, but ended up leaving that and, um, and looking for a position. Um, I discovered, uh, that Boulder is saturated with people like me. I think clinicians and broadened the scope of my search and, uh, landed in Asheville, working in wilderness therapy, um, which was an amazing, uh, happening because I had never worked in wilderness. And so many people in wilderness programs and leadership positions, you know, they, they, they were born and raised in it practically, right. And cut their teeth. And, and, uh, the man that hired me, um, was willing to hire me regardless and thought it might be good to have an outside perspective as a clinical director. And I ended up just falling in love with wilderness there. Um, did that for a few years, went and worked in a therapeutic boarding school, a recovery boarding school, um, in Asheville, and then came back as the CEO, when my former boss moved on said, Hey, why don't you, why don't you apply for this?

Daniel Fishburn (00:13:33):

I think you'd be a good fit. Um, and that was an amazing experience. I've, it's just been, uh, about two weeks since I left that position and deciding to go into private practice therapy and get back to the root of what I've always loved doing the most, which is that direct service, uh, as a therapist. Um, and I've had a lot of these experiences trip where I'm leaving a job that I love to go to something that I think I'll love. Um, that's been the case, nearly every position that I've had. Um, and I know that that's not, uh, that's not often people's reality and there's, there's a lot of privilege in that. And there's a lot of great opportunity. I don't take that for granted. Um, well

Tripp Johnson (00:14:17):

You gave me so many directions to take that, but the first one I want, I just want to ask, because you are navigating a transition yourself, and we've talked a lot over the years about, you know, the people who work with us and work for us. And, um, how do we, like what you just said? How do we kind of honor? Someone's, you know, we might've loved this now, but it's time to move on. And how was that something that, you know, you brought to your leadership style in, in working with whether it's therapists, field staff, support staff, um, because you're not

Daniel Fishburn (00:14:51):

Like you are in the midst of navigating your own transition. So how do you help others do that? Yes. You know, it, it goes counter often to the way we would operate in those worlds. And that wasn't just, you know, uh, in, in the place I was last or other net set programs, but, um, you know, human resources, which is, you know, that phrase of this is a resource just like our property. Uh, you know, we don't want to lose good people. Um, and being in a leadership position, heart of your job could be to make sure you don't let those people go right. You fight to keep them. Um, I have, for years had this thought in my mind that we are not a baseball team. We don't own your contract. In fact, you don't get a contract. Um, that means we don't get to contract, keep you, and you don't have a contract to fulfill, to stay.

Daniel Fishburn (00:15:47):

I can't promise you a lifetime career in benefits and pension. So you don't owe it to me, um, to give me the rest of your life until I'm done with you. Right. And I love to help people grow. I love to help people overcome adversity and suffering so they can move forward in life and do what they want to do. If that's true with my clients, that needs to be true with the people that I serve as a leader. And I really see us in our leadership positions where we're there to serve people. They're there, they're not there to serve us. And the way that our hierarchies are set up that can nurture this idea of a reverse of that. But, um, as an employer, that's part of what I do is I provide employment to people and I need to do that in a way with an idea of customer service, just as I would for a paying client.

Daniel Fishburn (00:16:41):

Um, if working here has been a part of what has been a fulfilling life for you, that's wonderful. I want to help make that possible. And when it's time for you to move on, it's my job to help you do that in a way that you feel good about the work that you've done and the decision you've made in moving forward. And if there's something I can do to support that, that's what I want to do, as opposed to, I don't want to leave you hanging with this feeling like your son had betrayed me, or somehow I've not fulfilled your obligation that time that you showed up for work and did your work, that's what you were responsible to do. Um, you don't have to keep doing that. And that's not strategically is not always easy because that may leave a gaping hole. Or I will.

Daniel Fishburn (00:17:29):

I say, I may, I will have to face the onslaught of, oh my gosh, what's happening. We'll say Sue, since that's where I was last what's happening at Seuss, people are leaving. It must mean that you're falling apart. And it's like, no, we actually, we have good people and they'll move on. Yeah. Um, and with Seuss, you know, th that's an example of an organization where people have moved on, you know, for over the last 20 years to get their, their degrees and become therapists to open other programs. Um, to me, that's like, we've put stuff out into the universe. I hope it's not, it's like, gosh, this is so horrible. People always leave. But rather like now maybe we spawned some really cool stuff. Even competitor.

Tripp Johnson (00:18:11):

Absolutely. Absolutely. I mean, that's what I think you look at, then you all have a 20, was it the 20 year or a couple years?

Daniel Fishburn (00:18:17):

Yeah. 20 years, this last 21st,

Tripp Johnson (00:18:19):

21st year. But when you looked at who, the people that had gathered, I mean, it's a leaders from across the country. I mean, it was just like a training grounds for the next generations of leaders.

Daniel Fishburn (00:18:29):

Yeah. It really was. It's a sort of an Institute I always always sent when you should have it as citizens to do. Cause it's kind of what we've been. But, um, that feels great because that that's th that many more families, uh, are being touched by the work that's happening in that place. So if people go out and do that, it's an inconvenience. Uh, sometimes it's expensive. Yeah. It's, it's not always great for the bottom line, but there's a richness about that's part of who I want us to be. And I want people to feel good when they leave.

Tripp Johnson (00:18:57):

I think one of the first conversations we had, one of the first things I called you for advice was about this idea that I was, um, worried that I was going to get in trouble for what we would call poaching a therapist. And I, I said, I don't know, am I going to get in trouble? What should I do? Uh, and you said, people aren't cattle, you know, if they're not getting what they need, where they are, then you don't need to feel guilty about anything you do to give them an opportunity. And I like to think that now that I'm in the position where I imagine our therapists are often getting calls, that we want to have a conversation, like, tell us why you're leaving. Tell us if, if that makes sense. Great. You know, I always say our biggest success stories too right now are the people who leave because they're not leaving to take an equivalent role somewhere else. They're going for a major promotion or they're going back to school and yeah, there's the short-term discomfort, but, you know, and I know it's difficult, but one thing I feel fortunate about is I didn't have anyone investors, anyone to answer to, but, um, I, and I got to really trust the process that if, if I do the right thing by them, the next person will be in line and it's, it's worked out. But I think like I wouldn't have had the confidence necessarily to do that without our conversation. So

Daniel Fishburn (00:20:14):

It's a good Santana. I had a, a boss many years ago when I was working in, in workers' compensation. And, um, I also, you know, in the office that I was running in Houston, we had nurses that were helping injured workers. And, um, someone was going to be interviewing with a competitor and I had found out about it and I called them up and he said, Daniel always encourage your people to interview. You should always be interviewing. People should always be interviewing so that they feel solid about where they are. If that means that you need to look at what you're providing them for them to stay, that that's going to be really good for you, but you don't want people to be unhappy and you don't want people to feel like they have to be secretive about it, encourage that. And that's always stuck with me.

Daniel Fishburn (00:20:59):

And, and I've, I've, I've interviewed and talked to people about other jobs ever since then. And it has that effect on me. I'm want to have that effect on other people. And it goes back to, yeah, you're not, you're not cattle. Um, and you know, th there, there is to me poaching and everybody will have their different definitions. Um, what I have seen happen and in, in that field, in that industry is an organization pulling somebody away, um, for the sake of not, not even necessarily having a position for them yet, but they know it will give them a competitive edge to have that person on their team, by taking them away from someone else, send me that's that's poaching. And I understand it's a strategy, but that I wouldn't feel good about. Yeah. You know? Yeah.

Tripp Johnson (00:21:48):

Well, and, uh, you know, one of the, one of the things I'll say is I'm feel really good that I am now, like you said, with the interview, people, there are two people who now work for, you know, what's on paper, a major competitor of Greenhill that I was either the reference. One of them worked here, one of them didn't. And I always said, if we have a role for it, like when we have a role, you're my first call. It's just, we never, we, you know, we didn't figure that out yet, but I think what is interesting and I'm going to try and tie this back to spirituality, but, um, it's very difficult. And when we have a really narrow focus, like if our current business or the month or the quarter is what's all important, then it's really difficult because those are bad. We're making short-term bad decisions to keep more in mind. And I guess I would ask, because I know we've talked about meditation and some of our practices, but how has, uh, maybe having a grounding in spirituality helped you make those decisions and, and stay kind of true to those values?

Daniel Fishburn (00:22:52):

I mean, it's been, it's been integral. Um, I think when we, and, and so much of my spirituality is shaped from, you know, these Buddhist principles, if everything is impermanent, everything is impersonal and ultimately dissatisfying, right? Yeah. And, um, which can be a bummer if it's just left there, there's so much more to it, right. There's value in all of those things. Um, and there is something that I, I think it was Joanna Macy, who is, uh, um, a writer often has written about environmental justice over the years, and she coined the term growth, industrial complex or growth industrial society. And, and that is this essence that always above everything you want to always be growing, always be getting bigger and it takes a toll, right? So we want to grow in terms of the need being there, and we want to meet the need, but there's also growth for the sake of growth and that what you're describing there to me fits into that thinking.

Daniel Fishburn (00:23:54):

But it's all about the quarter. It's all about the quarter at any stake for investors, I can see where that has value. And we have to acknowledge the importance of investors in this, you know, and all of the machinery, that's, that's part of how it can, what keeps it going, but it can be short-sighted and can hurt your ability to, to make good decisions that have some integrity. Um, and I think integrity is, is key there. And that does come from, from spirituality and integrity is, you know, it's, it's doing the right thing for the sake of just doing the right thing. But I also love that integrity has a meaning that comes out of physics and engineering. That it's about something will withstand, um, will withstand a force and pressure and still stay integrated. Right. Right. Um, and if you have integrity in an organization that is going to support your ability to sustain itself over time, uh, remount remains, uh, sound and steadfast and able to evolve and change with whatever it is that the need is.

Daniel Fishburn (00:24:54):

If you come from a sense of fear about the quarter or about the year, um, you're, you're going to make decisions that are fear-based. And those don't tend to be solid long-term decisions that are really serving what you say you're going to serve. Um, I think that being able to stay in touch with all of those principles requires getting grounded and whatever it, whatever works for you to get grounded and be grounded. Um, I think you, you go to that for me, that's been meditation. Um, it's certainly meditation and sitting on the cushion for me is a big piece of that. And that's not necessarily about getting peaceful and chill. Uh, very often meditation leads me to being more disrupted than when I sat down on the cushion. Right. But at the end of it, I'm like, wow, there was a lot that's going on. That's disturbing. I, right now that I've been suppressing and putting down, but when I'm sitting, I can pull that all up in a way and have tools to be able to, to process that make meaning of it and make use of it. Uh, and that can really help me stay grounded, both in terms of my thinking, but the decisions that I'm making, uh, being more grounded decisions with as much awareness about what I'm, what I can see as POS.

Tripp Johnson (00:26:09):

So now I'm going to go in a really tough direction here, down the Buddhist rabbit hole a little bit. So I've recently gotten interested in, started to try writing. I haven't fleshed this idea out, but it's something I do think about a lot is, you know, in Buddhist teachings we talk about, they're not actually being a self, right. It's illusory. And so maybe you can actually explain your take on that. I mean, I'll try, but if you can explain your take just to, to prime that because yeah. I'll let you try and explain.

Daniel Fishburn (00:26:42):

So the, you, there are, there's all kinds of different, uh, approaches in Buddhism and some focus more on no self, you know, than others do. Um, mine has not tended to be so much that, but I have found that to be very useful. So this is, this is how it's been useful to me because I tangle with it. Right. I don't think if we pay attention to how you not tangle with, um, it's the danger of the allure of Buddhism that can lead to just detaching, right? Because if attachments, the problem I should detach, and that's not really what the word, attachment's not a good word for what, what the Buddha was really talking about was really talking, talking about clinging and entanglements. There's also the concept within Buddhism that there is an ultimate reality and in relative reality. So the ultimate reality is the truth of all things.

Daniel Fishburn (00:27:35):

And we would be able to be there if we were enlightened and liberated and see it for all of that. But there's also this very relative reality, which is through our subjective experience. Um, so the ultimate reality is there is no self, but in a relative sense, I've got to work with the fact that I have a sense of self. And so my ethics are about how to, since I'm in this flesh and I'm still making decisions and I still suffer in the way that I suffer, I wanna, I wanna, I want to stay in touch with that and not just think, well, this is all just a movie anyway. So nothing I do really matters. Well, no, actually what I do matters because of karma. Right. Right. And, and so it does matter, but that's a very relative reality thing. Um, I need to stay grounded and connected and so many paradoxes in Buddhism.

Daniel Fishburn (00:28:24):

Right, right. No self. Yes. Um, I kind of understand there is no self, this is illusory and yet day in and day out, that is my experience. So I have to make sure that I conduct myself in a particular way. Right. I can't detach from that. I can't, um, let go of the responsibility of what that illusory self is doing. Right. It's all, you know, it's, it's so complex and yet day in and day out, I am kind of able to make sense of that. Um, I don't know where I was going with that. What was the question again?

Tripp Johnson (00:29:00):

So in my, uh, in my obviously Buddhist teachings have been really central in my kind of spirituality as well. And I have a very simple explanation that may not be effective, but I always say like, if you really can just sit and pay attention, right. You know, what's the next thought that pops into your head and thought that, and when you realize that thoughts are just coming and going, when you create that sense that if I'm not my thoughts and I'm not controlling my thoughts and what is the self, what is there to dig into if it's all, you know, a screen and, and, but there is this very subjective, real, how do I conduct myself? So I've gotten interested in this concept of no self-leadership. And so the idea of being, not that I am actually Lee, I hope to lead from a place of no ego and the self.

Tripp Johnson (00:29:54):

But if I assume that everyone is coming from this no-self perspective, it's not really my job to affect people or their self or something behind their eyes or what they're thinking, but just that we are, you know, of course we probably both know dependent origination and you mentioned karma, but so if everything is arising from, what's already been put in motion, how can I put things in motion that, uh, allow people to flourish without me, you know, trying to be a charismatic leader, or like, let me assume, let me structure the environment in a way that, you know, the correct dependent origination that correct karma gets put in motion. So I'm kind of toying with that as an idea, because it takes a lot of the confrontation and blame away, you know, the gossip around this, person's not doing well. And I, you know, I'm what we call below the line too much of the time, but, you know, and that's been something I've been toying with was like, what, what would it be if we, if we could actually really buy into that doctrine of no self, to some extent. And we structured our environments, we structured our treatment, we structured everything we did. Um, not assuming that there's like this good and evil inside the person that we've got to fix either that it really, we just we've got to cultivate the environment. So that's been something I'm towing with,

Daniel Fishburn (00:31:20):

It's creating the space. So I, you know, I come from, um, you know, in terms of my Buddhist practice is, uh, is a tantric, um, experience of that in [inaudible] Buddhism, there's this, um, sense that through practices we can actually experience if only for a fraction of seconds are enlightened Buddha nature within, and, and it's like, well, we'll have more trust that that actually exists and, and continue to do the work for that. And, you know, and it's not just in tantric Buddhism there either. There is that essence that is fearless and, you know, completely aware, um, and everything else is just layers, right? Layers that are blocking that we call veils. And our work often is just to help remove the veils and the layers that we know that the true essence is not a bad person trying to get good. That is a good person who is trying to get more in touch with that.

Daniel Fishburn (00:32:13):

And our job is to create the space where they're able to, to let go of some of that, this idea of no self is it, this is coming to mind. I don't know if this will go where I want to get to go. But, um, I came to Buddhism really as practice through 12 step recovery and actually reading alcoholics anonymous, which in Texas, wasn't making sense to anybody else around me and that's okay. And then I found other people are getting this too, but I read it after reading it. You read it a lot in treatment. Um, after a couple of reads through I'm like, this is Buddhism. I have no idea why, but I think this is just, it feels like it, um, a key book in that program and a lot of people have read as a book called a new pair of glasses by Chuck C and there's this part.

Daniel Fishburn (00:33:01):

And it's, it's coming from this very dualistic idea of a God and, you know, and, and, and the person, but he, he writes in there about this practice that he would have if, if he did something that was bad, right. That he, that he would he'd have a prayer to God. He's like, you know, I'm so sorry I did this, I know this, isn't what you would have me to do. I'm going to try to be better and do better, and then just let it go. And he would do the same thing with a good thing. So when he wouldn't see that he had done something that he felt was a good thing, he would have this similar prayer of God. It's like, God, I want to thank you, uh, for this happening. Uh, it couldn't happen to a screw up like me. I'm so grateful.

Daniel Fishburn (00:33:41):

And then let that go. His point being that's as good as important to let go of the good as it is to let go of the bad. To me, there's sort of a no self sense in that of like, I can be inclined to hold onto the good things. Um, this looks good to people. This felt good to me. I really want to identify with that self that is this good man that can also hamper us and hold us down. And we just have to let go. And we're just kind of floating through these experiences and getting sometimes to be part of something that decreases suffering or brings happiness to something in the world. And I think I, as I'm hearing you talk, I almost, there was just the, just as this floating through life and trying to make choices and decisions and using this self, which is this body that can show up and do things to try to decrease suffering for others.

Daniel Fishburn (00:34:36):

And we forget ourselves in the west. We have to be doing that for our selves. Yeah. But this being that we are, but going back to the original question, which I don't remember exactly what it was, but it had me thinking about the narrative because part of this experience of the illusory self is we always, our brain is always telling a story. It's doing that because it needs to make sense of things for us to feel safe. So this goes to our nervous systems, our sympathetic and parasympathetic to, you know, to be able to face danger, but we're always telling a story. And that's why in meditation trying to stop thinking that can happen. And it's really cool when it does, but it's not the point of it. It's the watch what thinking is going on, but we're always telling a story and a story is always changing.

Daniel Fishburn (00:35:25):

And you, you had mentioned the other day when we were talking about getting back into journaling and writing. And for me, part of what I love about writing is the process that happens in my thinking, because it's engaging different parts of the brain and adding to the process. But it's always interesting to me to look at how the story changes and the fact that the story does change. So I can look back. I noticed this when I first told my story in recovery, which I planned for a year. Right. And I would write it down. I'm like, oh one day, they're going to ask me to tell my story. And of course I didn't tell the story I wrote down, but over the years I would tell my story. I'm like, wow, this is changing. And there's stuff I'd forgotten about some of this, my brain is healing.

Daniel Fishburn (00:36:05):

I'm getting memory back. And some of it is like, I just have a different story and it's not that I'm intentionally changing. It. It's just that life experiences is changing my understanding of what has happened and what that also points to the two is the fact that I always just have my own version of what's going on. And when I realized that that's always changing, I have mercy for the fact that other people have this narrative always going on and I can, I can, as a therapist, help them with that. Sometimes that's what I'm doing. You know, especially with trauma work, it's just often a big piece of that is, is it dressing where it is in the body, but it's also about helping change that person's narrative to something where the brain can make sense of it and stop having to process it over and over. So you can feel safe. Right? And a lot of energy can go into that processing and that storytelling, but isn't the storytelling. Uh, isn't the narrative, an example of, of how there is no self, because it's always changing. That story is always changing.

Tripp Johnson (00:37:11):

That's super interesting. So when couple of things, have you seen the movie inside out? Yes.

Daniel Fishburn (00:37:16):

So I

Tripp Johnson (00:37:17):

Just think like, when we talk about not holding onto the good or the bad, right. You're always trying to hold onto the happiness. They think that that's the true, that's what I'm supposed to be is happiness. Yes. And so I always think that, um, for me, that's actually, if you want to understand no self, just actually go watch inside out and take it seriously. And it doesn't mean that you don't have this subjective reality. And maybe this is a, a segue into that with some of the narratives. But I always think about, um, again, what's something can be true, but not useful, right? Like there could be no stable self, but it's very useful. And especially for people with certain mental health conditions, like the idea that we're going to talk about, no self is not remotely useful, correct. Correcting the narratives. And what is the predominant narrative that we're telling?

Tripp Johnson (00:38:06):

Because, you know, just on, on narratives on kind of my front, I, I have a couple of very, I have one very pervasive narrative and it's kind of this chip on my shoulder a lot of times is, uh, you know, I'm not, it's not that I'm not successful. I think it, by all accounts, I kind of am successful, but I don't think I did anything to deserve it. I mean, in fact, I almost screwed up, you know, I had like the perfect upbringing I had this and that I had every advantage and I almost screwed it up. And so there's this chip that I've got to do more and I've got to be better. Um, and I've, I've, you know, that, that, that is a predominant narrative. But then, uh, because I've tell it, I tell myself, you know, the stories we hear in our heads are often like our harshest critics and I hear other people, right.

Tripp Johnson (00:38:54):

It's really just me saying, or whatever thoughts saying that you wouldn't be in this position if you weren't so fortunate or so privileged. And I think that is true and it does it isn't always useful. So I am in this position for whatever reason, how am I going to use it to, you know, reduce, suffering and improve my karma, the karma of others. So I always find that interesting, especially from the clinical work perspective, because I remember early getting into this field, you know, being a little more dogmatic about my practices and what is the ultimate truth and everything else. And then realizing that, Hey, like we're all on our different journeys. And so what, what my understanding of ultimate truth is, is just not necessarily useful.

Daniel Fishburn (00:39:41):

Yes. Either.

Tripp Johnson (00:39:42):

So I've, I've learned to be careful with that one

Daniel Fishburn (00:39:45):

As, as sort of a parallel, I think, um, with quantum physics absolute, right. So try to build a bridge, uh, with engineering based on quantum physics, you're probably not going to get very far, right. That doesn't mean quantum physics doesn't there isn't truth in that. Right. Um, being able to hold that there are these, you know, there is the ultimate and the relative at the same time can be useful, but we've really got to figure out what's useful in this moment. Yeah. Yeah.

Tripp Johnson (00:40:16):

Well, back to the subjective reality. So we talked some about the NATSAP world. We briefly touched on it and I think one thing you and I have chatted about a lot and maybe commiserated over some as well, what we want to see, maybe change, what, what are some of the good things about our community that we've been a part of for the past? I mean, for me, it's only been three or four years, but you've been in the NATSAP world that 10 years, about 10 years. And what have, I guess, like, what are your thoughts on, I mean, I'm sure it's bittersweet. You have a lot of, you know, as you move into private practice, it's not like you won't be connected with some of these people, but absolutely. You know, you certainly won't have that same involvement. What are some of the things that I, you know, great about this community? What are some of the changes that you've seen or been a part of over the years? Yeah. Just give me a little bit of rundown on that.

Daniel Fishburn (00:41:09):

Oh gosh. That's yeah. That's a, that's such a loaded question. And you already know that, uh, I, some of the changes, a lot of the positive, I think that there is, um, and I have all kinds of faces that come to mind when I say this, there is a striving, um, to do the best work we can do it, providing healing. Um, and I think when we're at our best, you know, and I, I am including we, uh, myself in that as, as still kind of with my toe in, NATSAP um, we do want to be successful and we want that. We want that to include resources. And so we can say, yeah, that's profit that has to do with being sustainable. And we'll hope that in providing the best possible services with good ethics and integrity, that that also will affect the bottom line.

Daniel Fishburn (00:42:06):

And I think that that is a model that can work. Um, I also think that we can be driven, um, and viewing it as a market with a scarcity, uh, perspective that can, um, we need to thinking of empire building for the sake of empire building, as opposed to expansion of services and good ideas. Instead, we, we, we want to expand the empire because bigger is better and gets more acclaim. And I think that can be destructive. I mean, that's just the way our world is built now, you know, this is a country built on slavery. Right, right, right. Um, built quite a bit. Didn't we, but look, look, look at, uh, what's been lost. I think that recklessness, um, and that's just one aspect of the evil of that, but one aspect is recklessness and not paying attention to, um, what is lost and who was hurt in our empire building.

Daniel Fishburn (00:43:08):

Um, what do we destroy? I, you know, some of this, I was not around for a good part of the history of Aspen. And, you know, you you'll still hear about Aspen and Seuss was part of Aspen at one point, a lot of programs where, uh, one of the companies, you know, that's, it changed hands, you know, what was Aspen at one time, several times. And there was one iteration of ownership that closed a lot of programs that were not failing programs, uh, and were not necessarily programs that were hurting kids. They were good programs, but they weren't making enough. And this idea that something that is sustainable and doing good work, um, doesn't great. Do great for the broader, bigger bottom line that you would close that down and not only lose services, but have people lose their livelihood and, and move on. We've got to be careful.

Daniel Fishburn (00:44:03):

Uh, and I also think we don't want to, um, have the detriment of another program lead to better success for us. So anything that we might do to cut down a program that's doing good work. Um, and yeah, that can even include poaching. As I defined it earlier with like, we're going to take away, uh, one of your strengths to make you weaker. So we'll be stronger. I think that can, that can weave in why, because we're humans, right? This is not just NetApp. This is any, any kind of organization. I think we have to be, uh, very much aware of, uh, who our investors are and you know, where, where is their heart, where's their thinking. And it is a reality for us to survive that often we find ourselves with investors who have only profit in mind, they don't know much about what we do, and they're certainly not thinking, gosh, I really want, um, to improve, uh, behavioral health in this country.

Daniel Fishburn (00:45:00):

So I'm going to invest in companies that do that and do great work with that. It's almost sort of a blind, well, there's something that's making money. So I'll put my money there and now I'm going to drive, uh, that they increase their profits over time because that's, what's most important to me, even if long-term, uh, it's to their detriment, I'll just move on. And we, we just need to be aware that when though those investors have a say in what happens day in and day out on our program, we've we just need to have awareness about that. Or we all have the potential to become those people right. And lose sight of that. And, um, I know, you know, they're people, they went in with their heart and they went in, uh, as maybe clinicians or as nurses or something that they really had the values of that profession in mind and discovered, wow, I could make a lot of money doing this thing and they lose sight of, uh, the heart of their work. Um, who, who does that happen to that happens to humans that can happen to any of us. And that's where we need to stay grounded in aware and in dialogue all the time with each other about what is it that we're trying to do, uh, when we grow or when we shrink or when we make decisions about things, man.

Tripp Johnson (00:46:14):

Yeah, no, um, uh, question, that's setting up for the next one really, but the difference between being, um, potentially a, uh, just a private pay or not private pay, but a therapist say you're coming right out of grad school and you are where maybe a year or two in, but early in your career. And you were looking at community mental health yes. Versus working in a Nat app type program, you know, is there a pay discrepant? I mean, you and I know there's a pretty big pay discrepancy sometimes. And one of the things that I was saying earlier, so I'm not going to put any words in your mouth, but I think a lot of this, you know, one of the, one of the problems, but that we can, like, we talked about the importance of our team. We want everyone to be paid well.

Tripp Johnson (00:47:04):

Uh, but we also want to make sure that I think like we're delivering the value for the money that the families are spending or insurance companies are spending whoever it is, but often there's an outsize. Like we were paying a lot more, we're making more money for the number of people that are being served. Uh, but the results, I don't always know that they are, um, they're keeping up with the amount of money we spend. I, and, and I think like we in this world, uh, whether it's sometimes consultants, sometimes it's, it's just the world we're in where it can be. It can feel like we are focused on bells and whistles where we talk about clinical buzzwords, but the, the foundation that we have, isn't always as stable. And so what are your thoughts on that? If you want to touch that one, maybe you doll.

Daniel Fishburn (00:47:57):

Wow. All kinds of thoughts there. Um, uh, I would agree with you, um, where it goes well is when we're really wanting to see that there's good outcome to our work. Um, when you're talking about, you know, somebody coming out of grad school. So to me, like a great setup is that when you're out of grad school, whether you're doing community mental health, or you're going to work for, what's often called agency work, which if you work for an outset program, that's kind of like in that line of you're working for an organization, um, you can be fresh and green and new, and if you're getting good clinical supervision and you're part of a good solid team, um, your clients are going to get good services and you're going to get good training. And that can happen. You know, again, in either of those kinds of entities, you've got to have that, um, sometimes really great therapists and in that CEP world, get a reputation and referrals go those directions.

Daniel Fishburn (00:49:01):

And that's great for that kid. And for that family, what can also happen is that you have clinicians and here's where I'll just Wade right into it. Oh yeah. Who are really good at customer satisfaction and not necessarily really good clinical care and a result, and also get slammed with so many clients that it really is. It's a draw, but it doesn't necessarily mean that that kid or that family are getting the best care that they could get. And I've seen some very green freshly minted clinicians do phenomenal work, but they don't get the reputation. And I've seen some very seasoned, very well known clinicians kind of resting on their laurels, not necessarily doing the greatest work, but they've got the reputation. Um, I do think that Nat PSAP has been doing a good job. And, and I would also say it consultants in demanding this is, is better measurement of outcomes.

Daniel Fishburn (00:49:56):

Um, it's very easy. I remember back in when I was working strictly in, uh, substance abuse, that you'd go, you'd go to the webpage for a treatment program. And they would tell you, they've got a 99% success rate. And, you know, it's just understanding, you know, why do people not trust, research and statistics? What's because of that, it's, that's, that's impossible. Number one, that just doesn't happen, but you can shape the way you do your outcomes measurements in every way you wish to make it look better. And, um, I know one of the weaknesses I've had in leadership positions is I don't put a whole lot of effort into the outcomes measurement because I don't think we even know how to measure well, uh, unless we do it at great expense. So what does it mean that by the end of this day, this has shifted on this particular measure?

Daniel Fishburn (00:50:45):

Well, that can be sort of meaningful and it sort of says something, but what happens a year later, two years later, five years later is that measured on a phone call interview or a survey or somebody going and spending a couple of days in that house to say, what's really going on with, you know, it was a really quality of life. And I would see this trip away would see, I would see the stories of people, um, who maybe went to treatment. And five years later they've had three relapses and they are now doing phenomenally well. And then another person who claims having had no relapses. So there's ding, ding, ding, that's five years with new relapses, that's success, but the quality of life is not that good. And we're not even sure they're being honest about that. So it's like, I'm not sure we know how to measure well, uh, unless we do it at great expense and I think we need to do better.

Daniel Fishburn (00:51:37):

And I think Nat SAP is always trying to figure out how do we collectively do a better job in measuring outcomes? And I think that they've come a long way. Um, I'll say this and I don't, you know, and, and we'll keep this, but it's worth mentioning that I I'd been speaking when one of the people who's behind gathering data from all the different wilderness programs. And they said, you might not want to see what we found out about this particular. So there was a program within Seuss that is specifically substance use. And what they found was that for those kids, generally, when you look at, you know, mood, um, that their numbers went down, uh, in other words, they were doing worse than when they got there. Now, to me, this made perfect sense, right? Because yeah, when that kid got there, they were, yeah, they were clueless.

Daniel Fishburn (00:52:25):

They couldn't, they were clueless about what they felt much less that there, they were going downhill and hurting themselves and hurting other people. And in the course of eight weeks, Hey, discovered the reality of things. And they were a bit depressed and anxious about that. It's like, this is what happens when you start to wake up. Right. This is the mud that, that yields the Lotus. And I'm like, I don't know. I think that's a good outcome, but how do you measure that? Right. Yeah. Yeah. What does that really mean? All that to say, I think that, um, you know, we could do better, uh, in measuring outcomes to make sure that we're doing good work. Um, and I do think that Nat SAP is doing a much better job of that. Putting a lot of resources into that. And a lot of really smart good-hearted people were in that.

Daniel Fishburn (00:53:14):

And I think the people who refer to those programs are demanding and certainly parents are asking for that. Um, so I think we're, we're doing well in that regard, but I think we've gotta be careful with the empire building that we're doing it with integrity, with a good intention, and that we're not, we're not doing damage and we're not creating more and more of this ambition and drive that is blind to, what's really beneficial to the families we're trying to serve. And doesn't keep us back. And we've talked about this, about how we take what we have learned and whether it's in our programs or supporting it in the community, extend that great information to people in the community who can't afford, uh, most gnats that programs. Um, it is not necessarily helpful to put a kid, uh, with a bunch of kids they don't relate to, um, and, and think that we're really helping them and setting them up and knowing when they leave treatment, they're not going to have the resources for the aftercare that other kids have,

Tripp Johnson (00:54:12):

Man, a lot to dig into there. You know, as far as outcomes go, this is actually one of my largest frustrations as someone who I think we gather fairly good data. And I think it's actually very useful and actionable, but I'm married to a researcher. And so when we talk about this, I mean, when she looks at the stuff that people are touting, and I have been in contact with people who are collecting a lot of data in the field, I don't know if the same people and we don't need to know I'm horrified at what's going on. And I'm, I'm like I'm working with, you know, uh, so long story short until, and this is one of my reasons where one of my real fascinations with moving, trying to move the field forward, because I think, I think, uh, no one's gonna listening will be able to see this, but I think of what we get to do in the NATS app world and what we get to do and kind of private pay settings, uh, similar as concierge, primary care, we get to push what's possible on what what's going to work.

Tripp Johnson (00:55:09):

We get to try these new things because we're well-resourced yes. And then when we talk about like a more social work or public health perspective, we're talking about raising the floor or raising the floor. So we want to make sure we're improving circumstances for everyone. And we don't have to see this as an either, or we don't have to be super individualized and cutting edge or working for the public. Good. They can work in conjunction in certain programs, you know, the gnats that programs should be pushing what's possible, but they need to make sure. And one of the things that I go back to is make sure we're doing the basic stuff that you're taught in, you know, true agency work or true community mental health. Make sure you're doing that well too, because I think we get, I think we have personality cults beyond the empire building of, of maybe leadership.

Tripp Johnson (00:55:58):

Uh, we also have personality cults around, oh, this is the therapist for that, or this is, and it's like, but what are their protocols? You know, like, it's tough because I, I get frustrated with that as someone I think, who knows how to build their own personality brand, I don't like that that's actually makes me more successful or it makes my program make more money based on my, like, if I want to juice our numbers, I just go out there and talk to people. Oh, it has nothing to do with the training that we're necessarily doing, but you can really survive on that a long time. I mean, eventually it falls apart, but I mean, that might be a decade later. And by that point, you, if you're an empire builder, you've built an empire and you've sold it. Yes. So you can actually do, you can. So I, I don't know if you have anything because it's tough to, we also love the people we work with and we do have great therapists and we want to promote them because they're great, but it's, it's a tricky situation between

Daniel Fishburn (00:57:01):

We're talking about work. That's relational. Yeah. And so the way that we make these decisions, it's no surprise that that also is relational. I mean, there's, you know, there, there is a, um, there there's a relation there overuse that word, but it's like, well, of course we go that way. As you were talking to him. One thing that struck me that I think we've lost, um, over decades is, uh, the ability to turn to the resources of universities to study things. So some of the best studies on, um, new approaches is, are done through the VA because they have a massive amount of opportunity to collect data. So whether that be on EMDR or acceptance and commitment therapy for trauma, um, we can learn to these things work because they have the resources and the people that they're working with to really look at that.

Daniel Fishburn (00:57:53):

So it's some really good, solid research. There was a time when you could rely upon universities as a resource. So you could say, I could go to the university of North Carolina and yeah, they can do some of it, but not like they used to because their, their agenda has shifted. Um, they are becoming more like corporations, um, profit driven, and we just don't have that access. Uh, I was working, uh, again in this recovery boarding school and we were really tussling with this idea of how, how to measure outcomes. And we had some ideas about what, how could we do this better? But certainly somebody figuring this out. So we had a phone call with John Kelly at Harvard, which is, was amazing to get, to have a phone call with this eminent researcher, a brilliant man. And he said, yeah, this is what we've got.

Daniel Fishburn (00:58:41):

And he described this, this package and this approach to measuring outcomes. It was like, yes, this is what we're looking for. And like, could we set up to do this because it would be done through Harvard and they would, they would provide this service to us. And the quote was like over a million dollars to get this package. And I'm like, I understand that that would actually be what it would cost because it was similar to what I was talking about. We're going to have human beings go in and observe, you know, the functioning of these human beings along with all of these other measures. And it sounded fantastic, but this is not available to us. Um, you know, publicly supported publicly. Like I think it might have been at one time and I would love to see that happen. I don't fault the researchers and universities.

Daniel Fishburn (00:59:28):

It's just the reality of how things have changed in that, that entire system, whether it's, you know, state schools or private schools, but yeah. It's like, yeah. So the, the, the potential is there, it costs a lot and the resources that used to be there for that, they would also have us, you know, see research done. That's not going to be, uh, tainted, uh, by the people supporting and paying for the research because you know, for us and that's tab, that's us, you know, when we do bring any university and there's some objectivity and I think it's, you know, it's better. But, um, there, there was a time when we would have something, uh, akin to the VA to really be able to look at what we're doing in our programs and how effective it is.

Tripp Johnson (01:00:10):

Yeah. One of the, uh, one of the things, when I think about outcomes and NATS app, and just to tie it back to recovery programs in particular is, and this is, this is a push I'm trying to make. You know, we've talked a lot about my desire to build insurance driven programs and ultimately government funded programs. But if we're operating largely outside the insurance system, we're not allowing them to capture data that might actually support the work we're doing as well. And I don't mean that there should suppose to pay for everything. But I think one of the things that's really important when we talk about especially substance use disorder recovery is we probably know a lot of people who went to treatment and got sober and have stayed sober a long time, but maybe they smoke a pack of cigarettes a day. Right? And so when we start talking about like, we have to consider how interconnected everything is, and it's not that their life isn't better.

Tripp Johnson (01:01:09):

Maybe even if they die earlier, like that, it's a way better life. But when we're talking about truly measuring outcomes, we don't have this data until truly the end of people's lives. And often the only people with this type of longitudinal data is, are the insurance companies. So operating outside their system kind of hurts me because I know that this is actually one of the only places that is collecting. And you can argue there. Some of them are for-profit companies, some are not for profit. There are plenty of bad incentives everywhere, but at least they have longitudinal data and the stuff we're trying to collect the self-reports, it's pretty bogus. I mean, we know the bias there. So anyway, I think we should probably wrap up. So do you have anything else to say this was really fun? I, uh, I tricked you, you came for a quick visit and I said, we're going to record a podcast. So Daniel, thank you for chatting with me for an hour. Really enjoyed it. Thanks. All right. We'll talk soon.