Dr Andrew Greenland: 0:02

Welcome to Voices in Health and Wellness. This is the podcast where we explore the real stories and forward thinking ideas shaping how health professionals show up for their patients and for themselves. I'm your host, Dr. Andrew Greenland, and I'm a UK-based medical doctor practicing functional medicine. And on this show, we sit down with practitioners from around the world to uncover what's working, what's not, and how they're navigating both the clinical and business side of care. My guest today is Dr. Dany -McCurdy-McKinnon, a licensed psychologist based in Los Angeles, who specializes in neurobiological approaches to eating disorders. She's the founder of DMM Clinic and Cali Health, where she's building care models that go far beyond symptom management, integrating neuroscience, trauma-informed therapy, and whole person care. This episode is part of our special series for eating disorders awareness week, and I think you'll find Dany's insights incredibly timely and grounded. And with that, I'd like to welcome you to the show. Dany, thank you so much for joining me today.

Dr Dany McCurdyMcKinnon: 0:58

Thank you so much for inviting me.

Dr Andrew Greenland: 1:01

So maybe we could start at the top, if we will, with your journey. Could you tell us a little bit about um how you got into this space, what your journey was, and how you've ended up in this space doing what you do?

Dr Dany McCurdyMcKinnon: 1:12

Yeah, for sure. That's a great question. Um, a lot of people ask me if I have lived experience, as a lot of uh psychologists do, and whatever their specialties are. And I actually do not uh personally, but when I was growing up, I grew up, my my Mima is German, and you know, food was very important and a big part of all of our holidays and special events, and nobody struggled with under-eating in my family, let's just say that. And when I got to college, I was in a sorority, and um, our sorority was sort of known for having a lot of eating disorders, and I was observing them around me, and I was pretty fascinated by uh why anyone would not want to eat since it is such a biological drive to consume food and it is highly rewarding. Um, so that's kind of how I got into it. I started off my major was biology and I was pre-med, and my junior year I switched to psychology, and I still had that, you know, medical interest, which is why I love neurobiology. Um and I just happened to live in a state, I was in Oklahoma, where there was a really good eating disorder hospital, and I met my very first mentor, Dr. Craig Johnson, who kind of paved the way for me in this field.

Dr Andrew Greenland: 2:47

Lovely, thank you. Always good to hear about the origin story of how you've ended up doing what you do. And then from um those of early interest into what you're doing now, tell us a little bit about Cali Health and the DMM Clinic and how they came to life.

Dr Dany McCurdyMcKinnon: 3:00

Sure, sure. Um Well, I I never really intended to have a group practice and be exclusively a private practice. I originally thought I would do research, but it turned out to be a little bit too solitary uh for me. I mean, yes, there's research lab meetings and whatnot, but um especially I was doing neuroimaging research, so it's a lot of time behind the computer doing coding research, a little bit too solitary for me, I found, because I'm an extra extrovert, I like to say. So while I was working at UCLA as a clinical psychologist on their eating disorders unit, I started a part-time private practice. And then sadly, like is which maybe we'll talk about a little bit with the business stuff, um, a lot of academic medical center hospitals are closing, um, basically being bought out by venture capitalists and um, you know, private companies. So UCLA was one of the best eating disorder hospitals in the world and it closed. So I went on to do full-time private practice. And then the Cali Health was sort of a reaction to private practice, has slowed down. I don't know if we want to get it again. I don't know if we want to get into this right now. But anyone who you speak to who is especially cash pay only private practitioners, our caseloads have gone down maybe since COVID. They probably peaked during COVID and now are 50%, maybe less for a lot of us, some 30%. Um, mine has gone down about 30%, but I've heard people say upwards of 50%. And so I was like, I've got to get into this tech space. And I my patients have always said, I wish I could carry you around in my pocket. I wish I could just have you with me all the time. And, you know, with the boom of AI, that is kind of possible in terms of, you know, coding certain language and certain uh theoretical approaches. So Cali Health is essentially an AI therapist that you have on demand and it will sort of have my voice. Uh, we're in the very early seed stage of that company. Um and I just wanted to find a way to reach more people since obviously uh private practice isn't reaching as much people as it used to. I think some of that could also have to do with the economy. Some people see psychotherapy as a luxury, maybe more than a necessity, and something that you could utilize in an app at a much lower fee and still get quality care seemed really appealing to me. All the while, there's no replacement for that therapeutic connection and the face-to-face one-on-one. So I have vowed to keep a person-to-person component of my app with um doing weekly roundtables for anyone who wants to touch base and um, you know, having sessions with me as an extra bonuses and things like that.

Dr Andrew Greenland: 6:38

Thank you. That's really helpful. And perhaps we will delve into the um business side of things a bit later on. But give us a snapshot of what your typical week looks like at the moment, how you're kind of blending these two approaches together. Um, yeah, just give us a snapshot.

Dr Dany McCurdyMcKinnon: 6:52

Sure, sure. Uh well, I also um I have two kids. I have a five-year-old and a 10-year-old, and I have three dogs. Um, so my home life is quite busy as well. So I start off the day just rushing everyone out the door. Uh, I tend to go to my office. I'm working from home today. It's a rainy day, and in order for us to meet, you know, with the time, I had to get I had to get home a little bit sooner. So I'm at home today, but I usually go to the office, which I work in downtown Los Angeles, and I see anywhere as small as maybe two patients a day to as many as six. So it really varies based on the day. And in between sessions, I am writing my blog. I am working on um my app. I also have my own podcast, um, which we're on hiatus right now, but on um when we're back on, which we are starting next week for eating disorder awareness week, um, I will be editing that, planning that, doing social media. I also I find self-care is so important. And um I'm uh I have ADHD and so I get I like hyper focus on hobbies. So I'll have a hobby of the moment. Right now it's jewelry making. Um, so I might take a little time to you know bead some jewelry or or bend some metals, and um my day ends pretty early because I have to go pick up my kids, do dinner, um go to bed and do the whole thing again.

Dr Andrew Greenland: 8:34

Sounds highly organized and it sounds like you've got a real um boundary around work-life balance. Um is that fair to say?

Dr Dany McCurdyMcKinnon: 8:41

It's very fair to say. I really do. I used to not, you know, I'm 46 now, so I've been doing this for um, you know, I've been licensed at least for 15 years. Um I used to not. I would text patients at all times of the day. I would answer emails at all times of the day. And I'm, you know, I still am available, but there's a very hard line, and my patients are quite respectful of that.

Dr Andrew Greenland: 9:11

Well, we're very wary that people working in this space, but in the wider caring professions, the whole thing of burnout. So, you know, looking after one's time, protecting one's time, and having those clear boundaries must be so important.

Dr Dany McCurdyMcKinnon: 9:23

It is, and eating disorders are are, you know, one of the most lethal of all psychiatric illnesses. So there's a lot of stress and there's a lot of medical comorbidities, and you know, a lot of coordination of care with dietitians, physicians, psychiatrists. So it's not just you know the 45-50 minutes that you're spending time with the patient. There's a lot more. I mean, as with any case, there's a lot more that goes into it. But I would say it's certainly um one of the most time-intensive specialties one could have.

Dr Andrew Greenland: 10:00

So, what major shifts are you seeing in the mental health space right now, especially when it comes to you know things like eating disorders and trauma?

Dr Dany McCurdyMcKinnon: 10:08

What sorry, say that question again?

Dr Andrew Greenland: 10:10

I was saying what major shifts are you seeing in the mental health space right now?

Dr Dany McCurdyMcKinnon: 10:14

The major shifts I'm seeing is like I said, a lot of you know, big business kind of taking over clinics. Um, and some of that hasn't hasn't gone so well. Um, I think quality of care, you know, in order all of the best clinicians, and including, I would say, many of my colleagues and my employees at my clinic are really great, really specialized, spent a lot of time learning and getting to be where they are, that they deserve comp they deserve good compensation. And insurance is not willing to compensate most clinicians what they should be compensated. So if you don't take insurance, you are cash pay. And like I said a little bit earlier, for whatever reason, the economy, um, big tech, whatever it is, people are less willing to do cash pay right now. So that's one thing I see shifting. And um with patients, I see a lot more ongoing stressors based on uh the politics in our country, in America right now. Um, I would say at least one patient every day talks about the stressors of where they see our country going. And that is sort of like micro trauma over time.

Dr Andrew Greenland: 11:50

Thank you. Really insightful. And I want to pick up on that point because you basically said that you know there's the demand for cash pay is going down. Insurance companies are not remunerating um services properly. So, how are colleagues in your space surviving and how are they navigating this?

Dr Dany McCurdyMcKinnon: 12:08

Yeah, we actually um the Academy for Eating Disorders is sort of the biggest international uh organization for eating disorders. And recently there was a uh private practice special interests group started up about a year or so ago, and we actually had a full meeting around this about patients drying up in this space. And some people are getting, you know, creative and doing more things like me with my app. Some people are deciding to take insurance, at least for a certain portion of their patients, which also is great. I'm I'm probably going to do that uh as well because that does increase access. It's just again that burnout thing. There's so much more you have to do when you deal with insurance in the in the United States at least. And um some people are also just deciding to maybe go back to work at clin other clinics or hospitals or opening up their practice to more broad um patient care, like anxiety and depression, rather than exclusively eating disorders.

Dr Andrew Greenland: 13:19

Thank you. And what was your sense of you mentioned that um the demand seemed to go down after COVID? What's your sense of why that was? Because I thought COVID created a huge amount of mental challenges for people.

Dr Dany McCurdyMcKinnon: 13:32

Yeah, it peaked in COVID, I would say. So what I would say has gone down since COVID is the desire. Okay, people seeing the need for in-person face-to-face care. Some people, I would say teenagers and very young adults only want in-person. That has been my experience. I'd say 90, 95% of young teen to mid-20s want to meet in person. And I think that is because they had such a virtual burnout with so many of their academic years being virtual. But all of my adults, which I I see mostly adults, probably mostly people, I mean early 20s to late 80s is uh my patient age range currently. And the very old and the very young want to be in person. Everyone else wants virtual. And I think that you can get that on apps. You know, there's there's Talkspace, BetterHelp, Alma, there's still all of these companies that people can just go on, and that instant gratification of, oop, there's a therapist. Oh, I don't have to pay very much money. I'm gonna see them right now. And you don't know what you don't know. You don't know what high quality care is if that's your first foray into the mental health space. And so why would somebody pay me $300 an hour or for 45 minutes when they could pay, I don't know what it is, $10, $20 to see a doc in a box?

Dr Andrew Greenland: 15:19

It's interesting. I would have thought it's almost a little bit counterintuitive. I would have expected the very young generation to be wanting the tech and being able to do things they're so used to it and they're so tech savvy, and the older people wanting the connection. So it's interesting your take on this as being a bit of a reversal. I'm just finding it.

Dr Dany McCurdyMcKinnon: 15:33

Yeah, I mean, but and and the young people they like they like apps, you know, they I they like all the tracking apps that you know we use for food tracking or meal tracking or mood tracking. They like that, but they really the therapy they enjoy coming to the office.

Dr Andrew Greenland: 15:50

Interesting. So, what do most people under misunderstand about eating disorders? And how does your neurobiological or trauma-informed lens shift that?

Dr Dany McCurdyMcKinnon: 16:01

I think historically people saw eating disorders as a young, white, affluent female disorder, and that it was a choice. And fortunately, the research has dramatically expanded in the past 10 to 20 years to show that eating disorders affect everyone, every gender, every race, every ethnicity, every stage of life. Um, and that there are a lot of genetic and neurobiological underpinnings. Now, genetically, they haven't found, say, you know, an anorexia nervosa gene or a bulimia nervosa gene, but there are certain genes related to temperament and personality that leave one more susceptible to some of these disorders. Um, a lot of patients are highly perfectionistic, highly conscientious, um, high attention to detail. Um, this is speaking, sorry, I'm speaking of anorexia nervosa right now. Um, individuals who are maybe more prone to bulimia nervosa or binge eating spectrum disorders may have more emotional dysregulation, higher levels of impulsivity, um, you know, ADH ADHD is a comorbidity oftentimes. And that sort of drives the disorder versus, you know, oh, my mom has anorexia, I have anorexia. It's more like, oh, my mom was extremely um obsessive and um controlled and organized, and I saw that, and now I'm doing that with my food and with my exercise and with my routine.

Dr Andrew Greenland: 17:51

Thank you. And where do you think the field is still getting eating disorders wrong? The wider field?

Dr Dany McCurdyMcKinnon: 17:56

Oh, that's a really good question. Um, I do think that not paying as much attention to the medical side of things is still a shortcoming, meaning most specialists know you've got to have a general practitioner on your team. You've got to have a medical standpoint. But a lot of people who aren't as experienced don't realize how important that is, and to be working hand in hand with an MD in these uh in this space, as well as I would say um being aware of the complexities of gender non-conforming patients and the effects of hormones and um older perimenopause, menopause women, I think are still kind of left out of the game a bit.

Dr Andrew Greenland: 18:54

And is there any resistance from colleagues in terms of the approach to eating disorders that you've encountered?

Dr Dany McCurdyMcKinnon: 19:02

What do you mean resistance?

Dr Andrew Greenland: 19:03

I guess you mentioned it's important to have an MD on board. I just wonder whether everybody's on the same page when you're trying to manage a patient, you know, with a number of different colleagues on board. I just wonder if you find any bottlenecks or any resistance from uh particular clinicians.

Dr Dany McCurdyMcKinnon: 19:15

Yeah, some people I think find the like, you know, the the the old adage, like too many cooks in the kitchen. I think maybe if you're less confident or less maybe secure in your abilities in this space, that that could be intimidating, maybe to speak to, you know, medical doctors or dietitians or psychiatrists. But really, we're stronger as a team. And I do I have a very strong um preference that the psychotherapist is the lead of the team. Uh, and actually, again, most exper people who are have experience in eating disorders would agree with that. We're sort of the touchstone who see them most often. I mean, dietitians often see them every week too. But uh I think the only resistance would be sometimes people may not think that the clinician should be leading the ship.

Dr Andrew Greenland: 20:15

And in terms of um eating disorder recovery, how much would you say is biology versus psychology versus environment? Are they all equal or is there kind of a some of those who've got a bigger slice of the pie?

Dr Dany McCurdyMcKinnon: 20:27

Mm-hmm. Environment is actually really, really important. Having a supportive, we call them carer, because it could it doesn't have to be uh, you know, a partner or a parent. Um, it could be a really good friend uh or a roommate, but having somebody to support you in the environment is extremely important. Um I always make sure there's some carer involved. And if I had to break it down a percentage, maybe 50% treatment, 25%, uh 30% environment, and then the biology, I think kind of uh I like to say doesn't weigh in as much as recovery because it would be working against them. Um, so finding ways, I guess, to make the best out of some of those uh biological traits. You know, if somebody is highly perfectionistic and organized, well, let's put that into another aspect of life or let's put that into your recovery and let's be the perfect recovery and track all of our meals and take our meds as prescribed and get the right amount of sleep, you know, or if somebody is more dysregulated and we'll find something that they can do that kind of itches that or scratches that itch of excitement and novelty, uh, whether that's like a new activity or um a hobby. Or, you know, focusing on their relationships or something like that.

Dr Andrew Greenland: 22:09

And with the patients that you treat, what are the signals that tell you the patient is really healing versus just coping better?

Dr Dany McCurdyMcKinnon: 22:16

That's a good question. A lot of people want to pay attention to the numbers on the scale, or you know, are they gaining weight or are they stabilizing weight or whatever that the numerical goal is? I actually don't focus on that. I focus on the functionality. So are they going to class? Are they going to work? Are they engaging with friends? Going out to eat at restaurants? Um, am I getting less, you know, calls or emails from parents? Uh, it really is about the functionality.

Dr Andrew Greenland: 22:55

So obviously you're running business, you're running a business or businesses. Um what are the things that are going particularly well for you at the moment from a business perspective?

Dr Dany McCurdyMcKinnon: 23:04

Oh, actually, not that much. Um what's going well? I mean, I've learned a lot about business. I always say that in graduate school there should be a business course because a lot of us are going to run small businesses, and you get very little, if no, training for that. So it's a steep learning curve. I've learned a ton about business throughout the years I've been running a practice, and now even more so with my app. Um I think, yeah, I'll just leave it at that.

Dr Andrew Greenland: 23:46

And on the other side of the coin, what are sort of the big challenges that you have at the moment or things you've had to overcome recently as you develop your businesses?

Dr Dany McCurdyMcKinnon: 23:56

Well, time management running two businesses, you know, figuring out like being sure that I'm still giving my patients uh the best care, being sure I'm still giving my trainees the best supervision and best training. And all the while also trying to, you know, get a startup off the ground that I think is going to be really important and really change things and help a lot more people, um, you know, balancing the the care that I'm already doing with the care that I want to do. And then business-wise, I think again, the challenges are financially figuring out, you know, how to get more patients, figuring out how to access people who need help. And one of those um ideas is accepting insurance.

Dr Andrew Greenland: 24:47

Thank you. You mentioned the app a couple of times. Very interested to know about how it's sort of been developed. What was your kind of um what did you want to put into it? How has it evolved? Um, and obviously there's lots of talk about AI being used for therapy, and there's lots of concerns. And I just wondered how you've put guardrails into the app.

Dr Dany McCurdyMcKinnon: 25:08

Right. Yeah, there I I mean I came up with the idea, like I said, because patients sort of want round the clock care, and eating disorders demand that as well. Uh, as far as guardrails, you know, there are some apps already out there. There, I mean, there's quite a few mental health apps, but there's um at least one or two in the eating disorder space. Most of them operate on open AI um languages with some rules and parameters. Me and my um tech expert discuss building it from the ground up with my influence. So we're not relying on open AI, Chat GPT, anything except for the code and the rules and the information that we're putting in. And then over time, the data will perfect the model basically. Um, but we are going to constantly have a hand in that because if you are relying on OpenAI, you may not be able to have as much safety and as much expertise in the mix. We're also starting small using dialectical behavioral therapy, that's one of you know the best treatments for um emotionally dysregulated patients. And then there's also an offshoot of DBT called radically open dbt that's really excellent for the more overcontrolled and restricted personality types. And so that's our main focus is DBT and RODBT. We don't want to get too big too fast, and you know, do family-based therapy, right, regular cognitive behavioral therapy, acceptance and commitment therapy, couple interventions, you know, we're really focusing on the DBT and the RODBT to have a really good um treatment model. And like I said, I think having the human component is a hundred percent necessary.

Dr Andrew Greenland: 27:24

And so, in terms of the development, is it basically a tech wizard downloading your brain and the way that you think and operate and practice? I say that I have a jest, just curious to know how it how it comes about from you know your experience, your journey, how you create something.

Dr Dany McCurdyMcKinnon: 27:39

Yeah, that's sort of how I was explaining it. So my best friend is also on our advisory board because she's an international leader in eating disorders and DBT. And she was, she said that. She was like, I mean, what it and yes, she can. So Maddie is my Maddie is my tech um guru. She can take transcripts, de-identified, of course, transcripts of my sessions and work them into the language model so that it does, you know, sound like me, or I also my therapy style is sort of irreverent, which works with GBT, and also a little bit casual. Like, I don't like to be super serious, and um, I'm definitely not like I always tell my patients, I'm not the wizard behind the curtain. Like anything I am theorizing or thinking about your case, you're gonna know. Um, so I'm extremely transparent. There's no sort of all-knowing mystery. Um, you know, I sometimes uh stick my foot in my mouth or say something silly, and we're trying to, you know, work that into it so that there's a level of uh humanness and connection.

Dr Andrew Greenland: 28:52

Amazing. Is it ready to go? Is it we're waiting to launch or still in development? Where are we at with it?

Dr Dany McCurdyMcKinnon: 28:58

It's in development. I mean, it's you know, my my tech partner has to get paid, right? Like it's very time, it's very time intensive, and she has many years of expertise, and we're $60,000 short of her raise. So it's basically once we get that, we'll be good to go. And that's why I say we're in the seed phase. So we're just trying to get that last you know, little bit of money so that she can pay herself and we can get it distributed.

Dr Andrew Greenland: 29:30

Well, I wish you all the best with that.

Dr Dany McCurdyMcKinnon: 29:32

Thank you.

Dr Andrew Greenland: 29:32

If you so if you were designing the ideal eating disorder clinic from scratch tomorrow, what would it look like? We had a wealth of experience, you've had a very you know interesting journey, um, training. I'm just curious to know what will you put into it with everything that you know?

Dr Dany McCurdyMcKinnon: 29:47

That's a really awesome question. Um a whole team being able to find uh, you know, a lot of, I mean, even my clinic operates as only clinicians. But if I, you know, could wave a magic wand, I would have a general practitioner, I would have a psychiatrist, I would have a dietitian, I would have a number of therapists. I would also have um patient advocates, so people with lived experience or parents who had had experience, you know, with their child as support for other carers. I would have a group component for both age ranges, you know, younger, younger groups, older groups, um, specialty groups, you know, neurodivergent group, LGBTQ group. Um, and I would have in person be mandatory. You at least have to come in person for part of it and get that human connection. Um yeah, that's what it would look like if I could wave a magic wand.

Dr Andrew Greenland: 30:59

Amazing. And with the same magic wand, um obviously you've created um the kind of the optimal business, but if I gave you the magic wand to fix one thing in your own business right now, what would that be?

Dr Dany McCurdyMcKinnon: 31:12

Figuring out a way to mass advertise how important specialty care is and that you get what you pay for, you know, you're you're not going to get the same quality of care in a general app with people with no real eating disorder experience and how important the mentor-mentee relationship is in this field. I I have everything, you know, to thank to my to my main mentors.

Dr Andrew Greenland: 31:52

And if you were starting your business again tomorrow, would you do anything differently other than waging waving the magic wand and creating the perfect model that you talked about a few moments ago?

Dr Dany McCurdyMcKinnon: 32:00

But would you do anything differently apart from I yeah, I would have had a I do have a business manager now. I would have hired a business manager from the very beginning to help me navigate that because my very first year, I remember I was shocked at how much taxes I had to pay. And that was such a steep learning curve. And then all of the bookkeeping and what you keep track of as you're trying to build a practice, you know, you're still a little bit green in the field, and then you're learning all this new stuff. Like, I have always had this attitude, like, I feel like I have to know everything. Like, even when I was building my app, I was like wanting to know about the coding language. And, you know, Maddie was like, you don't need to know this. Like, you focus on you. And I would say the same thing as building a practice. Focus on what you're good at and hire out the rest as much as possible.

Dr Andrew Greenland: 33:01

Great advice. So, what does the next 12 months look like for you? What are your plans for the next 12 months with the businesses and everything else?

Dr Dany McCurdyMcKinnon: 33:08

Ideally, we will be uh taking insurance. I will have some more practicum students. Uh, practicum students are great because they can see patients uh for low fee, but they're you know, they're highly trained, they're in graduate school, um, getting their PhD or Psy D and you know, mentoring me mentoring them, um, and the app being launched and off the ground.

Dr Andrew Greenland: 33:36

Do you have a launch date in mind or is it too early to say?

Dr Dany McCurdyMcKinnon: 33:39

I mean, we originally wanted to launch um in January, but the you know, the finance uh piece has held us back. I would say in the next six months would be my goal.

Dr Andrew Greenland: 33:54

Well, I hope it comes to fruition and I hope it all goes well. Thank you, Dany, for spending the time with us today talking about your journey, your experience, your very in-depth knowledge of eating disorders, and also the business aspects of what you do. It's been a really interesting conversation. I'm very grateful for you joining us. Thank you.

Dr Dany McCurdyMcKinnon: 34:11

Thank you, and thank you for all the awesome questions.