At Two Chairs, our mission is to build a world where everyone has access to exceptional mental health care. There are so many people that help move us toward this mission, from the clinicians directly serving our clients, to the engineers building our technology, to the leadership paving the way to make this possible through an innovative approach. It is motivating and exciting to have such a diverse team of individuals working toward solving a problem as complex as mental health care delivery.
Nick Forand, PhD, ABPP, is our Head of Clinical Innovation and Research at Two Chairs. He recently spoke at the Association for Behavior and Cognitive Therapies 56th annual convention about how he has used his training in evidence-based psychotherapy and clinical science to guide care delivery and innovation. I sat down with him to learn more about what he shared at the conference, his role at Two Chairs, and any takeaways he has for clinicians looking to move into this space.
Sabrina Schoneberg: Tell me a little bit about what you do at Two Chairs.
Nick Forand: Our goal is to combine the best available research evidence with our own internal expertise in design and product development to produce tools that support our therapists in what they do best: providing exceptional care to our clients. As Head of Clinical Innovation and Research, I work with our company’s leadership to ensure that our clinical strategy is informed by the best available clinical research and practices. I also collaborate closely with our Product, Design, and Engineering teams to design, build and test new software products that support our therapists in delivering high-quality care.
My team also helps test these solutions to ensure that any new innovation we launch is achieving the clinical and safety goals we set for it. Ultimately, it’s important for any science-backed company to publish outcomes in peer-reviewed journals, and this is one of my team’s longer-term objectives.
Schoneberg: What was the career path that led you here?
Forand: I am a clinical psychologist, which means I was trained as both a therapist and a clinical scientist. I started out thinking that I would become an academic, which would mean serving as a faculty member at a university, teaching, writing grants, and publishing papers. I tried this for a while and found it wasn’t really for me.
In addition to my general dislike for the grant cycle, I found that the time between when I would develop and test an idea and when that idea might have any impact on actual peoples’ lives was far too long. I wanted to have a more immediate impact on the people I was trying to help, which led me to search for jobs with a more applied focus.
Through that search, I found a position at a major health system where my role was to identify gaps in evidence-based behavioral health practices and then take steps to fill those gaps, which included commissioning training as well as developing and launching new clinical services. Through this role I became more familiar with behavioral health technology companies, which appeared to value the contributions of people like myself, and also presented an opportunity to help innovate and increase access to high-quality care on a much larger scale.
In October 2020, I made the jump to industry to a company called AbleTo, and two years later I found myself here at Two Chairs. My career path has consistently led me towards roles where I could use both my clinical and scientific skills to have the most positive impact, most immediately, for the most people. As a bonus, at Two Chairs I get to work with a great team of smart and dedicated colleagues who are all equally passionate about our mission to expand access to exceptional care.
Schoneberg: The COVID-19 pandemic has been a catalyst for change and innovation, especially in the behavioral health tech space. How has this changed the opportunities available for mental health professionals?
Forand: Yes, it certainly has. When I was in graduate school, my classmates and I had no concept that working in industry was a viable career path. It just didn’t exist as an option, outside of conducting research for pharmaceutical companies, which was not very appealing to those of us who really believed in the value of therapy. As digital behavioral health took off in the mid 2010’s, we started to see roles emerge for psychologists and other mental health professionals in the behavioral health tech space. A few brave friends and colleagues made the leap early! And the COVID-19 pandemic accelerated this process.
Now there are roles available for mental health professionals to directly provide clinical care, conduct research, and help design and build products, among other things. Most individuals who have made the leap to industry seem happy with the change; it’s a fast-paced environment where clinicians and behavioral scientists can have a big impact because they are well-integrated into the organization.
Schoneberg: How do you identify that a company is worth backing? How does Two Chairs fit this bill for you?
Forand: This can be a challenge. All behavioral health technology companies will talk about the quality of their care, how they use evidence to inform their products or services, and claim they have excellent outcomes for their clients. However, not all of them truly integrate clinical expertise, and some are actively dismissive of clinical input. A few questions to ask yourself when looking for companies where clinical voices are respected and heard:
- Is there a clinician in a C-suite clinical leadership role, like a chief medical officer or chief clinical officer?
- Do they provide actual evidence for their evidence-based practice, meaning is there some concrete demonstration of how they deliver evidence-based interventions and not just idle boasting?
- Can they demonstrate how they use external published research or internal research and experimentation to inform their care model?
- Have they published research on their outcomes or products?
- And most importantly, do they treat their clinicians as valuable and respected members of the team, not just as expendable workers?
At Two Chairs, we have the great fortune of having Colleen Marshall as Vice President of Clinical Care on our senior leadership team, and we lean heavily into the evidence-based practice of measurement-based care. Our evidence-base is fundamentally sound, and we’re working to build out and scale up our ability to leverage research to inform our work.
Finally, clinicians at Two Chairs have a number of opportunities for building community and for professional development, which is unique among our competitors.
Schoneberg: What are some of the strengths and challenges of working with such a diverse team?
Forand: I love working with a diverse team. In my previous roles I often had to be a ‘jack of all trades,’ functioning as clinical subject matter expert, service designer, people manager, project manager, researcher, data analyst, accountant, and clinician, among other things! At Two Chairs, we have cross-functional teams of highly skilled individuals who expertly fill these roles.
Our challenge is to honor each team member’s unique perspective and priorities, which we need to harmonize to be successful. For example, though everyone’s ultimate goal is to provide excellent mental health care, our business, product, and clinical stakeholders might have different perspectives on how to get there. Related, there is an art to effectively communicating highly specialized knowledge to people who are not experts in that particular subject. This can take the form of explaining why we need a specific clinical guardrail for a project, or what the clinical evidence base can actually tell us (or not tell us). Sometimes details get lost in translation, but if you have a strong collaborative team, there is usually a chance to correct it. I enjoy these kinds of challenges because it’s rewarding when truly collaborative projects are successful.
Schoneberg: How do you balance the business side with maintaining quality, evidence-based care?
Forand: This is a very real concern. We’ve all seen media reports of companies in the behavioral health space who have sacrificed quality, safety, or clinician well-being in the name of productivity and growth. This is unethical and can actively harm the vulnerable individuals who are in our care. At the same time, in order to achieve the goal of expanding access to high-quality care, companies have to prioritize their business needs.
Along with others on the clinical team at Two Chairs, I advocate strongly for the prioritization of clinical quality and safety as we take steps to grow and innovate. Sometimes, highly novel interventions or services might lead us to a space where we do not have clear safety or ethics rules. In these situations, it’s my job to ensure we have the right clinical guardrails or safety nets to protect our clients and therapists and fulfill our ethical obligations. Alongside this, we must ensure we have the right observational methods in place to understand whether something is working as intended and quickly identify any safety risks. Finally, sometimes it’s necessary to draw a hard line if I believe we are in danger of putting anyone at unnecessary risk. So far in my career, I’ve been fortunate to work with teams who have taken these concerns seriously and have worked collaboratively to address any concerns raised by clinical experts.
Overall, the experience of working in industry as a clinical psychologist has been rewarding. I’ve enjoyed the challenges of innovating and solving problems in this area, and have had the opportunity to use my clinical and research skills to make real, meaningful improvements in the lives of the people we serve. I would encourage others who have similar experience and passions to explore this space — it might end up being a good fit for you too.
We’re always interested in meeting talented, mission-driven clinicians. Take a look at our open positions, or get to know us and see what's happening at Two Chairs here.