SPEAKER_01 0:00

Hey everyone, welcome to another episode of Beyond the Case. Today my guests are Mark Kohlberg and Christine Kavil. They are the president and chief clinical officer at Cerebral, and they are at the forefront of shaping the future of accessible, high-quality mental health care. As a husband and wife team, they've built a model that trains the next generation of therapists while using AI and measurement-informed care to improve outcomes at scale. Mark and Christine, it's a pleasure to have you here.

SPEAKER_02 0:31

Well, thank you for inviting us.

SPEAKER_01 0:33

Yeah. And you are both uh part of the OPM program at Howard Business School. But what sets you all apart is y'all are doing the program together.

SPEAKER_02 0:41

Yes. Yes. We did uh OPM 64.1 and OPM 66.2. We could not come back to campus in 2025. Work was too busy. But we came back in February, which was wonderful.

SPEAKER_01 0:56

And don't go back till it's OPM 67 for Unit 3, because that's the cohort I'm part of. Hopefully we can do unit three together. Well sure. So get us uh started on how how you had the inspiration to go about your entrepreneurial journey. You know, is this something uh you had dreamed of growing up to be an entrepreneur, each of y'all individually? Just walk us through the mindset.

SPEAKER_03 1:16

Well, for for me, it was sort of born out of necessity. I became an entrepreneur when I was still a college senior. I w went to a liberal arts college and was majoring in philosophy and just knew that I wasn't going to necessarily be able to get a job. So I luckily met a group of founders and we created a an adult incontinence product or a suite of products using a super absorbent polymer technology. So I sort of created a job so that I would have income after graduation. And then it just became sort of a path that I took of starting different companies, but uh did a career pivot actually in my early 30s after my third company, after 9-11. And I really took time to decide what I wanted to become good at and have a profession around. And so I became a psychotherapist. I went back to school, got my master's, and sort of had this vision of becoming a clinician. Um and around this time I met Mark and who was also an entrepreneur throughout his life. But I'll I'll let him talk about that.

SPEAKER_02 2:29

Yes, so I met Christine 11 years ago. Before that, I'm a software engineer by training. Um, and I have invested and operated in software-driven companies in Europe and in the US for many years. I have made myself unemployable. So once you're unemployable, the only thing you can do is to create a company, uh uh, you know, so you can have a living. Um I went from software engineering to product management to business unit management to funding and investing and operating software companies. Uh, I had never built a company in healthcare. I met uh Christine in 2015. We started to talk about the US healthcare industry, and I was fascinated by how large, broken, dysfunctional this industry was. It's 20% of the US GDP spent for the lowest life expectancy of any developed countries. And so from an entrepreneur, it's wonderful because it's utterly broken. Huge spending, terrible outcome. So the naive entrepreneur thinks obviously there had to be a better way. Obviously, we can fix it. And at the heart of uh healthcare is mental health care, which is a social driver of a lot of the comorbidity. And so we decided with Christine to start a company that would have a systemic impact on mental health by developing at scale great clinicians. What's really unique in mental health is it's a unique encounter of two humans. And so there is a supply side in balance where you don't have enough licensed clinicians. And so we took it on us to take Christine's class that she teaches at the Columbia School of Social Work and create a machine, a platform that could create at scale as many great clinicians as we want. And as of today, we've trained more than 700 clinicians into what's called the resilience methodology. And we can prove that if we train you in that methodology, you will deliver great outcome, even though you might be a new clinician. And so that's the journey that we took. We created the company in July 2019, sold it in July 2025 to a bigger company called Cerebral, and we're both serving Cerebral as chief clinical officer and as president in helping Cerebral to scale to further develop the solution it has in US mental health. So this is this is what took us here.

SPEAKER_01 4:58

And you all then found Cerebral, correct? Y'all were part of the acquisition and then you all started leading the company?

SPEAKER_02 5:03

Yeah, so they bought the company and they bought our brains. And so we went from our company where we were co-founders, uh, to the new company where Christine drives clinical, uh, I drive the AI and external growth, um, and I sit on the board.

SPEAKER_01 5:21

At Resilience Labs, which you started in 2019, um were quite bullish on the role of technology to parse data and build a model which could train future clinicians. I don't believe AI was at an inflection point back then, um, or in the news, the way we hear about AI all the time today. And so what led to that conviction in terms of going ahead with resilience labs and what were some of the risks that y'all felt y'all were taking but still venture ahead?

SPEAKER_03 5:49

Well, I I mean for me, when when Mark first sort of took me out of my clinical world, hospital world, and sort of lured me into back into the entrepreneurial, let's scale an opportunity in mental health. For me, the only way that that would be possible as a clinician is through technology. And because there is so much data collected as a clinician, and what I had been doing for 10 years is just everything was by hand and everything was being relied on by memory, and you're missing so many opportunities as a clinician when that is the case. And technology makes it possible for you to augment your treatment through data collection and through what we call the the co-pilot of using AI technology to improve upon the treatment that's delivered. And um, so that was always something that we we had in the back of our mind as we're building our tech platform and our our electronic medical record stack that that we conceived of from the beginning.

SPEAKER_02 7:01

Well, so so I'm I'm an engineer, and so I believe that everything can be engineered so you can scale and optimize it. That that's kind of one of my view on life. And so when I started to talk with Christine, my belief was that this was a very interesting domain because it was very unengineered. There was no data, there was no data collected. You had 600,000 licensed clinicians in the US that were all practicing in their own way, and and there was no way to, there was no standard of quality. And it's an interesting pattern when you have a hyper-fragmented industry with no standard of quality, then this is a business opportunity. If you can create that standard, can improve the fluidity and the efficiency of the marketplace, because it's sort of a two-sided marketplace. You can add value, and if you can add value, you can build a company because you can take part of that value. And so the belief at the beginning is let's own the data, let's own the software stack, let's be a software company supporting healthcare. Um, and and we spend considerable amount of money building that software, uh, which turned out to be much more complicated than we thought. But that was one of our premises, which was we want to create a new standard in this industry that has no standard. We need to have data, and to have data, you need to capture data and you need to own the software. So this is this this was one of our beliefs. We're not building a practice of one. We want to build a practice of a thousand people collaborating at scale together.

SPEAKER_01 8:40

You feel regulations were business friendly at that point for what you were attempting to do, or did you also have to um somewhere be mindful of regulations not having evolved?

SPEAKER_02 8:51

This whole industry is organized to defend incumbents and to be inefficient. And it's healthcare industry. Yeah, yeah. So if Christine is the New York clinician, she cannot go and practice in New Jersey. She's to be licensed in Jersey, that will be very complicated. And the Jersey people are defending the Jersey clinician.

SPEAKER_03 9:15

Each of the so it's because there's also the layer of HIPAA. So there's you know, personal health information that must be protected at all costs and is highly penalizable by the various regulatory bodies if you violate. So we have to build that in as well.

SPEAKER_02 9:34

And so it's organized to be inefficient, and and the information wants to be free. You know, it's like how do you share your information between your GP, your mental health clinician, your specialist? And how can you own this information so that it can move with you? And it had it got a bit better six, seven years after there are standard like Fryers, for example, where you can move data in and out of and and anonymize it so it's hit by compliant. But there's still a long way to go.

SPEAKER_01 10:05

And so, what point has your company reached today at Cerebril? What are some of the new um features or milestones that you'd want to share?

SPEAKER_02 10:14

So we are a privately held company. So we just bought a digital therapeutic company called Inflow, which enable us to have continuous care, so to be able to help you with software, with digital therapeutics before and after a visit to a human and to move to move you up and down the equity scale depending on what's happening to you. So we announced this acquisition uh several several months ago. Still not talking about copilot. We're building AI co-pilot to assist our clinician sitting next to the clinician and uh helping the clinician prepare for the session with the client. We don't replace the human, we enhance the human with data insight, and we've deployed that to our people. We are a fairly large company. We have more than 500 clinicians, more than 100 uh medical providers. Um, and we're small in the scale of the problem in the US. We are in a network with many insurance companies covering 100 million commercial life. And so we get up in the morning to improve each of the elements of the business.

SPEAKER_01 11:20

And so at what point did you decide to go back to school? And why do you pick OPM program at Howard Business School?

SPEAKER_03 11:26

It was a friend of ours that that recommended. So this friend and his wife had created a huge luxury event global company. And he he ended up telling us about the value that this particular program added to their business. And this was already, I think, a billion-dollar business or something like that. But he said that it was invaluable the amount of learning and acceleration that this OPM program had done for their their business. And then once he had completed the program, he insisted that his wife and partner complete it. Um and that's when he said if they could have done it together, that it would have been even more helpful. But um, but there's just, and it was hard to conceive the impact that it could have made on their business, which was already so, so, so successful. And then we entered the program. And the first year for me, I had never had any formal business school coursework. And so, and it really was apparent in my, I just had no rigor and and no frameworks to to really build the businesses that I had been working in. And so I it wasn't, I wasn't breaking through. I wasn't building the foundational aspects of the business that were required for growth. And after completing the first year, it it was challenging for me, but I I was able to put so many, many of the principles and learning into practice. And I saw from the first session to the second session in the business and in my leadership, just how much it really added to my ability to to build the foundation of the business. Mark, what what about yourself?

SPEAKER_02 13:12

For for me, going back to school is the most incredible present you can give yourself. Um as business people, we are always on charge of the business. So we're supposed to have the solution. We're here to help everybody, we're here to create the we're here to create an environment where people can show up and do the best that they can. Going back to school is this this joyful, fulfilling experience of uh learning. It's I I there there is no words to describe the pleasure of being back in class. Really for uh for two reasons. One, the teachers are masterful, and and and there's a lot of similarity between leading and teaching. So sitting in a class where the teaching is masterful is also not so much learning about the subject, but you're learning more too. And and you know, some of the OPM teachers are are mastered, you know, whether it's Francis or Das or other, they are I've never seen people teaching like that. So that that's really an incredible gift to be able to see master-level people teaching. And the second thing is so I'm European, sitting in a class which is non-white Western from an understanding, and where which is a global class, and where you have people from the south, whether it's Mexico, India, Brazil, and where Europe and the US is not the center of the world, is really interesting and exciting. And I had never had that chance before. I sat in class in in Europe, but I never sat in a class which was a global class. And I think OPM is a global class in terms of the voices and the people and the challenges and the experience that they have. And so it's uh it's it's uh it's it's the best gift. And then for us as a couple doing it together and going back in class, uh going back to the dorm and uh it's fun.

SPEAKER_03 15:19

And having two separate living groups that we can combine.

SPEAKER_01 15:23

Yeah, you know, as amazing as it sounds, it could even be nerve-wracking, right? The fact that both of you are disconnected from the world for a period of three weeks together. And so that's why this journey of yours stands out for me, and I'm guessing for the listeners as well, because couples usually or business partners do it one at a time, but you all did it together, survived two units. Quite commendable.

SPEAKER_03 15:45

Yes.

SPEAKER_01 15:46

Another part of your journey is while you were both at OPM, the business school, Howard Business School, chose to write a case about your business. Could you talk a little bit about that, what that experience was like?

SPEAKER_02 15:58

Yeah. So we sat in an AI class about how to use data to improve your business. We we loved the person that was teaching it. We went to see her and see if we could enroll her as a researcher to help us in one of the key elements of our business, which is the matching algorithm. So therapy works because we match you with Christine, who is the right clinician for you, and then there is this magic between the two humans. And so, how do you match supply and demand is the core of the efficiency and your customer acquisition cost and your churn and your CAC2 LTV. And so we started to talk to her about her learning in matching immigrants with immigration resources in the US and what she had learned there. Totally different vertical, but same question. And then uh she put us in touch with another researcher that was very interested to peek under the hood in how we were doing things.

SPEAKER_01 16:56

And did your case get taught while you were at the program?

SPEAKER_02 17:00

No, no, no. The case was finished after.

SPEAKER_03 17:03

Yeah.

SPEAKER_01 17:04

You probably have to go back to to the school to participate as uh the business owners while it's being taught at some point? Not yet.

SPEAKER_03 17:12

But it it does speak to um the availability of the instructors of the class, you know, to be able to approach them, to have lunch with them, to sign up for their office hours, and to, you know, to follow your curiosity for your own business. And and they become so curious about your business and uh to to not give up that that opportunity of the one-on-one time. Because it can lead to so many, many great conversations and the re the researchers, all the research that's going on at Harvard Business School could lead to studies being done on your company.

SPEAKER_01 17:48

Guys, now that you all have built and you've learned from the company and your professional careers, what advice would you give your younger selves at the very start of the journey? And how do you think that would shape the way you lead today? Do you want to go first?

SPEAKER_03 18:00

Well, I mean, so I could have read, you know, the Harvard Business Review every month, or I could have read the textbooks and I never would have gotten the substance that I got, the the lived experience of the difference between leadership and managing or building and strategy and the case study method unique to Harvard Business School, I think was spoke so profoundly to me as a as a psychologist and how I learn and how I'm curious about solving problems. It was it was perfectly tailored to to my learning. So I I would have gone earlier. I would have, I would have done done, if not this program, maybe even Harvard Business School earlier.

SPEAKER_02 18:48

So the three things that I would say to myself are one, it's gonna be okay. You know, I I've lived most of my life thinking that a disaster the sky was falling, disaster was was coming. Every company I have start was gonna crash, and finding a lot of energy to avoid deaths. So it works, but but but you know, that's it's not a great way to live your life. So the first thing is it's gonna be okay. It's okay. Strangely, amazingly, it's okay. And it's okay because it's it's mostly about showing up, and I've spent most of my life showing up. A lot of the people I went to school or which paths I have crossed at some point in time have stopped showing up. Now, showing up means that 99% of what you try to do fails. It takes a warped sense of humor to be okay with that. But if you can take 99% no, you will get a yes, and you can build on it, and you can keep showing up on that yes, and then you can build amazing things. And so it's not so much about where are you from, which school you went to, but it's do you have the ability, do you have the ability to again and again show up and show up in good days and show up, show up in bad days and bad days or or hard? Really hard.

SPEAKER_01 20:05

Beautiful, thank you. The two of you all work together, you all went to business school together, uh part of the same cohort as well. How do you all find a balance uh between work uh and and taking some time out? Or is there a concept of balance?

SPEAKER_03 20:24

We observe Shabbat, so we take Friday night to Saturday night off, but that's it.

SPEAKER_02 20:28

So uh there is no life balance. We work non-stop, we work non-stop because we love to work, and and and um we we got a coach, we got an organization psychologist to help us at the beginning on how not to kill each other. Because at the at the beginning, she wanted to do everything. I wanted to do everything. And so at at the beginning, you gotta negotiate your lanes, and it's it's really hard. And yeah, the grand rule is we don't work seven days a week, we work six or even better, five days a week. And that has served us well.

SPEAKER_01 21:04

In closing, my only question would be Is there a book that you think you could talk to us about that might have influenced the way you think?

SPEAKER_02 21:10

So I love Unleashed, the Francis Fry book. I fell in love with Francis Fry. I think she's her class on not how not to be an asshole is the best business class of this program. And it and it's a really good topic for entrepreneurs and people that own business because it's really easy to fail there. So leadership as the art of of create of leading in your absence is is really uh a very profound subject. And um I think it's a fantastic book. I I I have it on my shelf. I'm reading another book of her, and so I'm I'm a I'm a devotee of Francis Fry. Chris?

SPEAKER_03 21:51

I kind of like the one that I just started. What the scale?

SPEAKER_02 21:57

Yeah, yeah, it's a really good book. It's called Scaling People and it's It's written by the Strife guy, and it's about how do you build the operating system of your company? With the what are the components of the operating system and how does it scale?

SPEAKER_03 22:10

This is the one that you were talking about. Move fast and fix things.

SPEAKER_00 22:15

That's an HBS professor as well, right? Yeah. That is the one.

SPEAKER_03 22:19

Yeah. And her wife. And then the one that Mark just got and I stole is by Claire Hughes Johnson, Scaling People Tactics for Management and Company Building. And it's it's really concrete, but talk about the that foundational structure that I said I was missing. Like now that I've had the scaffolding of the case study method, like I I think I have the capacity to now read this book and get a lot out of it. Wonderful.

SPEAKER_01 22:49

Thank you for sharing. Well, uh, and this has been a very pleasant conversation, a lot of takeaways. I appreciate both your times for making yourself available for this chat. Thank you. And uh come to see us in WordStark. Thank you, Christine and Mark. It's been a pleasure.

SPEAKER_00 23:04

Bye.