The Modern Therapist's Survival Guide with Curt Widhalm and Katie Vernoy

By Curt Widhalm, LMFT and Katie Vernoy, LMFT

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Description

The Modern Therapist’s Survival Guide: Where Therapists Live, Breathe, and Practice as Human Beings It’s time to reimagine therapy and what it means to be a therapist. We are human beings who can now present ourselves as whole people, with authenticity, purpose, and connection. Especially now, when clinicians must develop a personal brand to market their private practices, and are connecting over social media, engaging in social activism, pushing back against mental health stigma, and facing a whole new style of entrepreneurship. To support you as a whole person, a business owner, and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.

Episode Date
What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive intervention
01:15:21

What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive intervention

Curt and Katie chat about suicide assessment, safety planning, and how to keep clients out of the hospital. We reviewed the Integrated Motivational Volitional Model for Suicide, we talked about what therapists should be assessing for in every session, what strong assessment looks like (and suggested suicide assessment protocols), and why the least restrictive environment is so important when you are designing interventions and safety planning. This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about suicide assessment, safety planning, and intervention

We continue our conversation on suicide, progressing from risk factors (from last week’s episode) to how to assess and safety plan with the least intrusive interventions at the earliest stages.  

Review of the Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley

 

  • Continued to review the IMV model (graphic in the show notes at mtsgpodcast.com)

What should therapists assess for in every session, related to suicide?

“When clinicians are burnt out, when we have caseloads that are too big, when we aren't taking care of ourselves, we tend to [think], “Okay, this client is at a six, they can live at a six for a while,” which is absolutely true. And if they can [live with this level of suicidality], and they have the good factors that allow them to live there – great. It's just how close are they to that 7, 8, 9?” – Curt Widhalm, LMFT

  • Moderating motivational factors, which move clients from passive to more active suicidality (or the reverse)
  • Looking at what is keeping someone from being at risk for suicide (protective factors)
  • The importance of knowing our clients well before they move into the volitional phase
  • Understanding the clinician factors and putting structure around assessment

Assessment for Suicide

“Assessment is intervention.” – Curt Widhalm, LMFT

  • SAMHSA’s GATE protocol
  • Gather information using a structured assessment tool (Columbia Scale, LRAMP)
  • Looking at intention, means, plan as well as risk and protective factors
  • Moving into a safety plan
  • The importance of recognizing the human during the assessment (versus focusing only on the protocol or your liability)
  • Seeking supervision or consultation – don’t do this alone

The importance of using the least restrictive intervention for suicide

“There is a rupture in the therapeutic relationship when you are sending your client or facilitating a hospitalization against their will. It can save their lives …but that may not always be the case.” – Katie Vernoy, LMFT

  • The idea of “responsible” action
  • The range of options for keeping a client safe
  • Having a conversation with the client on how to avoid attempting suicide
  • The potential impacts of hospitalization, including trauma
  • The danger of hospitalizing someone who does not need this level of intervention
  • Additional intervention between sessions
  • The practicalities to set up your schedule and your practice to support your clients and your self
  • Additional risk factors (transition phases between providers)

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Simplified SEO Consulting

Have you spent countless hours trying to get your website just right and yet, it's not showing up on Google and it doesn't seem like anyone's able to find it? Simplified SEO Consulting has a unique solution. They've been training therapists to optimize their websites, so they show up better on Google for the past 4 years. But let's face it, with the busy schedules we all keep it can be hard to find the time to optimize your website even when you learn how. So, they are hosting a 16 day cruise in July 2023 going from LA to Hawaii and back. When you join them, you'll get intensive SEO education and coaching during the 10 days at sea. Most importantly, you'll have plenty of time to sit next to the pool and implement everything you've learned and then ask their team for feedback. Yes, it's the perfect excuse for a Hawaii vacation. But it's also a time to both learn about SEO and actually implement what you learn.

The upcoming cruise is a unique opportunity to learn to optimize your own website, have time to practice what you learn and the ability to get feedback from leading SEO professionals in our field.

To reserve your spot before it fills up, go to https://simplifiedseoconsulting.com/training-cruise-for-better-seo/ 

 

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

SAMHSA’s TIP with the GATE Protocol

COLUMBIA-SUICIDE SEVERITY RATING SCALE

LINEHAN RISK ASSESSMENT AND MANAGEMENT PROTOCOL (LRAMP)

References mentioned in this continuing education podcast:

Carmel, A., Templeton, E., Sorenson, S. M., & Logvinenko, E. (2018). Using the Linehan Risk Assessment and Management Protocol with a chronically suicidal patient: A case report. Cognitive and Behavioral Practice, 25(4), 449-459.

Goldman-Mellor S, Olfson M, Lidon-Moyano C, Schoenbaum M. Association of suicide and other mortality with emergency department presentation. JAMA Netw Open. 2019; 2(12):e1917571.

Interian, A., Chesin, M., Kline, A., Miller, R., St. Hill, L., Latorre, M., ... & Stanley, B. (2018). Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) to classify suicidal behaviors. Archives of suicide research, 22(2), 278-294.

Linehan, M. M., Comtois, K. A., & Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232.

 

Pinals, D. A. (2019). Liability and patient suicide. Focus, 17(4), 349-354.

Posner, K., Brent, D., Lucas, C., Gould, M., Stanley, B., Brown, G., ... & Mann, J. (2008). Columbia-suicide severity rating scale (C-SSRS). New York, NY: Columbia University Medical Center, 10.

Substance Abuse and Mental Health Services Administration (US); (2009. Addressing Suicidal Thoughts And Behaviors in Substance Abuse Treatment [Internet]. Rockville (MD): (Treatment Improvement Protocol (TIP) Series, No. 50.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK64022/

*The full reference list can be found in the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

Part 1: Risk Factors for Suicide: What therapists should know when treating teens and adults

Rage and Client Self-Harm: An interview with Angela Caldwell

Work Harder Than Your Clients

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Oct 03, 2022
Risk Factors for Suicide: What therapists should know when treating teens and adults
01:10:33

Risk Factors for Suicide: What therapists should know when treating teens and adults

Curt and Katie chat about suicide risk factors.  Suicide rates have been increasing across the nation and there is an increasing need for the mental health workforce to be prepared to assess and intervene with clients of all ages. We take an in-depth look at the risk and protective factors associated with suicidal ideology and behaviors in both teens and adults. We also lay the beginning foundations of a suicide model to help clinicians better understand and intervene with clients exhibiting suicidal thoughts. This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we explore what makes someone more likely to attempt suicide

We’ve talked frequently about suicide, but thought it would be important, especially during Suicide Prevention Awareness Month, to go more deeply into the risk factors that make someone more likely to attempt and complete suicide.  

What are the highest risk factors for suicide?

“Anxiety Sensitivity… the fear of the feelings of being anxious… is even more so correlated with suicidal ideation and suicide attempts than depression is.” – Curt Widhalm, LMFT

  • Defining acute, active suicidality (versus passive or chronic suicidality or non-suicidal self-Injury)
  • Going beyond the list of risk factors to how big of a risk each factor is for attempting or completing suicide
  • Exploring how impactful a previous attempt is on whether someone is likely to attempt of complete suicide
  • The importance of getting a complete history of suicidality and suicide attempts at intake
  • The impact of family members who have attempted or died by suicide
  • Alcohol and other substance use and abuse as an additive risk factor
  • Cooccurring mental disorders (eating disorders, psychosis and serious mental illness, depression, anxiety and anxiety sensitivity, personality disorders)
  • Child abuse history, especially folks with a history of sexual abuse history
  • Life transitions, especially unplanned and sudden life transitions
  • Owning a firearm makes you 50 times more likely to die by suicide
  • Racial differences in who is more likely to attempt or complete suicide
  • Living at a high elevation

What are additional risk factors for suicide specific to teens?

  • Early onset of mental illness
  • Environmental factors
  • Exposure to other suicides (social media, contagion)
  • Not being able to identify other options
  • Seeking control over their lives and lacking impulse control leading to suicide attempts
  • The importance of communication and the potential for a lack of communication
  • Bullying and lack of social support, without a way to escape due to social media and cell phones

What are protective factors when assessing for suicidality?

“Just because protective factors are present doesn't mean that they balance out risk factors [for suicide].”– Curt Widhalm, LMFT

  • Reasons for living, responsibility to others
  • Spirituality or attending a place of worship that teaches against suicide
  • Where you live based on cultural or societal factors
  • Having a children or child-rearing responsibilities, intact marriage
  • Strong social support, employment
  • Relationship with a therapist

 

Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley

 

  • Reviewing the model shown in the graphic in the show notes at mtsgpodcast.com

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Information on the ACEs Study

References mentioned in this continuing education podcast:

Bodell, L. P., Cheng, Y., & Wildes, J. E. (2019). Psychological Impairment as a Predictor of Suicide Ideation in Individuals with Anorexia Nervosa. Suicide & life-threatening behavior, 49(2), 520–528. https://doi.org/10.1111/sltb.12459

Borges, G., Bagge, C. L., Cherpitel, C. J., Conner, K. R., Orozco, R., & Rossow, I. (2017). A meta-analysis of acute use of alcohol and the risk of suicide attempt. Psychological medicine, 47(5), 949–957. https://doi.org/10.1017/S0033291716002841

Bostwick, C. Pabbati, J. Geske, A. McKean (2016) Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew Am. J. Psychiatry, 173 (11), pp. 1094-1100, 10.1176/appi.ajp.2016.15070854

Brådvik, L. Suicide risk and mental disorders. Int. J. Environ. Res. Public Health 2018, 15, 2028

Campisi, S.C., Carducci, B., Akseer, N. et al. (2020) Suicidal behaviours among adolescents from 90 countries: a pooled analysis of the global school-based student health survey. BMC Public Health 20, 1102. https://doi.org/10.1186/s12889-020-09209-z

Doyle, M., While, D., Mok, P.L.H. et al. Suicide risk in primary care patients diagnosed with a personality disorder: a nested case control study. BMC Fam Pract 17, 106 (2016). https://doi.org/10.1186/s12875-016-0479-y

Martin, M.S., Dykxhoorn, J., Afifi, T.O. et al. (2016) Child abuse and the prevalence of suicide attempts among those reporting suicide ideation. Soc Psychiatry Psychiatr Epidemiol 51, 1477–1484. https://doi.org/10.1007/s00127-016-1250-3

O'Connor RC, Kirtley OJ. The integrated motivational-volitional model of suicidal behaviour. Philos Trans R Soc Lond B Biol Sci. 2018;373

Stanley, I. H., Boffa, J. W., Rogers, M. L., Hom, M. A., Albanese, B. J., Chu, C., Capron, D. W., Schmidt, N. B., & Joiner, T. E. (2018). Anxiety sensitivity and suicidal ideation/suicide risk: A meta-analysis. Journal of consulting and clinical psychology, 86(11), 946–960. https://doi.org/10.1037/ccp0000342

Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019, March 14). Age, Period, and Cohort Trends in Mood Disorder Indicators and Suicide-Related Outcomes in a Nationally Representative Dataset, 2005–2017. Journal of Abnormal Psychology. Advance online publication. http://dx.doi.org/10.1037/abn0000410

*The full reference list can be found in the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

Rage and Client Self-Harm: An interview with Angela Caldwell

How to Understand and Treat Psychosis: An interview with Maggie Mullen

Navigating the Food and Eating Minefield: An interview with Robyn Goldberg

How Therapists Promote Diet Culture: An interview with Rachel Coleman

The Practicalities of Mental Health and Gender Affirming Care for Trans Youth: An Interview with Jordan Held, LCSW

Working with Trans Clients: Trans Resilience and Gender Euphoria: An interview with Beck Gee-Cohen

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Sep 26, 2022
How Therapists Can Manage a Sedentary Job: An interview with Celina Caovan, DPT
29:33

How Therapists Can Manage a Sedentary Job: An interview with Celina Caovan, DPT

Curt and Katie interview Celina Caovan about physical self-care for therapists. We talk about how to mitigate the impacts of a sedentary job as well as the benefits of physical therapy and consistent physical activity. We also look into what physical therapy is, how clients can advocate for it, and how therapists might collaborate to support the physical and mental health of their patients.

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Celina Caovan, DPT

Celina Caovan received both her undergraduate degree and Doctorate of Physical Therapy degree from the University of Southern California. She has been practicing in an outpatient orthopedic setting in the South Bay in California for the last two years and is a Certified Strength and Conditioning Specialist.

In this podcast episode, we talk about how therapists can take care of their bodies while working in a sedentary job

Many therapist friends of ours have described low back pain and challenges in maintaining physical health when much of the work we do is while sitting.

What should therapists know about physical activity and physical therapy?

“Physical therapists are trained movement experts… we can diagnose, we can treat using hands on skills, patient education, and then we prescribe individual exercise for a bunch of different injuries, the ultimate goal being to improve the way someone moves and emphasize injury prevention. And the cool thing about physical therapy: it can be an alternative to pain medication, in a society where they prescribe a lot of a lot of pain medication, and then surgery as well.” – Celina Caovan, DPT

  • There are a number of subspecialties in physical therapy to support all different elements of improving movement
  • The importance of moving outside of a sedentary job
  • US Department of Health guidelines on activity levels

What can therapists do to take care of themselves during the work week?

  • Getting out of the chair, some chair exercises
  • Stretching and gentle movements during the breaks between sessions
  • No drastic differences in activity from the work week to the weekend (i.e., avoid weekend warrior behavior, especially when extremely sedentary during the week_
  • Slowly increase activity and gradually increase cardio or resistance training
  • Stretching (static and dynamic), warming up, and cooling down

How can therapists think about physical therapy for their clients?

“Someone's physical and mental health – that’s interconnected… that mind body connection. And I think this would be a really great opportunity for us to create this interdisciplinary relationship where we can approach it from a physical and mental standpoint.” – Celina Caovan, DPT

  • Referrals and direct access to physical therapy
  • Psychoeducation and support for advocacy to obtain physical therapy
  • Chiropractors versus physical therapists
  • How physical and mental health therapists can collaborate to support patients

 

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Physical Activity Guidelines for Americans from the US Department of Health and Human Services

Beach Cities Orthopedics and Sports Medicine

Reach out to Celina Caovan, DPT: celinaDPT at gmail.com

Relevant Episodes of MTSG Podcast:

Managing Chronic Pain and Illness: An interview with Daniela Paolone, MFT

How Therapists Promote Diet Culture: An interview with Rachel Coleman, LMFT, CEDS

What You Should Know About Walk & Talk and Other Non-Traditional Therapy Settings Part 1, Part 2

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Sep 19, 2022
Therapists on the Hostage Negotiation Team and Supporting Police Work: An interview with Dr. Andy Young
31:02

Therapists on the Hostage Negotiation Team and Supporting Police Work: An interview with Dr. Andy Young

Curt and Katie interview Andy Young about hostage (crisis) negotiation and his work with SWAT and crisis negotiation in Lubbock, TX. Content warning: discussion of violence, suicide, and homicide. We talk about what therapists can do within police departments, the interplay between mental health and law enforcement, what that work looks like – especially when involved in crisis negotiation, and skills therapists need when working in these settings. We also look at trauma response and how it is handled when things go south.

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Dr. Andy Young

Dr. Andy Young has been a Professor of Psychology and Counseling at Lubbock Christian University since 1996 and a negotiator and psychological consultant with the Lubbock Police Department’s SWAT team since 2000. He also heads LPD’s Victim Services Unit and is the director of the department’s Critical Incident Stress Management Team. He has been on the negotiating team at the Lubbock County Sheriff’s Office since 2008 and is on the team at the Texas Department of Public Safety (Texas Rangers, Special Operations, Region 5). He is the author of, “Fight or Flight: Negotiating Crisis on the Frontline” and “When Every Word Counts: An Insider’s View of Crisis Negotiations.” He was recently added as a third author for the 6th Edition of “Crisis Negotiations: Managing Critical Incidents and Hostage Situations in Law Enforcement and Corrections”.

In this podcast episode, we talk about the role therapists can play in crisis negotiation

There have been many calls to defund the police and create roles for mental health professionals in law enforcement. Dr. Andy Young has already been doing this for 20 years. We talked with him about what that experience looks like.

What can therapists do for law enforcement?

  • Crisis counseling
  • Hostage or Crisis Negotiation support (advising on the negotiation)
  • Psychiatric consultation
  • Predicting violence or suicide, assessing subjects’ mental health

What is the interplay between mental health and law enforcement?

  • Police officers get 40 hours of active listening and mental health
  • Officers started out a bit stand-offish, reported increased mental load due to needing to protect mental health professionals at the scene
  • Finding value in taking mental health out of scope of law enforcement
  • There is a huge importance in developing relationship with the officers
  • Specialized training needed that can support integrating mental health providers into law enforcement teams

What does work look like for therapists in law enforcement and crisis negotiation?

  • Coaching on communication
  • Assessing the situation and the subject
  • Strategizing interventions to de-escalate the situation
  • Provide context and reassurance to law enforcement professionals
  • Hostage Negotiation calls are typically once to twice a month (and not every month).
  • There are successful outcomes 97% of the time

How do these law enforcement and mental health providers handle things when they go south?

“There's me and other people like me – therapists who understand the law enforcement culture, and even are trusted by the law enforcement culture – where officers will reach out for additional assistance if they believe that they need it [after a traumatic incident]. And of course, me being around just walking through the halls of the police department, inevitably, somebody will say, 'Hey, can I talk to you for a minute?' and then it gets personal”. – Dr. Andy Young

  • Crisis support
  • Critical Incident Stress Management
  • Mental health providers who are accepted within the law enforcement culture
  • The political, investigative and personal elements of a lethal force incident
  • Processing and debriefing within the team

What skills should therapists have to work with law enforcement and hostage negotiation?

“People get to make decisions for themselves. And we might be able to coach people on how to land the airplane, but they get to land the airplane themselves. And in my office, that's one thing. But out on the street where there's guns or elevated positions that we can jump off of or innocent people that we can kill. It's the same principle, but at its extreme, and it really tests a person about being able to apply that to yourself and your circumstances.” – Dr. Andy Young

  • Pragmatic and understanding the situation you’re in
  • Practical, knowing your own limits
  • Ability to manage emotional situations calmly
  • Navigating the extreme stakes out in the streets
  • Understanding law enforcement

The benefit of having a mental health provider on a hostage negotiation team

  • Training the team on mental health concerns
  • Improving “batting average” on successful outcomes
  • The importance of a well-trained team

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
www.DrAndyYoung.com

Relevant Episodes of MTSG Podcast:

Treating First Responders: An interview with Yael Shuman, LMFT

Special Series: Psychiatric Crises in the Emergency Room

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Sep 12, 2022
Why Therapists Shouldn’t Be Taught Business in Grad School
37:29

Why Therapists Shouldn’t Be Taught Business in Grad School

Curt and Katie debate whether graduate school programs for therapists should include business education. We look at the pros and cons for including business education for students, specifically identifying a mismatched developmental level, bloated curriculums, and underutilized career resources. We also look at the responsibility graduate schools have to their students to be employable or to be able to create a sustainable business.  

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about whether clinical grad programs should include business education

We have seen marketing that highlights that business isn’t taught in grad school (and have done a lot of it ourselves). We discuss whether it actually should be included.

What is already included in grad school for therapists?

  • A large number of clinical courses required for graduation
  • Career centers and other business resources may be available, but not used

What career or business resources should therapists get through graduate school?

  • Career centers with up-to-date relevant employment resources
  • Potentially an optional class or workshop for how to run a business

Why shouldn’t business education be added to clinical programs?

“The timing of it just isn't right. Like, yeah, these are ideas that can be introduced, but the practicalities of it, in my experience, just aren't developmentally where a lot of grad students are… I don't think that [teaching someone to run a business] at a developmental time when people aren't capable for it or aren't ready for it – or legally not allowed to put those things in place – it just ends up being so far off that it's not a practical sort of training thing.” – Curt Widhalm

  • Accreditation bodies don’t access for employability, so programs won’t focus their attention
  • The increasing number of credits required to become a therapist
  • Developmentally inappropriate timing for what therapists are able to do when they graduate

What would business education look like if it were included in graduate programs?

“I'm not ready to let the grad schools off the hook for their responsibility to students. I feel like they are responsible to students to adequately prepare them for the job.” – Katie Vernoy

  • Potentially lackluster participation due to overwhelm
  • The importance of introducing what clinicians will actually face
  • Seminar versus a full course
  • Orientation to job options and business basics

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Saving Psychotherapy by Dr. Ben Caldwell

 

Relevant Episodes of MTSG Podcast:

I Just Graduated Now What? Career Advice for New Mental Health Clinicians

The Clinical Supervision Crisis for Early Career Therapists: An Interview with Dr. Amy Parks

The Fight to Save Psychotherapy: An Interview with Dr. Ben Caldwell

Why Therapists Quit

Career Trekking with MTSG: An interview with Marissa Esquibel, LMFT

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Sep 05, 2022
What Goes in Your Notes? Interstate therapy practice and documentation for clients considering abortion or gender affirming care
01:07:57

What Goes in Your Notes? Interstate therapy practice and documentation for clients considering abortion or gender affirming care

Curt and Katie chat about documentation and practice questions related to abortion or gender affirming care when providing therapy to folks in states where these types of medical care are banned or will be banned soon. We look at medical documentation privacy concerns (related to HIPAA and the 21st Century Cures Act), how therapists avoid “aiding and abetting” a client to get an abortion, what to include in your notes, and special considerations related to duty to warn and child abuse reporting. This is a law and ethics continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we explore post-Roe documentation for therapists

We’ve heard a lot of questions about what therapists should do now that Roe has been overturned. We decided to dig into practice and documentation guidelines to help modern therapists navigate the changing times.

Medical documentation privacy concerns with interstate practice and the new abortion bans

“Your records aren't as private as you think that they are.”  - Curt Widhalm, LMFT

  • HIPAA and the 21st Century Cures Act
  • The impact on clients who move from safe haven states to states with abortion bans
  • The impact of the Counseling Compact (and similar mental health compacts) and how many participating states have trigger laws to ban or limit abortion
  • Paying attention to jurisdictional differences and where the client lives
  • Who qualifies as a HIPAA covered entity?
  • Psychotherapy (Process) Notes versus Progress Notes
  • Psychotherapy notes are not defined the same and/or protected in every state
  • The impact of civil law suits on confidentiality of process notes
  • The huge challenge of information blocking and who may pass along your treatment information
  • Talk to an attorney or your professional organization when subpoenaed

How do you avoid “aiding and abetting” a client to get an abortion during mental health treatment?

  • Processing feelings and helping client to make their own decisions
  • Aiding and abetting can include telling them where to go, encouraging them to get an abortion, or providing practical support (like money or a ride)
  • How to provide resources without aiding and abetting
  • Self-empowerment and clients making their own decisions
  • Liability and risk in practice (check with your malpractice insurance)
  • Whether/how you let your clients know where you stand on the overturn of Roe v Wade

What do you include in your notes when talking about abortion and gender affirming care?

“You need to give meaningful consideration to what goes in [the mental health] record and you also want to be clear in what you're talking about with your clients. So, that way you're not unintentionally aiding and abetting a client who's living in one of these states where an abortion ban is currently in place.” – Curt Widhalm, LMFT

  • What is relevant to your treatment goals?
  • Documenting progress toward treatment goals
  • Creating a policy related to medical decision-making
  • Phrases that you can use to briefly describe what is happening in session
  • How much to document and the recommendation to be less specific in progress notes when discussing medical decisions

The special considerations related to duty to warn and child abuse reporting when talking about abortion and gender affirming care

  • No case law to guide us here
  • The difference between permissive versus required reporting
  • Vast differences across the states with all of the different pieces
  • HIPAA says that we should not report, but we will be impacted by state laws
  • Recommendations to pay attention to what is happening in the states where you practice and to identify advocacy opportunities to protect information, safe haven laws

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

21st Century Cures Act

Person-Centered Tech (help to become HIPAA compliant)

What the End of Roe v. Wade Does (and Doesn’t) Mean for Your Relationship With Your Therapist | by Monika Sudakov | Jul, 2022 | Medium

Frequently asked questions about abortion laws and psychology practice (apaservices.org)

Information blocking FAQs 

HIPAA, Psychotherapy Notes, and Other Mental Health Records by Holland and Hart

Additional references mentioned in this continuing education podcast:

Holloway, J.D. (2003). More protections for patients and psychologists under HIPAA. American Psychological Association. https://www.apa.org/monitor/feb03/hipaa#:~:text=Under%20HIPAA%2C%20psychotherapy%20notes%20are,can%20contain%20information%20that%20is

Stranger, K. (2020). HIPAA, Psychotherapy Notes, and Other Mental Health Records. https://www.jdsupra.com/legalnews/hipaa-psychotherapy-notes-and-other-42359/

U.S. Department of Health and Human Services (2013). Summary of the HIPAA Privacy Rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html#:~:text=The%20Privacy%20Rule%20protects%20all,health%20information%20(PHI).%22

Zubrzycki, C. (2022) Abortion’s Interoperability Trap: How the Law of Medical Records Will Facilitate Interstate Persecution of Contested Medical Procedures, and What to Do about It. Yale Law Journal Forum, Forthcoming, http://dx.doi.org/10.2139/ssrn.4147900

 

*The full reference list can be found in the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

What Therapists Need to Know about Abortion and Termination for Medical Reasons: An Interview with Jane Armstrong

The Practicalities of Mental Health and Gender Affirming Care for Trans Youth: An Interview with Jordan Held, LCSW

Working with Trans Clients: Trans Resilience and Gender Euphoria: An interview with Beck Gee-Cohen

Is the Counseling Compact Good for Therapists?

Now Therapists Have to Document Every F*cking Thing in Our Progress Notes?

Noteworthy Documentation: An interview with Dr. Ben Caldwell (on the 21st Century Cures Act)

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Aug 29, 2022
Speaking Up for Mental Health Awareness: An Interview with Metta World Peace
58:50

Speaking Up for Mental Health Awareness: An Interview with Metta World Peace

Curt and Katie interview Metta World Peace about his efforts toward mental health advocacy, awareness, and access. We explore what led him to speak up, the challenges he’s faced as a public figure, his solutions for prevention, and how his businesses and philanthropy support mental health.

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Metta World Peace

Metta World Peace played professional basketball for 19 years. He won the NBA World Championship with the LA Lakers in June 2010 and received the J. Walter Kennedy Citizenship Award – the NBA’s highest citizenship and community service honor – in April 2011. He was selected to the 2005-06 NBA’s All-Defensive Team, was voted by the media as 2003-04 NBA’s Defensive Player of the Year and was the only man with 271 steals in his first two seasons in the NBA, breaking Michael Jordan’s record. His autobiography, “No Malice: My Life in Basketball” was released in May 2018 with Triumph Publishing and a documentary on his life in basketball, “Ron Artest: The Quiet Storm” was released on Showtime in May 2019. World Peace is currently pursuing entrepreneurial projects including the XvsX Sports project he cofounded in 2017 and an NFT project, Meta Panda Club, to bring decentralized basketball community to the masses.

World Peace is also known as a prominent mental health advocate, pop culture personality, philanthropist, and media favorite. He raffled off his 2010 NBA World Championship Ring with the proceeds going to his nonprofit, Xcel University (now known as Artest University). The online ring raffle raised more than $650,000. Funds were donated to nonprofits in 5 cities that provide mental health therapists and mental health services to their communities, and to provide scholarships to underprivileged youth in the New York City area.

World Peace was part of the 13th season of ABC’s Dancing With The Stars, a contestant on CBS’s first edition of Celebrity Big Brother, as well as the CBS competition show, Beyond The Edge. He is active in entrepreneurial endeavors, serves as an advisor to several tech start ups, and seeks to help other basketball players who have aspirations for a pro career with his app and league, XvsX Sports. For more information, please visit https://www.xvsxsports.com/, https://metapandaclub.com/, and https://artestuniversity.org/.

In this podcast episode, we interview Metta World Peace about..

Curt and Katie spent an afternoon chatting with Metta World Peace, exploring his work to reduce mental health stigma. We’re excited to share that conversation with you.   

Why did Metta World Peace start speaking about his mental health?

“I've experienced so many things – you know you’re playing basketball [as a kid], and you got to duck under the bench, people shooting. Sometimes you got to go to the game with guns in your bag, you know, different things like that, to make sure everything's cool. And that's just that's just not life. Life is tag. Life is freeze tag. Life is… hopscotch when you're a child… life is learning. That's life. Kids should be outside playing in parks.” – Metta World Peace

  • Metta shared his story growing up
  • The Crack Epidemic and the impact on his neighborhood
  • The challenges of incarceration, lack of education, and access to resources
  • Building a shell to protect yourself on the streets
  • What you learn and practice in the neighborhood he grew up in
  • The role of history and the impact of slavery on mental health of generations of Black people
  • The number of friends who are incarcerated
  • The role of “chemical imbalance” in the mental health landscape and the family members who have dealt with more serious mental illness
  • Metta’s desire to give back to the mental health community

How Metta World Peace is working to solve the problems that lead to poor mental health

  • The meaning of his name and why he changed it
  • Coming together with all types of people
  • Pushing back on separation and division or divisive statements
  • No guns or drugs allowed in my neighborhood
  • Challenging what has been defined as “life” in his neighborhood
  • The lack of connecting resources (like parks) in all neighborhoods
  • The importance of play and letting kids be kids

The challenges that Metta World Peace faces in putting forward his message

“I'm a colorful, I love comedy. I like to do silly stuff. It's just fun to me, honestly. But then people want to put me on television to do something silly. But when I want to do something meaningful, they don't want to do that programming... that's why I'm so vulnerable, honestly, because I don't know how else I'm going to get it out to the to the world.” – Metta World Peace

  • Describing self as emotional and colorful
  • Needing to boost his confidence
  • Mental health stigma before his first disclosure (thanking his therapist in 2010)
  • How people perceive Metta versus how he sees himself interacting in the world

Metta World Peace’s vision for the future

  • Everyone has access to mental healthcare
  • Everyone has a chance to have a good life
  • We try to understand each other and what motivates them, what they are going through
  • People coming together to improve society
  • Parenting and partnership training in schools
  • Putting parks in every neighborhood so kids can play, connect, and be kids

What Metta World Peace is doing now

“Sometimes it's too much [speaking about mental health], you know, sometimes I'm too vulnerable, and it hurt me a lot. Because I'm telling people where I'm from, I tell people how I live.” – Metta World Peace

  • After retirement, Metta is focusing on spending time with his children, partner
  • Speaking up to address mental health disparities
  • Sharing his story to shine a light on the challenges he has faced
  • His desire to do something powerful to make a difference
  • Partnering with OOTify to support mental health access
  • Business endeavors to support philanthropy for mental health
  • Supporting other businesses to be successful
  • Artest Management Group: Embedding philanthropy into all of the businesses Metta World Peace supports
  • XvsX Sports helping athletes to get discovered, compete, and coach

 

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
https://www.xvsxsports.com/

https://metapandaclub.com/

https://artestuniversity.org/

OOTify

Relevant Episodes of MTSG Podcast:

Therapy as a Political Act: An interview with Dr. Travis Heath

Antiracist Practices in the Room: An interview with Dr. Allen Lipscomb

Being a Therapist on Both Sides of the Couch: An interview with Rwenshaun Miller

Let's Get Political: An interview with Heather Walker Janz

Getting Personal to Advocate for Compassion, Understanding, and Social Justice: An interview with James Guay

Therapy of Tomorrow: An interview with Dr. Paul Puri M.D.

What to Know when Providing Therapy for Elite Athletes (CE podcourse)

What Can Therapists Say About Celebrities? The Ethics of Public Statements (CE podcourse)

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Aug 22, 2022
Infant and Early Childhood Mental Health: An Interview with Dr. Barbara Stroud
36:54

Infant and Early Childhood Mental Health: An Interview with Dr. Barbara Stroud

Curt and Katie interview Dr. Barbara Stroud on infant and early childhood mental health. We explore what therapists need to know about working with very young children, including the latest brain science and the very earliest developmental stages. We talk about the importance of children being safe, seen, heard, and helped. We also look at the importance of culture and how to support under-resourced families.  

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Dr. Barbara Stroud

Barbara Stroud, PhD, is a licensed psychologist with over three decades worth of culturally informed clinical practice in early childhood development and mental health. She is a founding organizer and the inaugural president (2017-2019) of the California Association for Infant Mental Health, a ZERO TO THREE Fellow, and holds prestigious endorsements as an Infant and Family Mental Health Specialist/Reflective Practice Facilitator Mentor. In 2018 Dr. Stroud was honored with the Bruce D. Perry Spirit of the Child Award. Embedded in all of her trainings and consultations are the activities of reflective practice, demonstrating cultural attunement, and holding a social justice lens in the work. Dr. Stroud’s book “How to Measure a Relationship” [published 2012] is improving infant mental health practices around the globe and is now available in Spanish. Her second book, an Amazon best seller, “Intentional Living: finding the inner peace to create successful relationships” walks the reader through a deeper understanding of how their brain influences relationships. Both volumes are currently available on Amazon. Additionally, Dr. Stroud is a contributing author to the text “Infant and early childhood mental health: Core concepts and clinical practice” edited by Kristie Brandt, Bruce Perry, Steve Seligman, & Ed Tronick.

Dr. Stroud received her Ph.D. in Applied Developmental Psychology from Nova Southeastern University, and she has worked largely with children in urban communities with severe emotional disturbance.  Dr. Stroud’s professional career path has allowed her to work across service delivery silos supporting professionals in mental health, early intervention (part c), child welfare, early care and education, family court staff, primary care, and other arenas. She is highly regarded and has been a key player in the inception and implementation of cutting-edge service delivery to children Prenatal to five and their families; her innovative approaches have won national awards. More specifically, Dr. Stroud is a former preschool director, a non-public school administrator, director of infant mental health services and agency training coordinator. She has held an adjunct faculty position at California State Long Beach and maintained a faculty position in the Infant-Parent Mental Health Fellowship for 12 years. Currently, Dr. Stroud’s primary focus is professional training and private consultation from an anti-racist lens, with a focus on social justice, in the field of infant mental health. Dr. Stroud remains steadfast in her mission to ‘changing the world – one relationship at a time’.

 

In this podcast episode, we talk about mental health services for infants and young children

Curt and Katie continue to identify gaps in typical therapist training. One such gap is working with children 0-5. We reached out to Dr. Barbara Stroud, expert in infant and early childhood to help us learn what therapists need to know about this age group.  

What is infant and early childhood mental health?

“What I often say to parents and providers is, it's our job to be the bigger cortex for the dysregulated midbrain. So, your little kid is not bad, they're not misbehaving, their dysregulated midbrain is doing the best it can. And we have to step in and be the cortex that holds that dysregulation and nurtures them through this process.” – Dr. Barbara Stroud

  • Looking at big feelings and social and emotional development
  • The current brain science that is impacting infant and early childhood mental health
  • How adults impact infant developing brains

What are the basics that therapists should know when working with children under 5 years old?

  • The importance of dyadic therapy
  • Parent training
  • Social emotional developmental stages
  • The damage of punishment on the development of an authentic self

What infants need to love themselves, have healthy development

“Let me give you something that I give parents and I give childcare providers and I give therapists as a way of thinking about one simple thing you can do and always remember that will support your child's social emotional health: keep them safe, make them feel seen, heard, and helped.” – Dr. Barbara Stroud

  • Infants want to be safe, seen, heard, and helped
  • Co-regulation and holding the big feeling with the child
  • The impacts of this work on adults
  • Transgenerational work – we treat the parent in the way that we would like the parent to treat the child
  • How to support parents in healing their own wounds

Therapy Interventions for infants and children under five years old

  • Play therapy is complex and advanced and requires training and supervision
  • Before children can think symbolically or have words, play is not effective
  • Attunement and attachment work

The impact of the pandemic on social emotional development

  • Developmental delays seen in research of kids related to the pandemic
  • The way children can catch up developmentally
  • The impact of parents’ stress responses on availability
  • How the lack of interaction with age-mates impacts development
  • The responses to stress based on these delays

Cultural impacts on early childhood development

  • Questions to ask about cultural and family traditions
  • The stories to explore and the importance of stories and practices
  • How to explore areas of inequity and disparities
  • Understanding our power as professionals

Interventions for families with very young children

“We can take everyday tasks and turn them into not just nurturing moments, but therapeutic moments… take nurturing tasks that parents have to do already (it's already something they're going to do) and turn it into a therapeutic moment.” – Dr. Barbara Stroud

  • Helping families to identify what they are able to do to make changes
  • The importance of predictability for families with a lot of chaos
  • How therapists without kids can work with parents
  • How parenting is an individual journey
  • The importance of loving kids and being emotionally available to kids

 

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
drbarbarastroud.com

Dr. Barbara Stroud | Changing The World One Relationship at a Time

Using Reflective Practice to Examine Microaggressions

The ABC's of Trauma with Dr. Chandra Ghosh Ippen

https://mcsilver.nyu.edu/ttac-deconstruct-racism/

YouTube: Dr. Barbara Stroud

Facebook: Barbara Stroud Training

LinkedIn: Dr. Barbara Stroud

https://profectum.org/

Relevant Episodes of MTSG Podcast:

Crafting Your Authentic Message: An interview with Mercedes Samudio, LCSW

Navigating Pregnancy as a Therapist: An interview with Emily Sanders, LMFT

Infertility and Pregnancy Loss: An interview with Tracy Gilmour-Nimoy, LMFT, PMH-C

Field-Based Private Practice: An Interview with Megan Costello, LMFT

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Aug 15, 2022
What Maslow Missed in his Hierarchy of Needs - The Native Self Actualization Model: An Interview with Dr. Sidney Stone Brown
57:16

What Maslow Missed in his Hierarchy of Needs - The Native Self Actualization Model: An Interview with Dr. Sidney Stone Brown

Curt and Katie interview Dr. Sidney Stone Brown on the Native Self-Actualization Model. We look at Abraham Maslow’s work, which was created after spending time with the Blackfoot people as well as how his Hierarchy of Needs supports greed and capitalism. We also talk through indigenous wisdom and how Dr. Brown incorporated their lifestyle and teachings into her work on the Native Self-Actualization Model. She emphasizes the power of altruism, reciprocity, and working together collaboratively.

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Dr. Sidney Stone Brown, LPC

Sidney Stone Brown was born in Kalispell Montana, and is an enrolled member of the Blackfeet Indian Nation of Browning Montana. She was raised on / near her reservation until 1955, living in her great grandmother’s log house with her parents, great uncle, brother and older sisters. They had no running water or indoor toilets; the house was heated with oil and light by kerosene lanterns until 1950.  Dr. Brown’s family relocated to Coos Bay Oregon when their reservation faced termination in 1955.  Thereafter Dr. Brown attended west coast schools.  She attended 30 different schools between first grade and graduation at Oregon State University in 1974.

Dr. Brown worked her way through college and was employed by her tribe as an employment counselor, where she met a resident psychologist working at the tribal Hospital and became interested in Psychology. Near completion of her master’s program she contracted with  1) the  University of Minnesota developing  community action teams for the Red Cliff Reservation, 2) a Lakota CAP agency in Rapid City South Dakota acting alcohol program director and 3) the University of Utah (Montana Wyoming) Alcohol Counselor Trainer and 4)  became permanent employment as director of NARA 1974.  The program was originally funded at $81,000 and in ten years was 1.2 million.  NARA (1981) won a national recognition award for program excellence and it was noted at the presentation in New Orleans that the model (Native Self Actualization) she developed was the most innovative cross-cultural model ever submitted to the National Council on Alcoholism since the awards began in 1946.

She has served on many other non-profit boards, appointed a member of the (ADAMHA) Alcohol and Drug Abuse Mental Health Administration Minority Advisory Committee (1974-1976).  She lobbied for Indian and minority services at the Oregon State Legislature subcommittees, and before the US Senate.  she helped form the board and helped develop the certification criteria for NW Indian Alcohol Drug Counselor Certification Board.

In 1989 she shifted her career emphasis from administration to clinical services receiving 3 years of clinical supervision at a community mental health center and a residential treatment center to obtain licensure (LPC and NCC-MAC).  Later she was mentored to be a CQI coordinator when employed at a JCAHO certified facility in Newberg Oregon. The program won re-accreditation with accommodation the second year of my employment.  She was admitted to the spiritual/psychology integration program at George Fox University George Fox for fall 2001. 

Her clinical work with Native people convinced her she had to understand the impact of religion abuse and abuse by clergy.  She is committed and determined to fulfill her goals to mentor the next generation of minority students and contribute to the literature and research that supports good practices for Native Americans. 

In this podcast episode, we talk about The Native Self-Actualization Model

Most of us learn Maslow’s Hierarchy of Needs, but did not hear the story about his time with the Blackfoot Tribe. There is more and more evidence that he took Native teachings and transformed it to match our individualistic, capitalistic society. We reached out to Dr. Brown to help us gather some of the history and the true wisdom about what actualization actually looks like.

How has native teaching impacted psychology?

  • Erickson and Jung studied with different tribes
  • Maslow studied with the Blackfoot people before creating his Hierarchy of Needs
  • Maslow did not publish or acknowledge the work of the Blackfoot tribe
  • Maslow’s work was for corporations

What did Maslow find when studying Native people?

  • Most people were secure (versus the high percentage of folks in poverty on the East Coast)
  • He moved from behaviorist to humanist
  • Learned the way of life with the Blackfoot Tribe

What is the Native Self-Actualization Model?

“Our world is suffering, people are suffering, because as we grow, and as we live in this world, we see the disparities. And it was never meant that just a few could have extreme wealth, at the expense of everyone else. Every person has a place and a purpose. And security is inherent in indigenous communities.” – Dr. Sidney Stone Brown

  • Inverted Lodge or Teepee (turning Maslow’s hierarchy of needs upside down)
  • The inherent purpose or promise babies come into the world with
  • The philosophy of Indigenous People
  • The importance of culture and altruism

“When I learned what the Blackfoot people were teaching [Abraham Maslow], I felt the world needed to know that we can look at this differently. Because right now that hierarchy of needs is causing harm. Just a few people being able to be actualized. And I would like to believe that everyone can be actualized.” – Dr. Sidney Stone Brown

What has impacted Native mental health?

  • Clement Bear Chief’s concept of the holes torn through Native communities
  • The sexualization and objectification of Native women
  • The need for protection people, earth, animals
  • The story of the Blackfoot relationship with the buffalo
  • The commonality of the indigenous experience
  • Everything that was taken from Native people creating holes
  • How to incorporate indigenous practices and teachings to support mental health treatment

Important Takeaways

“I also want to remind people that I'm doing this because Maslow didn't. I'm doing this because it's possible now. I don't think they would have listened to Maslow if he tried to explain what he learned from the Blackfoot people, so it's time and we need to help each other and teach each other.” – Dr. Sidney Stone Brown

  • The importance of intergenerational knowledge
  • It is essential that indigenous wisdom and way of life survive
  • The power of altruism and reciprocity
  • We all are human beings and need to take care of each other

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Facebook Page: Transformation Beyond Greed

TranformationBeyondGreed.com

Interviews of Dr. Brown

To get the book now, contact Dr. Sidney Stone Brown: drstonebrown-at-gmail.com

New Publisher for the Book Coming Soon!

Relevant Episodes of MTSG Podcast:

Therapy as a Political Act: An interview with Dr. Travis Heath

The Person of the Therapist: An Interview with Dr. Harry Aponte

Bridging Cultural and Communication Differences in a Bilingual Psychotherapy Practice: An Interview with Dr. Carmen Roman

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Aug 08, 2022
What Therapists Need to Know about Abortion and Termination for Medical Reasons: An Interview with Jane Armstrong
40:38

What Therapists Need to Know about Abortion and Termination for Medical Reasons: An Interview with Jane Armstrong

Curt and Katie interview Jane Armstrong, LCSW, a clinical social worker in Texas, about terminating a wanted pregnancy for medical reasons. We look at the impacts of the overturn of Roe v Wade on reproductive care. We also dig into what termination for medical reasons (TFMR) is, how society stigmatizes these parents, and what therapists can do to effectively support clients facing this decision and the outcome of TFMR.

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Jane Armstrong, LCSW-S, PMH-C

Jane is a termination for medical reasons (TFMR) mom, native Texan, & clinical social worker certified in perinatal mental health. Following the birth & death of her first child, Frankie, through TFMR, Jane opened Both/And Therapy, PLLC to provide individual therapy & support groups to other TFMR parents. These services aim to support clients through the unique barriers & grief of ending a wanted pregnancy, particularly in the state of Texas where such care is no longer accessible. She’s passionate about building community, eliminating shame, & honoring grief for TFMR families.  

In this podcast episode, we talk about Termination for Medical Reasons (TFMR)

In the wake of Roe v. Wade being overturned, we reached out to Jane Armstrong, LCSW-S, PMH-C who specializes in TFMR and is based out of Texas, a state with some of the biggest barriers to this type of medical, reproductive care.

What are the clinical impacts on individuals who are considering or who have had an abortion?

  • Trauma related to pregnancy as well as abortion
  • The differences between ending wanted and unwanted pregnancies
  • The shame – societal and internalized

What therapists can get wrong when interacting with the topic of abortion

  • Unexamined bias related to abortion
  • TFMR – is baby loss and TFMR parents are entitled to grief
  • Disenfranchised grief and traumatic loss

The impact of anti-abortion legislation on patients considering abortion and TFMR

  • Lack of access to all types of medical care
  • Logistics related to getting access to medical care
  • The emotional impact of continuing to carry a pregnancy when it is known that the baby will die
  • How late parents can find out about medical concerns that mean that TFMR is indicated
  • The lack of time to make a decision

What is Termination For Medical Reasons (TFMR)?

“These are things [a health issue with the pregnant person or with the baby leading to TFMR] that may be fatal, it may not be. A lot of them you may not know, but you do know that there is the potential for tremendous suffering.” – Jane Armstrong, LCSW

  • Terminating a pregnancy due to health issues with the pregnant person or with the baby
  • For the pregnant person: fatal Hyperemesis Gravidarum, requirement for treatment, mental health conditions
  • For the baby: 12 week genetic screenings or subsequent testing, scans, etc. can point out chromosomal abnormalities, neural tube deficits

“In my own experience, we did do an amniocentesis, but we knew that we likely wouldn't get the results until after my pregnancy had ended, because it would be typically about two weeks, which would have pushed us over the limit in our state. So, there is a very loudly ticking clock over most of these parents on what should be – and is – the most important decision they've ever made. And it leaves very little room for compassion for the time these parents need to research and get second opinions and really understand what this diagnosis means.” – Jane Armstrong, LCSW

How can therapists work with TFMR clients?

  • The conflict between the laws and a clinician’s own ethics
  • Make sure your clients know you will be a support resource to them
  • The importance of the client being able to tell their story
  • Recognizing that TFMR is typically not talked about and opening space for these clients
  • Trauma, grief, loss – sitting with the client with their hard stuff
  • Helping clients to make this impossible decision
  • Affirming parenthood and the challenge of the decision
  • Decision versus “choice” and the ways in which bias can enter the conversation about decision-making

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Jane on Instagram: TFMR Social Worker  Both And Therapy

Jane Armstrong, LCSW TFMR Social Worker – Both And Therapy Website

Resources for TFMR

Statement from Planned Parenthood:

Attributable to Dr. Meera Shah, Chief Medical Officer of Planned Parenthood Hudson Peconic & National Medical Spokesperson at PPFA 

The Supreme Court has taken away our constitutional right to abortion. Any person who believes in and values a person’s inherent right to control their own bodies, their lives, and their futures recognizes this decision for what it is: a disgrace to our society, to our health care system, and most importantly, to patients.

This decision robs our right to control our bodies and personal health care decisions, giving it to lawmakers and leaving millions without access to safe, legal abortion. Overturning Roe means dozens of states could swiftly move to ban abortion — including 13 states with laws that will go into effect immediately or shortly thereafter. That’s half the country where people may no longer have power over their own bodies and their own lives. 

We know the harm that will come from this decision because we’ve seen it play out in Texas: People who do not have access to the financial resources and support they need to travel out of state are forced to carry pregnancies against their will, and some will seek abortion outside of the health care system. Where you live should not determine your ability to control your reproductive future.



There’s no one way that a person feels emotionally before, during, or after having an abortion — their feelings are unique to them. But we know that being denied an abortion can cause physical harm. And we also know that being forced to continue an unintended pregnancy can cause financial, mental, and emotional harm. People from Black, Latino, Indigenous, LGBTQ+, and other communities historically targeted by racism, bias, and discrimination will disproportionately feel the effects of abortion bans and restrictions.

This might feel like a scary and confusing time. But while we are devastated, we are not deterred. Abortion is health care, and as the nation’s leading provider of sexual and reproductive health care for all, Planned Parenthood is committed to meeting the health care needs of as many people as possible. 

This is a crisis moment for abortion access. Organizers, advocates, providers, and patients need supporters and fellow providers across broad disciplines to channel outrage into action and send a clear message: We won’t back down. Here are some specific ways listeners can take action in the fight to protect our right to control our own bodies:

  • Attend a Decision Day Mobilization by visiting bansoff.org and clicking “events”
  • Give to Planned Parenthood organizations and abortion funds, and
  • Share why you fight for abortion access with #BansOffOurBodies and #WhateverTheReason by visiting bansoff.org and clicking “get involved”, then “share your story” 

Relevant Episodes of MTSG Podcast:

Infertility and Pregnancy Loss

Therapy for Intercountry Transracial Adoptees

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Aug 01, 2022
Therapy for Executives and Emerging Leaders
01:17:45

Therapy for Executives and Emerging Leaders

Curt and Katie chat about how therapists can support leaders. We look at optimal leadership, leadership identity development, barriers for emerging leaders, challenges that executives face, and how therapists can support these leaders. We explore specific interventions and career assessment questions. This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we explore how therapists can help leaders

During times of turmoil - like a global pandemic, an unstable economy, and social unrest - we want to be able to rely on our leaders to help us weather the storm. We look to our employers, our legislators, and our community leaders to solve problems and remain calm. But who supports our leaders? It’s important for therapists to understand leadership and the unique challenges that leaders face, so they can help. Further, therapists must be available to provide support to emerging leaders who are coming from much more diverse backgrounds and perspectives who may need help navigating a system that doesn’t always accept them or align with their lived experiences. We talk about leader identity development and how leaders develop over time. We look at common barriers and challenges for leaders at all stages of development as well as suggested interventions to address these needs.

What do therapists get wrong when working with leaders?

“We may be hindering folks that we don't see as leaders based on what we know about them: either their identity and the kind of the societal bias, or based on what we know about how much they're struggling. And so, we won't be able to help these folks move into these positions of leadership and help them elevate themselves in that way.” – Katie Vernoy, LMFT

  • Therapists don’t include career assessments and leadership assessment
  • Understanding the interrelation between work and mental health
  • Bias related to stereotypical leaders and not seeing leadership where it shows up outside of able-bodied, tall, white men
  • The calm, peaceful, work-life balance versus optimal performance and ambition
  • Cosigning on poor work behavior and overwork

What is good leadership?

  • Leadership can be taught and can be beneficial for every client
  • Concepts of leadership as a process and a position
  • Interdependent, collaborative
  • Servant Leadership
  • Transformational Leadership

What does leadership identity development look like?

  • The 6 stages of the model created by Komives, et al.
  • Moving from identifying leaders, understanding positional leadership, then moving to more of a process and interdependent relationship
  • How leadership identity development impacts adult clients

What impacts emerging leaders?

  • Identities, especially marginalized identities
  • Relationships with authority figures
  • Resources, privilege within typical leadership development opportunities during childhood and early adulthood
  • Relational trauma, boundaries, communication
  • Marginalized identities and stereotypes with no sure-fire way to perform acceptably
  • Lack of safety and empowerment

Career and Leadership Assessment

“Oftentimes, these stereotypes [related to marginalized identities] can really hit someone, and that can get in the way of them being able to be a good leader. First off, because they're not given the positions. But it's also something where they're navigating these stereotypes and having to twist themselves into pretzels, in order to fit in that little tiny line that is between ‘too much’ and ‘too little’.” – Katie Vernoy, LMFT

  • Career trajectory
  • Leadership identity development stage
  • Current employment
  • Work/life balance
  • Role of work in client’s life and within family system

Therapists Working with Leaders

  • Life experience that therapists can draw upon
  • Identifying what you don’t know
  • Understand your own work trauma and leadership development
  • The CHAT Model (or Katie’s model: clarify, imagine, simplify, act)

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Simplified SEO Consulting

Simplified SEO Consulting is completely focused on helping mental health professionals get their websites to show up on Google. They offer trainings and small group intensives to teach you how to optimize your own website. Their next small group intensive is open for enrollment now and starts in August. Take the first step to reaching more ideal clients with their next Small Group SEO Intensive. You don’t have to be tech savvy to learn SEO!

These days, most people go to Google when they’re looking for a therapist and when they start searching, you want to make sure they find you! Simplified SEO Consulting walks you step by step through the process of optimizing your website with their Small Group SEO Intensives. Led by Danica Wolf, a seasoned SEO instructor with an MSW and strong understanding of the mental health world, you learn what content you need to add to your website and how to optimize it with your ideal client in mind. Then watch your online rankings climb! Next one is enrolling now and begins in August, 2022! Visit simplifiedseoconsulting.com/seo-mastermind to learn more and register.

 

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Katie’s Leadership and Management Books Worth Reading on Pinterest

 

References mentioned in this continuing education podcast:

Ben-Noam, S. (2018). Cracking the Intrapsychic “Glass Ceiling” for Women in Leadership: Therapeutic Interventions. Psychoanalytic Inquiry, 38(4), 299–311. https://doi.org/10.1080/07351690.2018.1444856

Chang, Ting-Han. ”A Critical Study of How College Student Leaders of Color Conceptualize Social Justice Leadership.” Indiana University ProQuest Dissertations Publishing,  2022. 28964612.

Chen, C. P., & Hong, J. W. L. (2020). The Career Human Agency Theory. Journal of Counseling & Development, 98(2), 193–199. https://doi.org/10.1002/jcad.12313

Cullen, Maureen E., "Understanding Women’s Experience in Undergraduate Leadership Development Through a Transformative and Intersectional Lens" (2022). Graduate Theses and Dissertations. 102. https://pilotscholars.up.edu/etd/102

Komives, S. R., Longerbeam, S. D., Owen, J. E., Mainella, F. C., & Osteen, L. (2006). A Leadership Identity Development Model: Applications from a Grounded Theory. Journal of College Student Development, 47(4), 401–418. https://doi.org/10.1353/csd.2006.0048

Murphy, S. E., & Johnson, S. K. (2011). The benefits of a long-lens approach to leader development: Understanding the seeds of leadership. Leadership Quarterly, 22(3), 459–470. https://doi.org/10.1016/j.leaqua.2011.04.004

Oldridge, K. (2019). A grounded theory study exploring the contribution of coaching to rebalancing organisational power for female leaders. Coaching Psychologist, 15(1), 11–23.

Tang, M., Montgomery, M. L. T., Collins, B., & Jenkins, K. (2021). Integrating Career and Mental Health Counseling: Necessity and Strategies. Journal of Employment Counseling, 58(1), 23–35. https://doi.org/10.1002/joec.12155

Wallace, D. M., Torres, E.M., & Zaccaro, S. J. (2021). Just what do we think we are doing? Learning outcomes of leader and leadership development. The Leadership Quarterly, 32(5). https://doi.org/10.1016/j.leaqua.2020.101494.

*The full reference list can be found in the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

What to Know When Providing Therapy for Elite Athletes

Millennials as Therapists

Financial Therapy

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Jul 25, 2022
I Just Graduated, Now What? – Career Advice for New Mental Health Clinicians
29:59

I Just Graduated, Now What? – Career Advice for New Mental Health Clinicians

Curt and Katie discuss how clinicians can decide what types of jobs to pursue when they first graduate from their clinical program. We look at whether you should go into a community mental health organization or a private practice. We also dig into what you might want to consider when making these choices and looking for these jobs. Curt and Katie share their own perspective and experiences to help you consider many different options at this stage in your career.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about a new therapist’s career path  

We received a listener email asking advice for how to approach getting their first job after graduating. We decided to answer that listener and to address the question of how to start your career more broadly.  

Should you go into a community mental health organization or private practice?

“I'm of the philosophy that, especially if where you imagine yourself being is in private practice at some point, my recommendation is start doing that as soon as reasonably possible” – Curt Widhalm, LMFT

  • Considerations related to longer term goals
  • Practical and logistical factors related to compensation, benefits, and time
  • Clinical training and opportunities

What to consider when looking to join a group private practice

“When you are looking for a group practice, don’t look for something that’s just a duplication of a community mental health organization… there is a discernment that needs to happen to identify: is this actually preparing you for the private practice that you want to have in five years? Or is it a mill, where you're churning through insurance clients that don't align or… you're working for a fee that you wouldn't be able to sustain?” – Katie Vernoy, LMFT

  • Caseload and pay expectations
  • Training and supervision opportunities
  • What you are willing to do to obtain your own clients
  • Whether you will stay at an agency while building a caseload

What are the job options for therapists when they graduate?

  • The importance of informational interviews to understand the options
  • The benefits (and detriments) to different types of work settings
  • Community mental health versus private practice
  • Moving around and getting different experiences versus starting in a niche
  • Identifying what is right for you

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Simplified SEO Consulting

Simplified SEO Consulting is completely focused on helping mental health professionals get their websites to show up on Google. They offer trainings and small group intensives to teach you how to optimize your own website. Their next small group intensive is open for enrollment now and starts in August. Take the first step to reaching more ideal clients with their next Small Group SEO Intensive. You don’t have to be tech savvy to learn SEO!

These days, most people go to Google when they’re looking for a therapist and when they start searching, you want to make sure they find you! Simplified SEO Consulting walks you step by step through the process of optimizing your website with their Small Group SEO Intensives. Led by Danica Wolf, a seasoned SEO instructor with an MSW and strong understanding of the mental health world, you learn what content you need to add to your website and how to optimize it with your ideal client in mind. Then watch your online rankings climb! Next one is enrolling now and begins in August, 2022! Visit simplifiedseoconsulting.com/seo-mastermind to learn more and register.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Relevant Episodes of MTSG Podcast:

Getting a J-O-B as a Therapist

Interview Strategies for Therapists

The Burnout System

Why Therapists Quit

How to Overcome Impostor Syndrome to Leave Your Agency Job: An interview with Patrick Casale

Building Hope for the Next Generation of Therapists: An interview with Robin Andersen

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Jul 18, 2022
What Therapists Should Know about the Rollout of 988
31:36

What Therapists Should Know about the Rollout of 988

Curt and Katie discuss the new suicide hotline, 988, that is set to roll out July 16, 2022. We talk about the legislation for 988 as well as what the primary concerns are for the launch. We explore the resources and infrastructure that is promised (but not ready) as well as ideas that might improve the success of this new initiative.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about what is already going wrong with the 988 roll out.  

We have been paying attention to the 988 roll out and are concerned by the lack of preparation and funding for its implementation. We talk about why we’re freaked out about the upcoming roll out.

What is 988?

  • Legislation (from 2020) makes the national suicide hotline easier to access, using the phone number 988 – set to launch on July 16, 2022
  • Crisis, Suicide, or Lifeline phone number
  • Replaces the previous numbers: 800-273-8255 (phone) or text to 741741
  • Connecting local resources to local callers
  • An entry point into the local crisis response system
  • Opportunities for call, text, or messaging support during times of crisis

What are the primary concerns with the launch of 988?

“Mental health is not a priority according to any of the actions taken in response to [the 988 rollout] … Many states don't have the funding to implement this at all set up.” – Curt Widhalm, LMFT

  • Lack of infrastructure (calls are being sent out of state or not being answered at all)
  • Lack of local resources to handle crisis response
  • Lack of funding to develop these resources (potentially NO funding for staff, text, chat)
  • Huge gaps in the crisis response system that will be exposed by increased access to this system
  • Challenges with training hotline workers, who are likely going to be volunteers
  • Inadequate training for inclusive services and linguistically responsive services.

“We're looking at a good swath of folks who are most likely to be calling these [suicide hotline] numbers and they're going to reach somebody that has no training to work with them.”  - Katie Vernoy, LMFT

Ideas to improve 988 and the United States Mental Healthcare program

  • Funding streams through Medicaid, combining forces with 911
  • Using the implementation to identifying gaps
  • RAND suggestions to coordinate with local organizations for strategic planning and identifying stable funding sources, needs assessments related to personnel
  • Advocacy at the state level to make sure state legislatures are making this work
  • Curt’s idea: have hotlines staffed with prelicensed or provisionally licensed folks (earning double hours toward licensure)
  • Advocacy at the federal level to increase funding across the whole country

 

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

SAMHSA 988 webpage

RAND Report: How to Transform the US Mental Health System

RAND Working Paper – Preparedness for 988 Throughout the United States: The New Mental Health Emergency Hotline

Find Your Legislators

Relevant Episodes of MTSG Podcast:

Fixing Mental Healthcare in America

A Living Wage for Prelicensees

Episodes on Suicide

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Jul 11, 2022
The Clinical Supervision Crisis for Early Career Therapists: An Interview with Dr. Amy Parks
35:27

The Clinical Supervision Crisis for Early Career Therapists: An Interview with Dr. Amy Parks

Curt and Katie interview Dr. Amy Parks about the lack of resources for pre- and provisionally licensed mental health professionals to find a clinical supervisor. We discuss the current state of clinical supervision, the barriers for folks becoming clinical supervisors, what makes a good supervisor, navigating online supervision, and what licensed folks might consider when seeking consultation.

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Dr. Amy Parks, Founder of the Clinical Supervision Directory

Dr. Amy Fortney Parks brings with her over 30 years of experience working with children, adolescents and families as both an educator and psychologist.  She is a passionate “BRAIN -ENTHUSIAST” and strives to help everyone she works with understand the brain science of communication, activation and relationships.

Dr. Parks has a Doctorate in Educational Psychology with a specialty in developmental neuroscience. She is a Child & Adolescent Psychologist as well as the founder and Clinical Director of WISE Mind Solutions LLC and The Wise Family Counseling, Assessment & Education in Virginia.  She is also the founder of the Clinical Supervision Directory – a connection super-highway for supervision-seekers working towards licensure in counseling and social work across the US.

Dr. Parks serves as a Clinical Supervisor for Virginia LPC Residents, as well as Dominion Psychiatric Hospital. Additionally, she is an adjunct professor at George Washington University & The Chicago School of Professional Psychology. Dr. Parks is a frequently sought-after parent coach and speaker for families and groups around the world.  

In this podcast episode, we talk about clinical supervision for modern therapists

We look at the gap in clinical supervision for prelicensed or provisionally licensed mental health professionals.

What is the state of clinical supervision for mental health professionals?

“Arbitrary reasons or barriers to entry are one of the main reasons why we're not getting more clinical counselors on the ground to serve the public. Because when somebody graduates from graduate school… hundreds of thousands of clinicians are graduating, and hundreds of thousands of them will not get connected to supervisors, until they figure out where to find their lists.” – Dr. Amy Parks

  • No consistent resources for newly graduated clinicians to find supervisors
  • Different state to state or area to area
  • Lack of supervisors and a lack of a mechanism to connect supervisors and supervisees

What are the barriers to folks becoming clinical supervisors?

  • Different standards in different states
  • Sometimes becoming a supervisor is too overwhelming, complicated, or too much responsibility
  • The need for advanced training in supervision

What makes a good supervisor?

“Everyone should have supervision as part of their employment. It should be excellent. It should be professional, and it should be a benefit, period, end of discussion. But I can guarantee you 100% that that is not the majority of the country. And that's not the way it's done in every career field either.” – Dr. Amy Parks

  • Training
  • Diverse experience
  • Understanding the boundaries between supervision and counseling
  • Supervisor, consultant, teacher roles
  • Cultural humility, bias – looking at clients and supervisees

Navigating Online Supervision

  • Video supervision (rather than phone)
  • Have supervisees record (video) their sessions for feedback
  • Research shows that telesupervision is as effective as in person
  • Laws related to in-person versus virtual supervision

Supervision or Consultation After Licensure

  • The value of getting consultation after you’re licensed
  • The importance of a beginner’s mind
  • The challenges of finding good consultation
  • Finding the right match when seeking supervision or consultation

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Clinical Supervision Directory

Clinical Supervision Directory Sign up to be a Supervisor coupon code for $50 off the first year: FRIEND50

NBCC accredited supervisor program

Instagram @ClinicalSupervisionDirectory

Facebook @ClinicalSupervisionDirectory

LinkedIn - Clinical Supervision Directory

Amy’s practice: The Wise Family

Relevant Episodes of MTSG Podcast:

Giving and Getting Good Supervision

Getting the Supervision You Want

Bilingual Supervision: An Interview with Adriana Rodriguez, LMFT

Waiving Goodbye to Telehealth Progress: An Interview with Dr. Ben Caldwell

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Jul 04, 2022
What is Parental Alienation and How Can Therapists Successfully Treat it?
01:13:43

What is Parental Alienation and How Can Therapists Successfully Treat it?

Curt and Katie chat about a controversial topic: Parental Alienation. We look at what parental alienation is, the controversies and complexities surrounding this process, how to assess for parental alienation, and how to effectively treat the family system. We talk about how traditional therapy methods are inadequate and potentially harmful in these cases and what to do instead.  This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we explore Parental Alienation

We both have worked with families that  

What is Parental Alienation?

  • The impact a parent/guardian has over how a child interacts with another parent/guardian
  • Complex dynamic within a family where conflict is present
  • Breakdown of relationship based on behavior of alienating parent toward targeted parent
  • The Four Factor Model from Baker (2020)

How do you assess for Parental Alienation?

  • Challenges with correctly identifying this process/dynamic
  • Controversies and lack of recognition of Parental Alienation as a separate diagnosis from Parent-Child Relational Problem
  • Identifying what Parental Alienation is not
  • Clues that stories from kids are manufactured versus authentic stories of child abuse
  • The need for access to the full family system to obtain sufficient information
  • Exploring: What is alienating behavior? How does it work?

Effective Case Conceptualization and Treatment for Parental Alienation

“Research actually shows [for parental alienation] that only working with one part of the system and in a very isolated way, can sometimes create more harm in the system.” – Curt Widhalm, LMFT

  • The importance of a family systems approach
  • Involvement of government systems
  • Uncovering the generational or individual trauma for all members of the system
  • How to engage the tools available to advocate for important treatment elements to be in place
  • The importance of understanding scope and how to write recommendations to court
  • Preventing therapist shopping and treatment avoidance
  • Harmful recommendations that can hinder progress within these systems

“Don't be alone with these cases. Don't keep your observations to yourself – I think whether it's with a treatment team or your own consultation or your own therapy - these things can bring so much up in therapists because of their own stories, their own history and the just the intensity of what's happening in these systems.” – Katie Vernoy, LMFT

  • Treatment teaming and avoiding isolation
  • Educating about Parental Alienation
  • Supporting the targeted parent to improve the relationship with the child
  • Working with alienating parent to prepare for improvement in child’s relationship with targeted parenting
  • Co-parenting and conflict resolution
  • Therapist communication with all members of the system

 

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

GreenOak Accounting

 At GreenOak Accounting, they believe that every private practice should be profitable. They’ve worked with hundreds of practice owners across the country to have the financial confidence and information to make data-driven decisions. We want our client's businesses to be profitable so they can focus on fulfilling their mission.

GreenOak Accounting specializes in working with therapists in private practice, and they have helped hundreds of therapists across the country reach their financial goals. They offer a number of monthly packages to fit a growing practice's needs - from bookkeeping to CFO services. Other specialized services include Profit First Support, compensation planning, and customized KPI Dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice, and offer unsurpassed support along the way.

If you’re interested in scheduling a complimentary consultation, please visit their website at www.GreenOakAccounting.com/consultation to learn more.

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

References mentioned in this continuing education podcast:

Baker, A. J. (2010). Adult children of parental alienation syndrome: Breaking the ties that bind. WW Norton & Company.

Baker, A. (2020). Reliability and validity of the four‐factor model of parental alienation. Journal of family therapy, 42(1), 100-118.

Garber, B. D. (2011). Parental alienation and the dynamics of the enmeshed parent–child dyad: Adultification, parentification, and infantilization. Family Court Review, 49(2), 322-335.

Templer, K., Matthewson, M., Haines, J., & Cox, G. (2017). Recommendations for best practice in response to parental alienation: Findings from a systematic review. Journal of Family Therapy, 39(1), 103-122.

*The full reference list can be found in the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

What’s New in the DSM-5-TR? An interview with Dr. Michael B First

The Risks and Consequences of Failing to Report Child Abuse

CYA for Court: An interview with Nicol Stolar-Peterson, LCSW

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Jun 27, 2022
The Practicalities of Mental Health and Gender Affirming Care for Trans Youth: An Interview with Jordan Held, LCSW
46:47

The Practicalities of Mental Health and Gender Affirming Care for Trans Youth: An Interview with Jordan Held, LCSW

Curt and Katie interview Jordan Held, LCSW, about gender affirming care, trans mental health, the practicalities of transition (as well as the different types of transition), specifics when working with trans youth, and the politicization of trans folks. We also explore culture and privilege related to transition.

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Jordan Held, LCSW

Jordan Held (he/him/his), LCSW is a Primary Therapist and Gender Specialist at Visions Adolescent Treatment Center. Prior to Visions, Jordan was a Therapist and Intake Coordinator at Children’s Hospital Los Angeles in the Center for Trans Youth Health and Development, the largest trans youth health clinic in the USA.

Jordan’s mental health practice centers around creating a trauma-informed and healing-centered space for both adolescents and their families. Jordan’s expertise is working with gender and sexual minority youth with complex histories of PTSD and trauma. Jordan speaks internationally about creating and supporting affirmative LGBTQ+ environments with an emphasis on informed consent and enhanced family communication. As a queer-identified, transgender man, Jordan brings an important dual perspective to his work as a mental health provider.

Prior to social work, Jordan worked extensively in secondary school education, with a decade of experience teaching, coaching, and developing health and wellness curricula. Jordan’s work focuses on gender violence prevention, diversity, equity, inclusion, and cultivating strength and belonging for teens. Jordan is on the Board of Directors of the Los Angeles LGBT Center, the Laurel Foundation, JQ International, and Mental Health America of Los Angeles. Jordan is also a long-time facilitator at Transforming Family, a support group for gender-diverse youth and their family.

Jordan holds a Master of Social Welfare degree from UCLA, a Master of Sports Leadership degree from Northeastern University, and a Bachelor of Science in Kinesiology from the University of Connecticut. Jordan is an avid sneakerhead who self-cares by lifting heavy weights, going to the beach, loving his rescue dog, and embracing his gender euphoria!

 

In this podcast episode, we talk about trans mental health

For Pride Month, we wanted to deepen our conversation on trans mental health and what therapists should know when working with trans individuals.

What is gender-affirmative care?

“Trans people are being used as political pawns.” – Jordan Held, LCSW

  • The way that “gender affirming care” is being taken out of context
  • What is actually happening, how it has been politicized
  • The misinformation related to what is available to children who are exploring their gender (i.e., parental consent and youth care)
  • The role of therapists versus the role of medical providers
  • Discussion of gender norms

Different types of transition for trans individuals

  • Social transition (name, pronouns, clothes, haircut)
  • Medical interventions that may start during puberty (i.e., puberty blockers, progesterone only birth control)
  • Cross sex hormones and surgeries (which actually require a long process)
  • States are very specific for what they require for gender care (as do insurance companies)

Conversations in therapy for trans youth

  • Gender journey
  • Meeting the kids where they’re at
  • Lying to get what they need
  • Letters and recommendations for surgery
  • The gender dysphoria diagnosis and sorting that out from depression, anxiety, etc.
  • Supporting trans youth with social transition and getting the support they need
  • The concerns with maladaptive coping skills available online
  • Positive resources for trans youth (scroll down to resources)
  • Identity and impacts

The Politicization of Trans Individuals

“Shame on us as adults that we are so scared, we have so much fear over – let’s be honest – what’s in someone's pants, right? All of this has to do with the fear of something that we don't know. This fear… that somebody's genitals do not align what we think is in their pants. And as an adult talking to another adult, that's kind of gross, right? Like, why as adults do we care so much about what is in a kid's pants?” – Jordan Held, LCSW

  • Jordan grew in privilege when he transitioned
  • Legislation
  • Schools removing conversations related to gender and sexuality
  • Play and sports being withheld from trans kids
  • Bias and how being trans is perceived
  • The actual numbers of trans folks who want to play sports or want to use the bathroom that aligns with their gender identity
  • Advice for trans kids and families where gender care is illegal, advice for therapists
  • Age limits and laws that don’t align with logic

Culture, privilege, and being trans

  • Increasing or decreasing privilege when one transitions
  • Getting used to the changed dynamic within society based on external experience
  • The complexity of the experience and the changing of the experience
  • The concept of “passing” and how it taps into bias

 

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

GreenOak Accounting

 At GreenOak Accounting, they believe that every private practice should be profitable. They’ve worked with hundreds of practice owners across the country to have the financial confidence and information to make data-driven decisions. We want our client's businesses to be profitable so they can focus on fulfilling their mission.

GreenOak Accounting specializes in working with therapists in private practice, and they have helped hundreds of therapists across the country reach their financial goals. They offer a number of monthly packages to fit a growing practice's needs - from bookkeeping to CFO services. Other specialized services include Profit First Support, compensation planning, and customized KPI Dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice, and offer unsurpassed support along the way.

If you’re interested in scheduling a complimentary consultation, please visit their website at www.GreenOakAccounting.com/consultation to learn more.

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Visions Adolescent Treatment Center

Jordan Held’s Website

Jordan on Instagram

WPATH Standards of Care

 

Online support and communities for trans youth:

GLSEN

The Trevor Project (helpline, suicidality)

Human Rights Campaign (HRC) – Trans Resources

HRC – LGBTQ+ Youth

PFLAG

Flamingo Rampant (publisher focusing on diversity, including gender diversity)

Disclosure (Documentary)

Google local universities in state – they often have support groups

 

 

 

Relevant Episodes of MTSG Podcast:

Working with Trans Clients: Trans Resilience and Gender Euphoria – an interview with Beck Gee-Cohen

Vulnerability, The News, and Your Clients: An interview with Dr. Abigail Weissman

Additional episodes for Pride Month:

Bi+ Erasure: An interview with Dr. Mimi Hoang, PhD

Getting Personal to Advocate for Compassion, Understanding, and Social Justice: An interview with James Guay, LMFT

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Jun 20, 2022
Portrayals of Mental Health and Therapy in the Media: An Interview with Danah Davis Williams, LMFT
35:41

Portrayals of Mental Health and Therapy in the Media: An Interview with Danah Davis Williams, LMFT

Curt and Katie interview Danah Davis Williams, LMFT on the portrayals of mental health and therapy in the media. We explore responsible portrayals as well as the harmful practices that some writers and studios engage in. We also talk about the opportunities for modern therapists to have an impact on how diagnoses and mental health treatment are represented on film and television.

Transcripts for this episode will be available at mtsgpodcast.com!

An Interview with Danah Davis Williams, LMFT

Danah Davis Williams is a Licensed Psychotherapist, an Actor, a Psychological Creative Consultant, a Podcast Host and current Past President of the California Association of Marriage and Family Therapists (CAMFT).

As a therapist, Danah is in private practice in Santa Barbara, California (California Coastal Counseling) where she specializes in helping people break destructive patterns of coping through the use of practical, evidenced-based coping skills and personal process. She is extensively trained in Dialectical Behavior Therapy (DBT) and Cognitive Behavior Therapy (CBT).

As a consultant, Danah provides personalized psychological consultation for filmmakers, executives and creatives committed to socially responsible, captivating storytelling through authentic characterization of mental health, its treatment and interpersonal impact. She runs a psychological consulting business helping entertainment industry leaders ensure accurate representation of mental health: working with filmmakers, writers, execs, and high-profile actors from networks like FX, CBS, ABC, NBC, Freeform and MGM.

Danah is also the host, producer and co-creator of the Reel Psychology Podcast on Fireside, where she and Jon Lee Brody are raising mental health awareness by talking about fictional characters and their mental health.

In this podcast episode, we talk about how the media often portrays mental health

We invited our friend Danah Davis Williams to join us to talk about mental health in the media.

What does the media get wrong when portraying mental health and therapy?

  • Inaccurate portrayals of diagnoses
  • Manipulative or unethical therapists
  • The problems with “guilty pleasures” that include inaccurate or harmful portrayals

“I really feel that one of the ways that we can see more authentic representation is to have more diversity and more people with mental health background in storytelling, in the writers’ rooms, or becoming creators themselves – because people write what they know.” – Danah Davis Williams, LMFT

The opportunities for therapists to be creators and consultants

  • Translating clinical work into consulting and creating
  • Vulnerability when sharing journey as a therapist
  • Using skills from practice building to create opportunities as a creator
  • The process of consultation for scripts and what to consider when providing feedback
  • Ethical thoughts related to representations
  • How to build a network and consulting business

How the storytellers look at mental health and healing

“What I've had multiple times is a filmmaker or studio coming to me, and they're looking for the silver bullet. They have a character that has had some trauma or struggling with a specific diagnosis or relational conflict or what have you. And they want to know, what's the silver bullet, one- or two-page scene that we can include? (And sometimes not even that.) What's the five second dialogue that we can include that shows that they have worked on their mental health, they have recovered, and they are thriving? And it's like, it doesn't work that way.” – Danah Davis Williams, LMFT

  • The silver bullet that “heals” the client
  • Inaccurate portrayals of therapy or healing and the impact on clients
  • Ethics to consider (especially given you’re not acting within your profession with an ethical code)
  • The challenges of unscripted shows

Shows that get it right when it comes to mental health and treatment

  • This is us – Toby
  • Comprehensive and realistic, tapping into lived experience within actors and/or writers
  • The attempts to portray diversity and the experience of marginalized communities and their interaction in the mental health system

Diversifying Media and the Portrayals of Mental Health and Therapy

  • Ava Duvernay’s Array program
  • Michael B Jordan hiring students and mentoring the next generation
  • Decreasing stigma for folks who have not typically sought mental health services

How to advocate for accurate mental health portrayals in the media

  • Calling things out on social media that are good and things that are done poorly (or are harmful)
  • Content creation about shows you watch (like blogs, articles, etc.)
  • Discussing content in sessions to help process what folks are viewing or their own experience
  • Not watching or purchasing tickets to content that is harmful (not reinforcing “guilty pleasures”)

 

 

 

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

GreenOak Accounting

 At GreenOak Accounting, they believe that every private practice should be profitable. They’ve worked with hundreds of practice owners across the country to have the financial confidence and information to make data-driven decisions. We want our client's businesses to be profitable so they can focus on fulfilling their mission.

GreenOak Accounting specializes in working with therapists in private practice, and they have helped hundreds of therapists across the country reach their financial goals. They offer a number of monthly packages to fit a growing practice's needs - from bookkeeping to CFO services. Other specialized services include Profit First Support, compensation planning, and customized KPI Dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice, and offer unsurpassed support along the way.

If you’re interested in scheduling a complimentary consultation, please visit their website at www.GreenOakAccounting.com/consultation to learn more.

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Danah Davis Williams on Fireside Chat (Reel Psychology Podcast)

Danah on Instagram: @danahdaviswilliams

Danah’s website: calcoastalcounseling.com

Ava Duvernay’s Array Program

Michael B. Jordan Outlier Society Youth Fellowship

Relevant Episodes of MTSG Podcast:

Therapy with an Audience: An interview with Doug Friedman, LCSW

What Can Therapists Say About Celebrities? The ethics of public statements

Grow Your Impact as a Therapist: An interview with Kiaundra Jackson, LMFT

Reflections on Content Creation and the Therapy Profession

You Do Not Have to be a Thought Leader

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Jun 13, 2022
Beware of Scams Targeting Therapists
30:25

Beware of Scams Targeting Therapists

Curt and Katie discuss common scams that specifically target therapists. We look at how to identify scams or sketchy business practices that can be very confusing as well as dangerous to clinicians. We also talk about how to protect yourself as well as solid business practices that you can implement to stave off some of these scammers.  

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about scams that target therapists

We have heard about a lot of scams in our careers. We figured it was time to do another “survival guide” episode on how to protect ourselves as therapists.

What are the most common scams targeting therapists?

“And most of the scams seem to be trying to tell someone that they are in trouble -  And if you just pay me this trouble will go away.” – Katie Vernoy

  • Information used from popular therapist directories
  • Claiming to be a law enforcement professional, missed court date, or the IRS
  • Image copyright infringement
  • Businesses that target you to charge them for things that are free or with another company
  • Clients or people seeking therapy for family members and then overpay and ask for a refund
  • Text messages or emails with unsolicited links that can leave malware on your computer
  • Phishing schemes
  • Testing stolen credit cards or stolen identities

How can modern therapists protect ourselves from these scams?

“Be skeptical of these things, hang up, call legitimate numbers from the offices of these departments. And if nothing else, let those departments know, let your professional organizations know – these are the kinds of messages that I'm receiving. Those organizations will usually have some kind of response that they blast out to their members with their licensees, hey, there's a scam going around, be aware of it.” – Curt Widhalm

  • Get into wise mind (avoid responding to false urgency)
  • Go through official channels (contact actual officials)
  • Contact an attorney if unsure
  • Understand how legal notices are properly delivered
  • Caution with financial systems and not allowing people to pay upfront
  • Requiring person seeking services to contact therapist
  • Cyber security trainings
  • Communicating appropriately and consistently
  • Holding to systems and boundaries
  • Make sure to share these scams with professional organizations, the official entity, or your licensing board

 

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

GreenOak Accounting

 At GreenOak Accounting, they believe that every private practice should be profitable. They’ve worked with hundreds of practice owners across the country to have the financial confidence and information to make data-driven decisions. We want our client's businesses to be profitable so they can focus on fulfilling their mission.

GreenOak Accounting specializes in working with therapists in private practice, and they have helped hundreds of therapists across the country reach their financial goals. They offer a number of monthly packages to fit a growing practice's needs - from bookkeeping to CFO services. Other specialized services include Profit First Support, compensation planning, and customized KPI Dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice, and offer unsurpassed support along the way.

If you’re interested in scheduling a complimentary consultation, please visit their website at www.GreenOakAccounting.com/consultation to learn more.

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Abundance Practice Building Article on Copyright Infringement

From Joe Borders: Currently Active Scams Targeting Therapists

From APA: Protect your practice from scams targeting psychologists

From APA: More reports surface of telephone scammers targeting psychologists

From the SF Chronicle: ‘He held me hostage with no gun but with his words’: The phone scam gaslighting therapists

From Counseling Today: Technology Tutor: Scams aimed at counselors

From Psych Today: The Phone Scam That Targets Psychologists

From CPH & Associates: Scam Targeting Therapists: What You Need to Know

From 10News.Com: The jury duty scam you should know about

 

Relevant Episodes of MTSG Podcast:

Who’s in the Room? Siri, Alexa, and Confidentiality

Malpractice is No Joke

Gaslighting Therapists

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Jun 06, 2022
Beyond Reimagination: Improving your client outcomes by understanding what big tech is doing right (and wrong) with mental health apps
01:16:12

Beyond Reimagination: Improving your client outcomes by understanding what big tech is doing right (and wrong) with mental health apps

Curt and Katie chat about the big tech “disruptors” in the mental health space and what therapists can learn from their tactics to support clients. We look at who is using mental health apps, what mental health apps are getting right (and wrong), and how therapists can take what is working and work differently to more effectively serve our own clients. This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we look at what therapists can learn from big tech disruptors in mental health

We have seen more and more tech companies and apps come into the mental health space and have heard more and more folks worried about how their private practices will be able to survive. We are revisiting a topic we covered in a presentation at our Therapy Reimagined 2021 conference to help modern therapists navigate this new mental health landscape.

Looking at the gaps in mental health treatment and how big tech is working to “fix” them

  • Exploring the goals from the Rand report on fixing mental healthcare in the United States
  • Mental Health apps (with many broad definitions)
  • Access to lots of different types of services and self-help
  • A one stop shop with a full range of services
  • Direct negotiation with insurance companies

The types of technology used in mental health apps and the risks and benefits of these advances

  • Algorithms
  • Geo location data
  • Complex payment structures
  • Outcomes and feedback

What mental health apps are doing well for clients

  • Getting clients into therapy much more quickly
  • Decreasing costs for consumers
  • Increasing flexibility and availability
  • Not requiring for things to happen in real time (asynchronous therapy)

What mental health apps are getting wrong

  • McDonaldization and commoditization
  • Proprietary treatment methods and incentives for specific worksheets or staying within the app
  • Misalignment between the goals of the client and the goals of the corporation
  • Self-driven, leading to folks to potentially getting insufficient resources
  • Individual versus community focus
  • Caseloads and potential for therapist income (as well as burnout and poor care)

Concerns about the additional risks that can happen with mental health apps

“[In] this profit versus service model… there's this idea that you are not a client, not a patient, you are a consumer and someone to market to. And so you'll be marketed to as a client throughout the app. And as a clinician, you become a marketer for those things behind the paywall. And that is terrifying. Because it's not based on treatment.” – Katie Vernoy

  • The apps are not bound by HIPAA, but instead the SEC
  • Data sharing and Alexa suggesting supplements to address client mental health concerns
  • Additional legal and ethical risks

Who is using app-based mental health services?

  • Therapy veterans are moving to apps
  • Access is not actually improved
  • The reasons that clients are moving from a traditional therapist to therapy apps
  • Outcomes across different types of apps and different types of clients
  • Niche apps are more effective than generalist apps

What we can do to move our therapist practices forward?

“Now I've seen a number of people describe… if these therapy apps are going to be the McDonald's of therapy, well, we're the prime rib! You actually have to consider are you providing actual prime rib? Or are you more like a Carl's Jr?” – Curt Widhalm

  • Using the benefits of technology to decrease friction for your clients accessing therapists
  • Increasing flexibility and creativity
  • Be a better therapist and understanding the digital therapeutic alliance
  • Paying attention to laws and ethics, scope of practice, and treatment planning

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Turning Point Financial Life Planning

Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

Turning Point is a financial planning & coaching firm that helps therapists stop worrying about money.

Dave at Turning Point will help you navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

He'll help you move through that feeling of being stuck, frustrated and overwhelmed...

And arrive at a place where you feel relief, validation, motivation and hope.

And for listeners of MTSG, you'll receive $200 off the price of any service. Just enter promo code Modern Therapist.

Be sure and visit turningpointHQ.com and download the free whitepaper “7 Money Mindset Shifts to Reduce Financial Anxiety”

OOTify

OOTify. "OOT" or "uth" (उठ) means "lift up" in the Hindi language. OOTify is a digital health solution that acts as an evidence-based hub to unify relevant mental health resources. Community, Connection, and Collaboration are critical to OOTIFY.  As they lift the mental healthcare system, they ensure providers are part of the process. OOTIFY is a platform for providers, built by providers, and owned by providers. OOTIFY is the process of lifting up mental healthcare, while lifting each other up.

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We're going to go through trials and tribulations. But if we can work on our mental health, proactively, our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, “Hey, listen, I'm going through this too.” Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

TR 2021: Beyond Reimagination - Moving the mental health field from thought to action (video course)

Thrizer (payment and billing platform)

Economides, M., Ranta, K., Hilgert, O., Kelleher, D., Arean, P., & Hoffman, V. (2019, November 1). The impact of a remote digital health intervention for anxiety and depression on occupational and functional impairment: an observational, pre-post intervention study. https://doi.org/10.31234/osf.io/rhfpa

McBain, R. K., Eberhart, N.K., Breslau, J., Frank, L., Burnam, M.A., Kareddy, V, and Simmons, M. M. (2021). How to Transform the U.S. Mental Health System: Evidence-Based Recommendations. Santa Monica, CA: RAND Corporation, 2021. https://www.rand.org/pubs/research_reports/RRA889-1.html.

*The full reference list can be found in the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

Special Series: Fixing Mental Healthcare in America

Fixing Mental Health in America: An interview with Dr. Nicole Eberhart, Senior Behavioral Scientist, and Dr. Ryan McBain, Policy Researcher, The RAND Corporation

Online Therapy Apps

Why You Shouldn’t Sell Out to Better Help

Non-Traditional Therapy Series: Part 1 and Part 2

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

May 30, 2022
The Risks and Consequences of Failing to Report Child Abuse
39:21

The Risks and Consequences of Failing to Report Child Abuse

Curt and Katie discuss the CA Board of Behavioral Sciences case against Barbara Dixon, LMFT who failed to report child abuse for Gabriel Fernandez and Anthony Avalos who both subsequently died from abuse by caregivers. We look at what this therapist missed as well as appropriate child abuse reporting, including the nuance of when to report. CW: details of child abuse discussed.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about the importance of child abuse reporting

We talk about the failure to report abuse by Barbara Dixon, LMFT that has recently been in the news related to the deaths of Gabriel Fernandez and Anthony Avalos.

The case related to the child abuse death of Gabriel Fernandez

  • Content Warning: Details of the case, including the actions taken (and not taken) by Barbara Dixon, LMFT
  • The decision-making process with child abuse reporting

Who is responsible to decide to report child abuse – the clinician or the supervisor?

“I hear [prelicensees] wrongly state that ‘I'm working under somebody else's license; this falls on them’ … I cannot emphasize enough that decisions like this, in [Barbara Dixon’s] case, really do indicate that it is your responsibility, no matter what your agency says… People can and do get punished for not following through on their individual licensee or registration responsibilities as mandated reporters.” – Curt Widhalm

  • When supervisors or agencies tell clinicians under supervision not to report child abuse report
  • The individual responsibility that each clinician holds
  • The myth that you’re working “under” your supervisor’s license

How do you decide whether you should report child abuse?

“It's these gray areas where there's this nuance that I think feels really overwhelming. And for some folks, they'll lean towards reporting or consulting to identify if it's reportable. And for other folks, they use that as cover to not report when it feels too uncomfortable.” – Katie Vernoy

  • Clarity from child abuse reporting laws
  • Hesitation based on systemic response, the therapeutic relationship, and the paperwork hassle
  • Where there are gray areas and nuance

The consequences of failing to report child abuse or adequately document services or risks

  • Your agency or supervisor may not be held liable for your actions (especially if you don’t document what you did)
  • Incomplete documentation hurts – it doesn’t help you hide from liability

Appropriate Child Abuse Assessment and Reporting

  • Interviewing the child separately
  • Following up on what you’ve asked for
  • Understanding at what point it becomes our responsibility (i.e., having sufficient information)
  • Documenting each stage and make sure to appropriately close out treatment file when needed
  • Consultation and not making the decision on your own
  • Defining the injury and assess from there
  • Understanding normal childhood response to typical life events (and noting changes)

Navigating the gray areas in child abuse assessment

  • Looking at impact, intent, and injury
  • Using the context to help decide when there isn’t a definitive line
  • Adequately documenting, even when you aren’t sure you’re making the right decision, is important and necessary
  • Looking at what needs systemic intervention and what needs family therapy

Getting past the discomfort to report child abuse report

  • It is your responsibility
  • Taking a moment to understand the purpose of reporting
  • Reducing your own liability
  • Obtaining resources for families
  • Understanding the risk for families of systems getting involved

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

OOTify

OOTify. "OOT" or "uth" (उठ) means "lift up" in the Hindi language. OOTify is a digital health solution that acts as an evidence-based hub to unify relevant mental health resources. Community, Connection, and Collaboration are critical to OOTIFY.  As they lift the mental healthcare system, they ensure providers are part of the process. OOTIFY is a platform for providers, built by providers, and owned by providers. OOTIFY is the process of lifting up mental healthcare, while lifting each other up.

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We're going to go through trials and tribulations. But if we can work on our mental health, proactively, our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, “Hey, listen, I'm going through this too.” Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

Turning Point Financial Life Planning

Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

Turning Point is a financial planning & coaching firm that helps therapists stop worrying about money.

Dave at Turning Point will help you navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

He'll help you move through that feeling of being stuck, frustrated and overwhelmed...

And arrive at a place where you feel relief, validation, motivation and hope.

And for listeners of MTSG, you'll receive $200 off the price of any service. Just enter promo code Modern Therapist.

Be sure and visit turningpointHQ.com and download the free whitepaper “7 Money Mindset Shifts to Reduce Financial Anxiety”

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Los Angeles Times Article: Counselor who didn’t report abuse of Gabriel Fernandez, Anthony Avalos put on 4-year probation

Citation/Enforcement Decision on Barbara Dixon

LA Times Article: Charges dismissed against social workers linked to Gabriel Fernandez’s killing

Relevant Episodes of MTSG Podcast:

Now Modern Therapists Have to Document Every F*cking Thing in Our Progress Notes?

Do Therapists Curse in Session?

Toxic Work Environments

Giving and Getting Good Supervision

Make Your Paperwork Meaningful: An interview with Dr. Maelisa McCaffrey Hall

Noteworthy Documentation: An interview with Dr. Ben Caldwell, LMFT

CYA for Court: An interview with Nicol Stolar-Peterson, LCSW

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

May 23, 2022
Should Therapists Correct Clients?
37:28

Should Therapists Correct Clients?

Curt and Katie chat about whether therapists should correct clients who use offensive language. We look at what we should consider when addressing what clients say (including treatment goals and the relationship), how therapists can take care of themselves to be able to treat clients who hold a different worldview, and how (and when) therapists can address problematic language appropriately.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about whether therapists should call out their clients on words they find inappropriate

We decided to address the language that clients use in session and what to do when we find the language offensive or harmful.

Should therapists correct clients when they use language we find offensive or harmful?

  • Blank slate or “join your clients” approaches
  • Whether the language should be addressed when it doesn’t align with a client’s stated treatment goals
  • Showing up as a human and addressing the therapeutic relationship
  • Judgment or shaming that can happen with clients

What should therapists consider when addressing what clients say?

  • The relationship between the therapist and client
  • Relevance to clinical goals
  • The impact on trust in the therapeutic alliance
  • The importance of using the client’s language to affirm their experience
  • The power differential between therapist and client

How can therapists show up with clients who see the world differently than they do?

  • Addressing objectification of therapist’s identities
  • Assessing when therapists are centering their own experience versus responding to what is in the room
  • Using the relationship to process client’s perspective

“I feel like just living in the client's world without honoring my own experience at all doesn't feel quite right. But centering my experience feels wrong.” – Katie Vernoy

What can therapists do to appropriately address problematic language with their clients?

  • Process what is being said before correcting specific words
  • Address within the relationship and within the treatment goals
  • Using our own coping skills to be able to navigate what our clients bring to session

“I'm very worried that therapists don't have enough of their own coping skills to deal with these things coming up in sessions. Where they feel that they have to shut these clients down for the protection of themselves. You know, their only coping mechanism seems to be – I need to escape working with clients that don't already agree with my worldview.” – Curt Widhalm

  • Where social justice plays a role (and maybe shouldn’t)
  • Education and supporting the client’s whole development
  • Assessing the impact of these interventions (both positive and negative)
  • Assessing the harm in not pointing out bias or harmful language

 

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Turning Point Financial Life Planning

Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

Turning Point is a financial planning & coaching firm that helps therapists stop worrying about money.

Dave at Turning Point will help you navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

He'll help you move through that feeling of being stuck, frustrated and overwhelmed...

And arrive at a place where you feel relief, validation, motivation and hope.

And for listeners of MTSG, you'll receive $200 off the price of any service. Just enter promo code Modern Therapist.

Be sure and visit turningpointHQ.com and download the free whitepaper “7 Money Mindset Shifts to Reduce Financial Anxiety”

OOTify

OOTify. "OOT" or "uth" (उठ) means "lift up" in the Hindi language. OOTify is a digital health solution that acts as an evidence-based hub to unify relevant mental health resources. Community, Connection, and Collaboration are critical to OOTIFY.  As they lift the mental healthcare system, they ensure providers are part of the process. OOTIFY is a platform for providers, built by providers, and owned by providers. OOTIFY is the process of lifting up mental healthcare, while lifting each other up.

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We're going to go through trials and tribulations. But if we can work on our mental health, proactively, our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, “Hey, listen, I'm going through this too.” Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Therapist–Client Language Matching: Initial Promise as a Measure of Therapist–Client Relationship Quality

Feedback Informed Treatment

 

Relevant Episodes of MTSG Podcast:

Do Therapists Curse in Session?

How to Fire Your Clients (Ethically)

How to Fire Your Clients (Ethically) part 1.5

When is it Discrimination?

Conspiracy Theories in Your Office

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

May 16, 2022
Is the Counseling Compact Good for Therapists?
37:37

Is the Counseling Compact Good for Therapists?

Curt and Katie chat about the brand-new Counseling Compact and what therapists may not know or understand about these interstate agreements. We explore the proposed benefits as well as the potential risks and complications like regulatory discrepancies and a lack of consumer protections. We also look at how big tech can benefit while individual clinicians may be left unable to compete in a larger market.

In this podcast episode we talk about the new Counseling Compact and Psypact

The counselors got their 10th state and officially have Counseling Compact to practice in other states. We thought it would be a good idea to talk about what that means (and what we might want to pay attention to).

What is the Counseling Compact?

  • Opportunities for practicing privileges (not licensure) in other states
  • The complexity of putting together these interstate compacts
  • Implementation and regulation hurdles
  • Scope of practice discrepancies and concerns
  • Law and Ethics practices across states

Benefits of Interstate Compacts for Mental Health Providers

  • Continuity of care
  • Ease of meeting with clients who are moving around the country
  • Bringing clinicians to areas where there is a workforce shortage

Potential Problems with the Counseling Compact

“This very much goes against, according to the FBI, any sort of patient protection – that any of these licensing boards are put into place in the first place: to protect consumers.” – Curt Widhalm

  • Not bringing more clinicians, if only states with workforce shortages join
  • Doesn’t solve the infrastructure problems (i.e., stable Wi-Fi) for rural areas that typically don’t have local therapists
  • The people who most benefit: the big tech companies like Better Help
  • The FBI is opposing this legislation due to lack of federal background checks
  • Lack of consumer protection or consistency in what consumers can expect from their therapist
  • Costs for the therapists to get practicing privileges
  • Large gigantic group practices and tech solutions will contract with insurance and leave smaller practices unable to compete and required to be private pay

Solving the Problems with the Counseling Compact

“It may actually delay [a national license], because it's a band aid where people can go practice in other states. So why would I get a national license, if I can practice in a couple other states and not worry about taking another test, getting another background check…?” – Katie Vernoy

  • Overarching regulation and expectations at a national level
  • Federal bodies to oversee background checks and consumer protections
  • Expensive, time-intensive
  • We don’t have universal healthcare, so insurance parity will need to be addressed (and not just by big tech)

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

OOTify

OOTify. "OOT" or "uth" (उठ) means "lift up" in the Hindi language. OOTify is a digital health solution that acts as an evidence-based hub to unify relevant mental health resources. Community, Connection, and Collaboration are critical to OOTIFY.  As they lift the mental healthcare system, they ensure providers are part of the process. OOTIFY is a platform for providers, built by providers, and owned by providers. OOTIFY is the process of lifting up mental healthcare, while lifting each other up.

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We're going to go through trials and tribulations. But if we can work on our mental health, proactively, our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, “Hey, listen, I'm going through this too.” Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

Turning Point Financial Life Planning

Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

Turning Point is a financial planning & coaching firm that helps therapists stop worrying about money.

Dave at Turning Point will help you navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

He'll help you move through that feeling of being stuck, frustrated and overwhelmed...

And arrive at a place where you feel relief, validation, motivation and hope.

And for listeners of MTSG, you'll receive $200 off the price of any service. Just enter promo code Modern Therapist.

Be sure and visit turningpointHQ.com and download the free whitepaper “7 Money Mindset Shifts to Reduce Financial Anxiety”

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Counseling Compact

Psypact

Very Bad Therapy Podcast

Relevant Episodes of MTSG Podcast:

Special Series: Fixing Mental Healthcare in America

Fixing Mental Health in America: An interview with Dr. Nicole Eberhart, Senior Behavioral Scientist, and Dr. Ryan McBain, Policy Researcher, The RAND Corporation

Online Therapy Apps

Why You Shouldn’t Sell Out to Better Help

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm  00:00

This episode is brought to you by OOTify.

 

Katie Vernoy  00:03

OOTify is an immersive digital mental health ecosystem. It's designed to help minimize the fragmentation, trial and error and overwhelm felt by both patients and providers in the process of giving and receiving care. OOTify is the process of lifting up mental health care while lifting each other up.

 

Curt Widhalm  00:20

Listen at the end of the episode for more information.

 

Katie Vernoy  00:23

This episode is also brought to you by Turning Point.

 

Curt Widhalm  00:26

 Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life from practice financials and personal budgeting to investing taxes and student loans.

 

Katie Vernoy  00:39

Visit turningpointhq.com. To learn more and enter the promo code 'moderntherapist' for $200 off any service.

 

Announcer  00:47

You're listening to The Modern Therapist's Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  01:03

Welcome back modern therapists. This is The Modern Therapist's Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about things going on in the therapy worlds. And recently, the 10th state has joined the counseling compact, which initiates that it is all coming together for licensed professional counselors here in America. And what this does is creates a whole lot of space for people to make up what they think that it is. And we are here to correct that information. So, Katie, lots of things to talk about in this episode, what are your initial reactions.

 

Katie Vernoy  01:49

So my initial reactions typically with all of these pacts, so there's Counseling Pact, there's PSYPACT or Counseling Compact and PSYPACT, which is a psychologist, and then the social workers are working on something. As for MFTs so far, we don't have something going on. But I have mixed feelings. Because I think for me, I have clients who travel around to different states. And so I can only see them when they're in states I'm licensed in, I've got ideas around being able to support folks in areas that have fewer clinicians or clinicians who specialize in and what they need. And I also recognize I live in a state that has a very high cost of living. And so if there are therapists in states with much lower cost of living who are quote, unquote, taking my clients, I think it would be something where that that may make it harder for me to compete in my own market. So lots of mixed feelings. And I'm not quite sure at least until we started prepping for this episode, I wasn't quite sure what these compacts meant. And so I think probably we should start with, What's the Counseling Compact? If we, you know, it's PSYPACT different? What's the social workers working on? But broadly, what are these things? And why do people care about them?

 

Curt Widhalm  03:05

So these pacts are going to be slightly different between the counselors and the psychologists and psychologists is PSYPACT. The Counseling Compact is for counselors, we're not really going to talk a whole lot about social workers and MFTs, because they have not gotten their act together and have anything moving in this direction yet. Social workers do. But in talking about the two that are already in place, or quickly moving into place, what it does is allows for somebody, this is language from the Counseling Compact, what it does is allows for somebody who is licensed in and resides in one of the member states to have practicing privileges through some regulation stuff in other states. So it's not just like a license reciprocity where you are granted now a 10 state license, you have to go through some certain steps of just picking a couple of states out of this here. But if you are, say, practicing in Nebraska, and you have a person in West Virginia, who wants to utilize your services, you would need to go to the West Virginia Board and have a streamlined ability to get a privilege to practice with clients in West Virginia.

 

Katie Vernoy  04:30

Okay, but you have to live in Nebraska, it can't be like I live in California, and I'm licensed in Nebraska. So now then I can practice with somebody in West Virginia, if I get that streamlined.

 

Curt Widhalm  04:42

Yes, and this is the language that you have to be licensed in and reside in one of those states. So many people have licensure in multiple states already. If you are not one of the 10 states as a resident this does not apply to you. So this is not like a, you know, huge like opening up the gates to everybody living all over the place. California being where Katie and I reside, we can't just go and get licensed in Utah and now have the ability to practice in all of these other states. A residency requirement is part of this as well.

 

Katie Vernoy  05:20

Well, one thing, I think that it does start things moving, because I know with PSYPACT, there are 34 states in process. So it is the beginning of something, it's just a matter of right now, this is the very beginning stages and other states may join. But in some of the conversations and research we've done, it sounds like there's a lot that goes into it once a state joins. And even in putting together the overarching compact, there is this need to get kind of almost universal expectations, kind of an overarching, regulatory body, there's also needs to, you know, look at scope of practice issues, which at least as we're aware of MFT stuff, but there's very different scope of practice for California MFTs than there is for Texas, or West Virginia MFTs, for example. And so there's a lot of complexity that's going to be sorted out as this starts to get implemented. But the idea is that these compacts these interstate compacts are meant to provide a launchpad for more states to join, right?

 

Curt Widhalm  06:29

And this is some of the stuff that's got to be ironed out over the next couple of years. And frankly, I'd be surprised if all 10 of these states are able to address some of these discrepancies over the next few years. And for example, and I know not all of these states are currently part of the 10. But they do sometimes have some legislation to get them involved in the Counseling Compact here. But looking at the different requirements in different states, Georgia as an example, one of the 10 States does have a pretty high barrier to entry when it comes to becoming licensed within the state. And so I'm going to emphasize again, this is practicing privileges in other states, that is not a full reciprocity of license. So if somebody is practicing, gets practicing privileges in Georgia as a member of this Counseling Compact, one of the things that needs to be addressed is the discrepancy between what is allowed from one state to the next, for example, some states allow counselors to provide diagnostics of clients, other states do not and what has yet to be ironed out on this is how much does this change the scope of practice in these other states? What's unclear at this point is how these things are going to be regulated. While there is a central body that will oversee this compact, because of the way that it's set up each of these states are the ones who are still overseeing their own licensees, disciplinary actions and abilities to practice. So it's not like you're gonna be able to sit at home and do telehealth across all of these 10 states, and be able to practice just in the way that you are at home with your home state's clients, you're also going to run into well, I can diagnose this client but not this one. Or I need to be aware of, you know, my ability to do things ethically, one way in one state, but because of the ways that the laws are written in another state, I'm not allowed to do this. So these are some of the things that now have to be centrally addressed across all of these states here.

 

Katie Vernoy  08:48

And I think it's something that can get very confusing, but I want to re emphasize that there is this element of expectation that this means I'm in licensed and these other states and and because it's practicing privileges, is it telehealth only? If I go visit the state, could I still see those clients in person? Like what is the what is the practical difference between practicing privileges and licensure? In this regard.

 

Curt Widhalm  09:12

The differences is, it's not a license in another state. It's the allowance of you to be able to provide services to people in that state. But it is not the equivalent of having a license in both states.

 

Katie Vernoy  09:30

But what is the practical difference there? Like why do I care if I'm licensed or have practicing privileges?

 

Curt Widhalm  09:37

One of the major differences is that it's a lot easier to revoke practicing privileges than it is to revoke somebody's license. Having a license in both states means that you are obligated to both states licensing boards. What practicing privileges means is that you're allowed to practice here but you're still responsible to your own state's governing body for disciplinary actions, and so on and so forth. So it could be very easy. If a therapist is working with a client who's out of state and residing in Georgia, for example, Georgia could very easily be like, you're not meeting the requirements of practice in our state where you're doing out things, things outside the scope of practice in our state. And we don't like that, and you're no longer allowed to practice here. So it's a lot easier than going through a lot of the big disciplinary actions that may require revoking somebody's license in a state that they're actually licensed in.

 

Katie Vernoy  10:40

So for the clinician, it means that they would really need to be able to identify all the different scope of practice, how to really stay up to date in all these different states, as well as what is that kind of fine line that I can walk, either to treat all my clients the same, but super restricted, or, you know, like having different rubrics for how I treat each client. So it can get pretty complicated is what you're saying, for the clinician to pay attention to what's required of them.

 

Curt Widhalm  11:11

Yeah, and I think to this is where the goal is over the next couple of years to change some of this information. So that way, we're able to make it a lot simpler for people because the goal in this is with the intention of making practice easier, allowing for more people to have access to more mental health providers. However, these obstacles exist, and giving kind of the next couple of years of the ability for state legislatures to change the subsequent laws that now need to go into effect because this is in place, the goal probably is to simplify this stuff.

 

Katie Vernoy  11:50

Okay.

 

Curt Widhalm  11:51

And I haven't heard or seen anything where any of these member states have, you know, any real opposition in this way, it's just that things in the legislature can take other priorities. I mean, we saw this with the COVID 19 pandemic, where it's like all the states for a couple of years where like, everything now has to focus on COVID. So some of these obstacles are still in place. And it's just a acknowledgment that that's the system that we currently live in.

 

Katie Vernoy  12:21

So you mentioned kind of getting more providers for places that have provider shortages. And I think that's one of the biggest stated benefits, I think, clinician match and finding clinicians that have a specialty when you don't have a lot of clinicians in your state can be very helpful. There's also continuity of care. I've talked about my clients traveling around and especially as things open back up, there's clinicians or clients that are traveling a lot more and so we have to time their sessions versus just being able to meet at a regular time via telehealth, I think there's a lot of positives that are being seen here. We've started talking about some of the hesitations and and and we are aware that the for the MFT stuff CAMFT, AAMFT and AAMFTRB, you know, what least AMFT and CAMFT are talking and have reached out to AAMFTRB, whatever that is.

 

Curt Widhalm  13:12

Yeah, you got it right.

 

Katie Vernoy  13:13

So there's, there's conversations happening, I think, and obviously different stages for all the licenses, there's, there's a, there isn't a knowledge that this is something it's kind of the wave of the future, because we can interact so freely across state lines, like why not get this process in place, but there's a lot of complications, you know, the overarching scope of practice, the complication of setting it up and running it and all those kinds of stuff. There's a lot of stuff that's very challenging there. How much do we want to talk about that, that element versus you, you've already previewed for me anyway, that you are a little bit of a skeptic here. When do we want to what do we When do we want to shift gears to that? Because I think that there's so many folks are super excited about this. And I think there are things that are exciting about it. But there are some real concerns that I want to make sure we get to. So where should we go next? I guess is the question that I'm asking here.

 

Curt Widhalm  14:06

So this has all of the makings of a wonderful piece of legislation and cooperation that I don't know actually addresses what it's saying that it's intended to address.

 

Katie Vernoy  14:21

Okay.

 

Curt Widhalm  14:21

It is no surprise to anybody who listens to our podcasts that we have a mental health crisis, and we have a very understaffed mental health workforce. This theoretically allows for more clients to address more providers, but many of these states are amongst the most impacted as far as having the fewest providers available. And so if you combine 10 states who don't have enough workforce for each of their own individual states, by their 10 powers combined, theoretically can't address that even more people are going to be able to access a limited number of providers. It's not like we have, you know, a bunch of people who are all just residing in Utah, there's, you know, 9 million LPCs in Utah, who now just have like all of this free time to go and see clients who need to see counselors that Utah just has this, you know, mass amounts of people who have been confined to by state lines. This is, you know, a bunch of people without enough food now sharing that they don't have enough food with more people in more places.

 

Katie Vernoy  15:38

It doesn't make it worse. It just doesn't solve it is what is how I see it. But I think if folks who, if these states that have those needs don't get it started, I think it's hard because I think the big states don't need those extra jobs. Right? I mean, it maybe they do. I mean, I think there's a lot of clinicians in California, they're like, yeah, let me practice somewhere else, because I need I need clients, there's, you know, you could trip over a therapist, every few steps in California. So I mean, it's possible that with this starting, I mean, PSYPACT is going on 34 states. So we've moved beyond the the threshold in PSYPACT, where it's just states that are having provider shortages. I think I think I see what you're saying this does not solve? Did you want to start it?

 

Curt Widhalm  16:28

But I do want to correct one thing that you're saying is, we have a bias because we hang out with a lot of therapists in a very populated city.

 

Katie Vernoy  16:38

Sure.

 

Curt Widhalm  16:38

But California has a mental health workforce shortage as well. It's just that, this goes to address that there's rural parts of our states. And there's rural parts of a lot of these other states that are part of this, that we we have our own shortages, and we're not able to address this inviting more people to address, you know, people in rural areas. It's well intended, but it doesn't motivate or necessarily get people to the jobs that are needed in these positions.

 

Katie Vernoy  17:12

What you just said actually made me think about the series that we're still somewhat in the process of Fixing Mental Healthcare in America. But I think there's that that piece that the the RAND Corporation identified where there has been efforts and telehealth is a great effort to try to bring, you know, therapy to these rural areas, but the infrastructure and you know, good good WiFi, and all of the pieces to actually be able to address these things potentially are more impactful than just adding clinicians from another state that are probably going to want to access or your wealthy urban clients anyway.

 

Curt Widhalm  17:52

Which leads to my second criticism of this is that because of the scramble that's going to happen, the people who are most likely able to address the shortcomings of this public policy position across these 10 states are venture capital led groups like BetterHelp, that will do all of the legwork to match you up with clients in all of these rural areas. And we've got other episodes that we will talk in, you know, in BetterHelp's defence it's not just BetterHelp who can take advantage of these. But I have my concerns that the people who have already been doing this against the law, as we've discussed in our previous episodes are motivating therapists to practice across state lines, when they're not allowed to are the ones who are going to continue to contribute to the already capitalistic problems of our profession. And once again, not really with the best intentions of what clients have in store for them. But just by virtue of being able to match people more easily than any of the individual therapists in private practice. Where like, hey, my clients going on vacation, I can still see them for their regular session.

 

Katie Vernoy  19:21

We'll link to a lot of those episodes in the show notes. But but what I'm hearing you say Curt, is that this is super charging the big tech problem.

 

Curt Widhalm  19:31

Yes, it is.

 

Katie Vernoy  19:32

Okay. Mic drop.

 

Curt Widhalm  19:39

Pick that mic right back up, because they're, I don't know, I'm the resident, you know, contrarian of the show, the one who's maybe trying to poke at things and often I hear from listeners or from Katie or other people in my life is like, Why let perfection be the enemy of good? And so I am looking, you know, for who else opposes this? And I did come across somebody else on the opposition side of this. And it's a little group called the FBI.

 

Katie Vernoy  20:20

Why? Why is the FBI opposing this?

 

Curt Widhalm  20:25

For those unfamiliar with the FBI, they are a law enforcement agency. And they are one of the generally two places that when you go to get licensed that your background checks go to.

 

Katie Vernoy  20:38

Ah, yes.

 

Curt Widhalm  20:39

And so the rationale in other interstate compacts, including Counseling Compact, including PSYPACT, including medical compacts, and nurses compacts, the FBI has had a pretty consistent position on this. And their reasoning is that these states entering into these agreements, does not give them the right to supersede federal background checks. Now, allowing for practicing privileges in another state allows for the bypass of doing a background check for that state.

 

Katie Vernoy  21:13

Oh, interesting.

 

Curt Widhalm  21:14

And the way that the Department of Justice allows for some of these states to get the results of background checks, does not allow for them to share the information from those background checks.

 

Katie Vernoy  21:27

Oh, that's why if you get licensed in another state, even if you can say like, Hey, I'm licensed over here, they did my background check. The new state still needs a background check.

 

Curt Widhalm  21:37

And giving practicing privileges as I understand this legislation to be written today does not require background checks. It allows for the disciplinary boards to share information about discipline. But let's say that a therapist from one of these 10 states, goes on a weekend Bender in Vegas and ends up in the Clark County Jail. That information does not necessarily get shared with either licensing states because why, but then also doesn't get shared with any of the other practicing privileged states. It's not something that would mess like up. Overall therapists don't get arrested.

 

Katie Vernoy  22:22

Yeah, just don't

 

Curt Widhalm  22:23

Yes. But especially don't get arrested in your practicing states, because you're practicing states have with their own State Department of Justice's, like, California BBS. Like if somebody gets arrested, and they're licensed California, they get a little like, ping the next morning of like, hey, one of your licensees was arrested. But if you're, if you're gonna get arrested, don't get arrested, you know, being outside of your jurisdiction, at least, there's some opportunities to fall through the cracks there. And the...

 

Katie Vernoy  22:55

Are you telling people to how to avoid getting in trouble?

 

Curt Widhalm  22:58

This is not legal advice. And legal advice, once again, is don't get arrested. But what the FBI's database does, is allows for this information to be pinged in each time that somebody goes through a background check. The FBI is saying that this does not actually empower any of the states to know information if somebody was to have a an offense against them that wasn't caught or happened after their own background check to get a license in their own state.

 

Katie Vernoy  23:31

Well, I'm just even thinking for myself, I have not been arrested. I don't have anything that I have to worry about. But yeah, I haven't had a background check for 15 years? So I could be doing all kinds of stuff and get practicing privileges elsewhere - is what you're telling me?

 

Curt Widhalm  23:48

Yes. And so this very much goes against, according to the FBI, any sort of patient protection that any of these licensing boards are put into place in the first place to protect consumers.

 

Katie Vernoy  24:03

Well, I haven't think taking this further the whole consumer protection angle, and I think I'm gonna give you credit, you mentioned this before we started recording. But as a consumer, I have no place to check if you actually do have practicing privileges in my state, or if there's any problems. I mean, I guess I could look at your licensing state if I knew how to do that, knew where to do it, and can see if there's any any dings on your license, but, but it really takes some of the stuff out of the consumers hand being able to identify, you know, anything about the person that they're working with.

 

Curt Widhalm  24:41

And I imagine that these are things that are going to need to be addressed over the next few years as having some way of centrally notifying each other's state licensures or any of that kind of stuff. And I'm sure that there's somebody out there saying, But Curt this hasn't been a problem with PSYPACT yet. And the answer that I have back in response to you is "that we know of, and it will likely happen."

 

Katie Vernoy  25:13

Well, I think it's something where there's, and this was something that I hadn't thought about. But in a conversation that we had, I think it's something where, with psychologists, the, as far as I know, the licensing exams, their expectations are pretty constant across the United States. And so if somebody messes up in the state that they're licensed in, that's going to have a big impact, because it is the same pretty far across and I, this doesn't address the federal background checks. But I think it does address this kind of idea of all the complexity and and consumers having an issue because what they're expecting from their clinician is not what they get, because their clinician practices way differently than anybody in their state, for example, but MFTs don't have that. I mean, there's that there's a national association, but all 50 states basically have different expectations. Counselors, I think, are a little bit more streamlined and so that's probably why they're moving forward. Social workers are very streamlined, and I'm sure they're going to probably get, you know, glide through this. But I think it's something where that feels solvable, you know, getting a getting some way that there's this the background checks and that kind of stuff, if you're if you're part of this compact, if you choose to get practicing privileges, there's a federal body that you then have to get a background check. And then that, you know, somebody at the federal level is running it versus each state having to do it. You know, I think there's some legislation that could probably really help this. But that seems really expensive. And I'm wondering, you know, there's part of me, that's like do therapists care? Do to consumers care? I mean, like, we're worried about this regulation and there's part of me, and there's a whole podcast devoted to this Very Bad Therapy. But there's, there's bad clinicians that are not going to have oversight. But then there's also all of these clients, who don't have access to therapists who accept them as who they are. And so having some of these things come into place, like to me, it seems like it could be good. So I'm getting all over the place. So bring us back to something that's that's helpful. But I think there's, there's this element of it feels solvable. I just don't know the timeline, or how much money, but...

 

Curt Widhalm  27:36

That those two points are the problems that I foresee with this, that it's none of these things that I'm bringing up are unsolvable. Maybe the BetterHelp thing. But...

 

Katie Vernoy  27:52

That's a different problem. It's separate from this problem to solve.

 

Curt Widhalm  27:55

Right. But it's probably going to be a lot more costs that are passed on to the providers than anybody sees. The buzz that I'm initially hearing from people on this is very much like you that most people are taking this as, oh, I can just kind of see my clients wherever they travel, as long as they're in one of these 10 states.

 

Katie Vernoy  28:19

Yeah.

 

Curt Widhalm  28:19

And that is not true. And each one of these states is going to be additional costs. And you know, the background checks thing is, all right, you still go down to your local fingerprinting place, you do your live scan, you're just having it reported to a different state board and the FBI each time. And those things add up, you know, 50 bucks at a time adds up. Yeah, times that by 10 states, times it by the application fees, because part of the legislation that was written for all of these states is basically written by the same people. And it's, you know, quote, unquote, not actually a direct quote here, but not going to have anything more than administrative costs passed on to clinicians. There's a lot of administration costs in this that any of the licensing boards are more or less operating at a break even point that adding on a bunch of new staff to process out of state therapists and to verify things. Those are going to be cost that add up. Are they going to be cheaper than getting a license and meeting all the requirements in these other states? Absolutely. But these are costs that are going to add up for people. This is not going to be a free for all that all of these state licensing boards are going to allow here.

 

Katie Vernoy  29:40

Yeah, I think that's the thing that's that's hard because there's a lot of elements to this, that says that like this is this, this makes everything smooth and easy. This really provides additional access and the more we've talked together about it when we've talked to other folks about it, it just I'm hearing that there is so much complexity to how this operates, that it may not happen for all states, because you know, states that have enough clinician, states that have a higher cost of living, they may not feel the need to, to add to their costs, or their clinician base. And so they're not going to take it on. But but when I look at, you know, really what we're talking about, it's, it's trying to put a bandaid on this problem. And hopefully, it's it's something that there's actually real federal legislation that can help to increase the infrastructure in places that need more clinicians, help to, to create systems that actually address some of these concerns that you're bringing up. But that would require tax dollars, versus clinicians paying application fees, and all those things. I mean, I heard, I think that's the thing I heard was like, millions of dollars to get this setup, you know, I mean, like, that's, I guess, if you've got a lot of clinicians, that's a cross of a lot of clinicians, you know, if they are savvy clinicians, those fees are then incorporated into the fees they charge, which then for private pay clinicians anyway means that they're charging more. Insurance panels aren't going to pay you more just because you've got some extra that's under your belt. And so it's something where the cost thing hasn't been figured out, nor has the infrastructure both on the client side, but also on this regulatory side, it feels like there's just so much to figure out here.

 

Curt Widhalm  31:35

And that's something that I haven't even seen how insurance is going to work across state lines that I willingly admit that I don't know the inner workings of a lot of the insurance process, but knowing that, all right, yeah, it's great that you can see a client to timezones away. But does their insurance allow it? And this is another factor that's going to be in it. And, you know, we can talk all day long, and I'm already pre addressing some of the criticisms of this episode from people. We don't yet have universal health care. Don't even bring that up, like...

 

Katie Vernoy  32:14

Sure.

 

Curt Widhalm  32:15

Don't make arguments about systems that we don't have. These are problems that need to be addressed in the meantime. And yeah, I know that some people are going to say that this is the first step towards national licensure and this kind of stuff. OK or maybe...

 

Katie Vernoy  32:32

It may, it may actually delay it, it may delay it, because it's a band aid where people can go practice in other states. So why would I get a national license, if I can practice in a couple other states and not worry about taking another task, getting another background check, blah, blah, blah. I before we before we finish up, because I think there's probably going to be responses that then lead to additional episodes on this topic. But I think that just to kind of maybe poke the beast here a little bit. But with the with the insurance stuff, I think we're already seeing what insurance companies are going to do. And that is contract with these large tech companies that have clinicians across all the states pay them more so clinicians can get more, but it means that individual practitioners almost de facto have to be private pay, because they're going to get worse insurance rates, and they're not going to be able to really compete, certainly not in advertising dollars, or whatever. And we have a whole episode on this, but they're not able to compete with a gigantic quote unquote, tech solutions and or group practices. And so I think, I think it's something where there is a lot to consider here. I think there's going to be a lot of conversations that we want to have related to the disruptors, the tech disruptors in the space, who are the good ones, who are the ones that are challenging, and potentially hurting our profession? How do we, you know, step into this and, and take ownership of this space because, you know, there is so much and and potentially these these compacts allow for us to compete at this level. Or it may make it harder and I guess that's to be seen, I really think.

 

Curt Widhalm  34:14

Giving over the power, giving over the insurance contracts to publicly traded corporations means decisions get made quarter by quarter based on profits. And that is not what the healthcare system should be. We're kind of in a space where some people are able to compete against that but so many more episodes to be done on this. We will include some links to some stuff in our show notes. You can find those over at mtsgpodcast.com. You can bring up your concerns or tell us why you think that I am wrong on our social media.

 

Katie Vernoy  34:54

Or I'm wrong. I we've got a lot that we said here. So definitely join us over at the Facebook Group, tell us what we're what we missed, because we certainly missed a lot, I'm sure.

 

Curt Widhalm  35:04

And until next time, I'm Curt Widhalm with Katie Vernoy.

 

Katie Vernoy  35:08

Thanks again to our sponsor, OOTify.

 

Curt Widhalm  35:10

“OOT” or “uth” (उठ) means “lift up” in the Hindi language. OOTify is a digital health solution that acts as an evidence based hub to unify relevant mental health resources. Community connection and collaboration are critical to OOTify. As they lift the mental health care system, they ensure providers are part of the process. OOTify is a platform for providers built by providers and owned by providers. OOTify is in the process of lifting up mental health care while lifting each other up.

 

OOTify  35:43

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We're gonna go through trials and tribulations. But if we can work on our mental health proactively our wellness, we can handle all that as a community and come together, people are more open to talk about these stories and say, Hey, listen, I'm going through this too. Do you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the unified community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

 

Curt Widhalm  36:25

This episode is also brought to you by Turning Point.

 

Katie Vernoy  36:29

We wanted to tell you a little bit more about our sponsor Turning Point. Turning Point is a financial planning and coaching firm that helps therapists stop worrying about money. Dave, our good buddy over atTurning Point will help you navigate every aspect of your financial life from practice financials and personal budgeting to investing, taxes and student loans. He'll help you move through that feeling of being stuck, frustrated and overwhelmed, and arrive at a place where you feel relief, validation, motivation and hope.

 

Curt Widhalm  37:00

And for listeners of MTSG you'll receive $200 off the price of any service. Just enter the promo code 'moderntherapist', be sure and visit turningpointhq.com and download the free white papers Seven Money Mindset Shifts to Reduce Financial Anxiety. That's turningpointhq.com

 

Announcer  37:18

Thank you for listening to The Modern Therapist's Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

May 09, 2022
Clinical Considerations When Working with Asian Immigrants, Refugees, and Dreamers: An Interview with Soo Jin Lee
40:54

Clinical Considerations When Working with Asian Immigrants, Refugees, and Dreamers: An Interview with Soo Jin Lee

Curt and Katie interview Soo Jin Lee, LMFT on the clinical implications of working with Asian American immigrants, refugees, and dreamers. We explore how best to assess these clients, specific clinical considerations related to the immigration experience (and legal status in the country), and ideas for working with these clients clinically. We also talk about the impact of societal views, media portrayals, and representation on AAPI clients.

An Interview with Soo Jin Lee, LMFT

Soo Jin Lee is a co-director of Yellow Chair Collective and co-founder of Entwine Community. She is a licensed marriage and family therapist in CA and has a special focus on training and consulting on Asian mental health related issues. She is passionate about assisting individuals find a sense of belonging and identity through reckoning of intersectional identity work and those that are navigating through difficult life changes.

 

In this podcast episode, we talk about what therapists should know about Asian American immigrants, refugees, and dreamers

In preparation for Asian American Pacific Islander Heritage month, we wanted to dig more deeply into specific issues relevant to the AAPI community that are often not discussed in grad school or therapist training programs.

What assessment questions should be included for AAPI immigrant clients?

  • How to assess and ask about the immigration story (including about whether someone is documented or undocumented)
  • The assumption of citizenship status during the assessment
  • Exploration of cultural values and family dynamics
  • The definitions for refugee, asylum seekers, immigrant, undocumented immigrant, dreamer
  • Looking at reasons behind coming to the United States as well as legal status in the country

 

What is the impact of societal views and media portrayals of Asians on AAPI clients?

  • The common stereotypes and the gap in the representation in the Asian diaspora
  • The typical portrayal of undocumented immigrants from Latin America, Mexico, etc.
  • Lack of representation in the media of the broad experience of being an undocumented immigrant or refugee
  • The misrepresentation of families being all documented or undocumented (it’s actually a mix of statuses)
  • Language, cultural and values differences between the generations

 

What are the unique clinical issues for refugees and undocumented immigrants?

“We call ourselves dreamers, but at the same time the dreams tend to be a lot smaller or not attainable because there are also educational barriers and there are financial barriers as well.” – Soo Jin Lee, LMFT

  • The uncertainty of staying in the country
  • The hidden traumas and the fear of being kicked out
  • The lack of planning for the future
  • Education and financial barriers to pursuing the future
  • Trauma and PTSD are key elements, but sharing the story means that their survival is at risk

 

How do therapists more effectively work with refugees and undocumented immigrants in therapy?

“Provide a safe enough space and perhaps a more creative space, so that the story, the entirety of their journey, does not have to be nitpicked and talked about in a verbal manner. Are there modalities that you can adapt as a therapist, that they can go through in their mind, in a story book, in an art format, or any other way… that they can tell their story without being asked and interrogated about their story?” – Soo Jin Lee, LMFT

  • The fear and risk involved in disclosure and the challenge of talking about identity
  • Exploring their story creatively, without nitpicking or having to interrogate or make them verbalize their story
  • The importance of building trust and building a safe space within therapy
  • Bringing the mainstream media into the session
  • Addressing fear and decision-making
  • Soo Jin Lee’s healing journey to become a therapist and advice for other dreamers

 

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Turning Point Financial Life Planning

Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

Turning Point is a financial planning & coaching firm that helps therapists stop worrying about money.

Dave at Turning Point will help you navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans.

He'll help you move through that feeling of being stuck, frustrated and overwhelmed...

And arrive at a place where you feel relief, validation, motivation and hope.

And for listeners of MTSG, you'll receive $200 off the price of any service. Just enter promo code Modern Therapist.

Be sure and visit turningpointHQ.com and download the free whitepaper “7 Money Mindset Shifts to Reduce Financial Anxiety”

 

OOTify

OOTify. "OOT" or "uth" (उठ) means "lift up" in the Hindi language. OOTify is a digital health solution that acts as an evidence-based hub to unify relevant mental health resources. Community, Connection, and Collaboration are critical to OOTIFY.  As they lift the mental healthcare system, they ensure providers are part of the process. OOTIFY is a platform for providers, built by providers, and owned by providers. OOTIFY is the process of lifting up mental healthcare, while lifting each other up.

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We're going to go through trials and tribulations. But if we can work on our mental health, proactively, our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, “Hey, listen, I'm going through this too.” Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Yellow Chair Collective

Yellow Chair Collective on Instagram

Asian American Experience Support Group

 

Relevant Episodes of MTSG Podcast:

Asian American Mental Health: An interview with Linda Yoon, LCSW

Let’s Talk About Race Again: An interview with Yin Li, LMFT

Therapy with an Accent: An interview with Nam Rindani, LMFT

Invisible and Scrutinized: An interview with Dr. Sheila Modir

Therapy for Intercountry Transracial Adoptees: An interview with Moses Farrow, LMFT

 

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Patreon

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Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

 

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

 

Curt Widhalm  00:00

This episode of Modern Therapist's Survival Guide is brought to you by Turning Point.

 

Katie Vernoy  00:04

Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life from practice financials and personal budgeting to investing taxes and student loans.

 

Curt Widhalm  00:17

Visit turningpointhq.com to learn more and enter the promo code "moderntherapist" for $200 off any service.

 

Katie Vernoy  00:25

This episode is also brought to you by OOTify.

 

Curt Widhalm  00:28

OOTify is an immersive digital mental health ecosystem. It's designed to help minimize the fragmentation, trial and error, and overwhelmed felt by both patients and providers in the process of giving and receiving care. OOTify is the process of lifting up mental health care while lifting each other up.

 

Katie Vernoy  00:45

Listen at the end of the episode for more information.

 

Announcer  00:48

You're listening to The Modern Therapist's Survival Guide, where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm, and Katie Vernoy.

 

Curt Widhalm  01:04

Welcome back modern therapists, this is The Modern Therapist's Survival Guide. I'm Curt Widhalm with Katie Vernoy and this is the podcast for therapists about the things that we do, the things that we should be aware of in helping our clients and making the therapy a better place. And we are joined today by Soo Jin Lee, LMFT, and director of the Yellow Chair Collective, and wanting to have a really good conversation today about working with immigrants and refugees. Particularly, we're going to focus this episode around working with Asian clients, Asian immigrants and refugees, some of the considerations that we should have and how this fits within kind of the broader discussions around immigrants. And we're working with these kinds of clients that we've either ignored or not really had a great conversation about. So welcome to the podcasts. Thanks for joining us.

 

Soo Jin Lee  02:05

Thank you for having me.

 

Katie Vernoy  02:06

We are so excited to have you here and have this conversation. You and I met like almost probably a year ago and talked about this. And so I'm so glad we were able to make this happen. The first question we ask everyone is who are you? And what are you putting out into the world?

 

Soo Jin Lee  02:23

Yeah. So as Curt introduced, my name is Soo Jin Lee, I'm a licensed marriage and family therapist and the director here at Yellow Chair Collective. I guess a little bit about me outside of that is I myself am also an immigrant. So I am what's considered a 1.5 generation immigrant. And that just means that I came here at a very young age. I will also talk about this a little bit, I'm sure within this podcast, but I also grew up as an undocumented immigrant. And so those are aspects that I would love to introduce everyone to today.

 

Curt Widhalm  03:02

So we usually start with questions to help people in the learning process. This is not a shaming sort of question. This is a if we can prevent people from making the same mistakes that other people have made in the past. But what do therapists typically get wrong in working with immigrants and refugees?

 

Soo Jin Lee  03:22

Yeah, so one of the biggest things that come to mind for me is not having a proper assessment questions, or maybe even just having a lot of fear, general fear around asking clients about their immigration story. Right? When I say immigration story, I imagine that when people see me when I went to go see a therapist, my therapist also never bothered to ask me about my immigration story. So she'd never, in the span of two years, found out that I was an immigrant, and that even I was an undocumented immigrant, which speaks to a big chunk of my life, right. And so those are missing pieces, I think, in the therapy room, oftentimes, because those are not asked. So the therapists don't really get a full picture of a lot of immigrant and refugee experiences or the family of origin backgrounds. And I think this comes often for the case for a lot of mono lingual clinicians that are speaking English. And they find themselves sitting with a client that also speaks English very fluently. So then the assumption is that we're both American citizens sitting in the room together, right?

 

Curt Widhalm  04:46

There seems to be a lot of space for assumption in here and wondering if you could maybe give a little bit more guidance as far as like, on one hand, I don't want to assume that you're American by birth, but also don't want to assume that you're in immigrant just because you would appear different than a monolingual like clinician. I can see this potentially going both ways here and you have maybe a recommendation for people working with communities outside of their own backgrounds to maybe navigate that line a little bit.

 

Soo Jin Lee  05:20

Yeah, for sure. And I think one of the things that we'll go into detail about a little bit later is about how to frame and ask these questions. But I think the first thing is to quick get into the mindset of when you're assessing a client, just as much as you're asking them about their trauma history, that you get into the habit of asking about their cultural values and backgrounds and belief systems, which not only includes their immigration story, but it also includes their spiritual backgrounds as well.

 

Katie Vernoy  05:51

I would imagine that even just broadly asking about family and about cultural values, that that would be something that would organically come up. Is that your experience?

 

Soo Jin Lee  06:01

Exactly.

 

Katie Vernoy  06:01

Your immagration story?

 

Soo Jin Lee  06:02

Yeah, exactly. Right. And so when the therapist was asking me and I often are asking about family dynamic issues, or things that are impacting barriers that your parent and you are having, oftentimes, the immigration story is part of that if they are immigrants or refugees.

 

Katie Vernoy  06:23

It seems like there's a knowledge here that we need to have that we don't quite have yet. And so I want to ask more of a basic question, which is we're kind of using immigrant, refugee and undocumented immigrant, can you help us kind of make sure that we're all on the same page on those definitions?

 

Soo Jin Lee  06:40

Yes. So let's start by definitions, the fun stuff, right. All right. So I'm going to add another term to this conversation as well. Another definition as well. But first things, let's define refugees, right? This is a term that is being thrown around a lot on the news right now. So refugees are people who have fled their own country, because they are at the risk of serious human rights violation and persecution, from where they're residing, right. They're fleeing their country, they're fleeing their home. Okay, so those are widely known as refugees and can be defined as being refugees. Now, another term that I want to define that you didn't ask, is asylum seekers. And the reason why I want to do that is because on the news, they're also used, you know, interchangeably.

 

Katie Vernoy  07:34

Yeah.

 

Soo Jin Lee  07:34

Yeah. So asylum seekers are exactly the same, like a person that is leaving their country and seeking protection from persecution and serious human rights violations from their own country, but who haven't yet been legally recognized as a refugee, and they're waiting to receive the decisions for the claim of their asylum. Right? So there's kind of this legal status, that is the difference. So on the news, they're kind of thrown around, you know, interchangeably. But if a client is defining themselves to be either asylum seeker or refugee, that really speaks into kind of this political legal status of standing that they're in, in this country. So now we go into immigrants then. And immigrants, like I identified myself as an immigrant, right, are people that have made a conscious decision to leave their country, their home and to move to a foreign country and their intention of moving is to resettle there, right, to not go back home and relive there but to resettle into this new country. So we have a lot of immigrants in this country, right. A lot of people come from other places around the world and their intention and they make that decision very consciously. They plan for this immigration journey. And they intend on resettling here making this into their home, right. A lot of the reasons for resettling, a lot of people ask me this too like, what why do people want to live here? Why the United States? Some of them with a little bit of a snarky attitude, right, like why would anybody want to live here? Right. And there's a bunch of reasons. So I can't tell you exactly what those reasons are. And that's for you to find out with your client.

 

Katie Vernoy  09:37

Sure sure.

 

Soo Jin Lee  09:38

 There are that immigrants if they're the refugees, and you know that these are two different kind of journey that they have gone through, if they're refugee, they've really left out of a need, while for immigrants to they do leave out of a need oftentimes, too. But for refugees, really they had no choice but to leave. But for most of the times, a lot of immigrants did would have the choice to leave. Now I'm gonna add to that just a little bit. Because for me, as I've introduced myself, it was kind of a unique, where I didn't really get a choice to leave, but I am still an immigrant too, right. And so an undocumented immigrant are people who are born in another country, but have no legal status in the United States. You know, it's funny, because as I was kind of preparing this, and I was trying to think about how to define these kinds of terms, I read an article that was defining undocumented immigrants as foreign born person who does not have legal rights to remain in the United States. Right. And so when I saw this definition, I felt like, wow, this is perfect portrayal of how many Americans think about undocumented immigrants, right, that they don't have any rights to be here.

 

Katie Vernoy  11:03

Hmm, interesting. Yeah.

 

Soo Jin Lee  11:07

So my definition is that I just don't have or had in the past, a legal status here, a document that tells me my identity as anything here in the United States.

 

Curt Widhalm  11:20

You're talking about dreamers. Right.

 

Soo Jin Lee  11:22

So dreamers? Well, I do identify as dreamers, but undocumented immigrants or anyone that does not have any legal status in the United States.

 

Curt Widhalm  11:32

Okay.

 

Soo Jin Lee  11:33

Yeah, dreamers, I identify as dreamers. And that's another term where they came so with their parents, as young children in the United States, and became undocumented through that journey, right.

 

Curt Widhalm  11:49

Okay.

 

Soo Jin Lee  11:49

So an example of that is, and you can add this too. So the reason why I was undocumented is because my parents came here with a ToR visa, a visitor's visa. So a visitor's visa in the United States from where I'm from, allows you to stay in the United States for up to six months. Their intention was to overstay the visa and resettle here. But they could not find any other way of staying in the United States. Without having found a job in the six months of visiting the country, right, which they really couldn't, they couldn't find a right sponsor and the job. So then, during the time that my parents were looking for a job that would sponsor them to become residents, we all became undocumented. And then, during the time, where that sponsorship, was gained and lost, and this whole process of becoming a resident, I ended up becoming 21 years of age and older, which meant that my parents were able to gain their residency status, where I had to now be an adult here by myself, applying to become a resident. So that defined me to be a dreamer. Dreamers are under this umbrella of undocumented immigrants.

 

Curt Widhalm  13:22

So depending on the mainstream news source that people watch, there's some different portrayals of people. And I think that that has created an overarching narrative around some of these terms, and especially around you know, as you're describing undocumented, and refugees, and I don't know that the media necessarily separates them as well as you do here. Katie, and I is born and bred, people from America, we have a different perspective on how the media portrays immigrants. How are from your side of things, how are Asian immigrants portrayed? And what does that impact like?

 

Soo Jin Lee  14:04

Yeah, that's a really good question. So Asian Americans in general, right, whether they are immigrants, whether they're refugees, whether they're undocumented, or and all of these terms, whether they were born here, or whether even they might be fourth or fifth, sixth generation Americans, they're all portrayed into this box. And often this box is painted as Asians with lighter skin color, often East Asians, and often a lot more recently, too, as wealthy or quote unquote, Crazy Rich, right? They're often portrayed to be smart, law abiding, but not yet citizens. They're still foreigners, but they are law abiding right? So there's this huge gap of representation in the Asian diaspora. So geographically, Middle East, Southeast Asians are still part of Asia too. Right. But in the United States, it really seems that how Asian and Asian Americans are displayed is really just one way in one picture. And I fall under that category to as Korean American as East Asian, often I find myself seeing people that look like me have my colored skin being displayed on the media. But yeah, they don't really have the full scale of experience that I carry, right. They're usually very wealthy, I have no idea what they, how those people got their wealth. But often, right, that those are the stories that are being told. And none of the other stories get to be represented in the media.

 

Katie Vernoy  16:02

Or it seems like if they're represented in the media, there is this kind of sinister tone to it. And there's kind of a negative portrayal. And so I guess the question I have we've, we've had some of this conversation before, we've talked a few times about the model minority myth, we've talked about kind of some of the representations in the media, but but like, holding this conversation into immigrants, refugees, and undocumented immigrants, it seems like that experience is a bit different than the folks that are fourth, fifth generation, those types of things. Because I think there's, there's something that we're missing, when we don't have that full perspective. So maybe speaking into that would be helpful for our audience today. And we'll link to the other episodes in the show notes so people can dig deeper into kind of the broader topic of AAPI mental health.

 

Soo Jin Lee  16:52

Yeah, for sure. And so going off of that a little bit. So then when you think of undocumented immigrants, right, oftentimes, there is absolutely no portrayal or representation of Asian immigrants in that picture in that light at all. Right? Oftentimes, you are seeing on the news of people from Mexico or Latin America, Central America that are crossing the border, or they're criminals, or they are portrayed to be drug dealers, and undocumented immigrants, for a lot of them, although around half of them are from either Mexico or Latin America. A lot of the other half are from all other parts of the world, and a big chunk of that are Asians. And yet, we're not being displayed in that way. Right? We don't We are not represented in that manner.

 

Curt Widhalm  17:50

What's the impact on people growing up without that representation?

 

Soo Jin Lee  17:55

A lot of the things the, I guess, the commonly shared concerns that undocumented immigrants and refugees have, first of all, most of the immigrants and refugee families when we also think about them, it's that family unit that we think are all immigrants, or refugees, right? Because that's also portrayed in the media, like all the families are coming together to have this survival. But in the United States, most immigrants and refugee families are what we like to call a mix immigration status. Right. So one of the examples of that is, of course, what I've mentioned, right, where my parents became president, and then now citizens were I wasn't able to I was undocumented. Right. So there's this mix immigration status within one family unit. So I read that about two thirds of children of undocumented parents, right. Have US foreign citizen, kids. So then they also have a lot of this, you know, mixed status within families. Right. And then there's also children, like me, who move to the country at a young age and then stay undocumented. And then their parents got status. So there's a lot, right. Commonly shared concern that this family unit can have is this gap, right? between parents and children. There's a huge gap of sometimes language barrier, but cultural barrier and value barriers to an understanding each other. And so these are things that a lot of our clients, my own clients are bringing to the table of being able to kind of discuss, hey, here's my identity as this one person And my parents do not share that identity in a similar manner, or their struggles are looks so different from me. And yet I'm trying to figure out how to connect with them, and connect with myself and connect with the community. And so these are very, very common struggles that I hear.

 

Katie Vernoy  20:20

I'm thinking that you have two clients, similar age, potentially similar heritage, you know, let's say both are Korean American, and one is a refugee and one or, or an undocumented intergroup immigrant. And you can decide which one is more relevant here. And one is fourth or fifth generation. I may make assumptions if I don't understand the different stories, but But what might be the nuance there of what I need to be aware of for this client that has either refugee undocumented immigrant status, like what what what are the things that are important for me to be aware of separate from kind of the experience as an Asian American, or Korean American in the United States?

 

Soo Jin Lee  21:02

Yeah. So as undocumented or refugee immigrant, that daily struggles of unhidden trauma that they endure, can look really different. If you can imagine, if you're an undocumented immigrant in the United States, you always can be thrown out of your home at any time of the day, they literally come to your door, say pack up your things, and then you're headed to the jail, where then you will wait to be sent to the airport, and then out of here. For a lot of undocumented immigrants like me, who consider themselves to be dreamers, this is our home. This is where we grew up, we have no other home, we have, oftentimes, the dreamers may not even speak the language of their parents origin or where they come from themselves, right? So then there's this continual fear of is this going to be it. So a lot of times, you'll find that we call them dreamers, we call ourselves dreamers. But at the same time, the dreams tend to be a lot smaller or not attainable, because there's also educational barriers. And there's financial barriers to right. Undocumented immigrants also suffer from the fact that after you graduate from high school, you may not be able to go to college, because oftentimes, undocumented immigrants need to go through this whole other other paperwork in order for them to be admitted, and pay for the tuition. And out of college, if they do get through college, then how to find a job, right. Without documentation, oftentimes, they are unable to find employment, or when they do, it's what's called, you know, under the table, pay, right? So then this whole question of what is my future going to look like? I want to become this or that I want to be an engineer, just like everyone else. And I'm told that in America, that we can fulfill this dream, right? I'm told I can be anything. Except I'm not an American. So that dream is not really applicable to me. Right? What I have to think about is, what I'm, what am I going to do to survive here? What am I going to do to obtain status here so that that dream can come true? Right, so this extra barrier, extra concern, extra fear, that is always in the back of their minds.

 

Curt Widhalm  23:48

What do you recommend for therapists to do to work with this? I mean, there seems to be such great existential exploration here. But a lot of existential stuff can kind of come with the, at least the traditional ways that it seems to be taught comes with the security of at least you have this time in this space that is going to be yours. But what do you recommend therapists do in working with clients presenting with kind of this fear that's kind of constantly always sitting there?

 

Soo Jin Lee  24:20

Yeah, so I think for a lot of therapists, you're pretty familiar with being able to work with trauma, and being familiar with working with PTSD. And so the first thing that I do want to note is for a lot of undocumented immigrants and for refugees, sharing the story oftentimes meant that they their survival was at risk. And it speaks true still for undocumented immigrants that are living here, right. For refugees, that might mean that back home that that was the case, if they identify themselves in a certain way or if they find And if people find out or the government finds out about their their identity, their status, then they might be murdered, right? For undocumented immigrants here, if their undocumented status becomes known to the public known to the government, anybody reports them, or anything like that, there's always the fear that now my home is going to be taken away, my everything will be taken away, right. So there's always that fear. So being able to come to therapy, and to be asked to speak on your identity, to speak on your journey is quite a huge gap of what's being told for you to do on a survival basis. Right. And to get to that story, I think, takes a long time of building rapport. And, of course, that is the basic of all therapy. But really, though, to treat it, treat it very carefully, and being able to provide a safe enough space, and perhaps a more creative space. So that perhaps the story, the entirety of their journey, does not have to be nitpicked and talked about in a verbal manner, right? Are there modalities that you can adapt as a therapist, that they can go through in their mind, in a storybook, in an art format, or any other way in a motion format, right? That they can tell their story, without having to be asked and interrogated about their story.

 

Katie Vernoy  26:39

I feel like I want to know more about what you're describing here. Because this I think I'm understanding but I don't want to make, I want to make sure I'm not making assumptions. So you're talking about putting creative methods forward.

 

Soo Jin Lee  26:53

Yeah.

 

Katie Vernoy  26:54

Tell me more. I'm still kind of trying to sort this out.

 

Soo Jin Lee  26:56

Okay. I don't know. So, I really love utilizing EMDR as part of my practice. And I know brainspotting can be another another one that goes off of EMDR. Because it utilizes the body, and it goes through the journey of people's trauma without having to verbalize it. I think that's a perfect example of how people can go through processing their fear and trauma responses, without having to tell me about it.

 

Katie Vernoy  27:29

That makes sense. Thank you.

 

Soo Jin Lee  27:32

Yeah. Another thing EMDR is definitely not for everyone. And it may not be very acceptable for some of my clients too, especially some of the older older folks. They really don't like having to move their eyes or, you know, they they really don't understand, like, Why Why am I keep tapping myself. So, so then I introduce just another format of like, being able to draw out their story. So literally trying it out, like is there a color that represents how you're feeling is there, or a rock or any item on your on your table that you want to tell me about? Right, that speaks to your culture, that speaks to your value. So then we're talking about this headband, that's sitting on their table, we're talking about sensory oriented things, too. We talk about the weather a lot, actually, as a way to imagine and use imagery of going back into their place of origin. Because weather exists everywhere, it's a common thing that we are experiencing. And we are using our sensories to connect with it all the time, connect with ourselves, and our sense of belonging in the world is oftentimes through temperature through weather through the humidity in the air. So then we talk about that, and we talk about in comparison to how it was back in your country as well, right. And so then that brings about a little bit of healing in a way I get to explore, I get to talk about my other self, or my other parts that I was told that I have to be hiding. And I get to bring that in here without being interrogated.

 

Curt Widhalm  29:25

And like you said earlier, this for clinicians who are coming from different backgrounds takes a lot of time to develop that trust and that ability to create and honor the space and the stories of people being able to tell them in their own ways. You know, one of the things and this is totally not on our list of questions, but one of the things that I've seen a lot of excitement about is even just kind of the positive representations of like the movie Turning Red coming out that has really opened up a lot of these stories and opportunities to talk about things in ways that haven't necessarily been so mainstream that clients, clinicians are really resonating with as an opportunity to say, oh, yeah, this is this is now something that allows for me to connect to this in a way that you might not have understood before.

 

Soo Jin Lee  30:22

Yes. What is the question in that?

 

Curt Widhalm  30:25

There is not a question.

 

Soo Jin Lee  30:30

Okay, yes, for sure. I think if I were to kind of just add to that, yeah. For a lot of clinicians, you can do a lot of research now, on looking at these shows, and being able to bring that into the therapy room, I think being able to talk about some of the mainstream media, that is how they are portraying certain cultures, and how clients they resonate with that or not resonate with that, what the differences are, what were you drawn to, what emotions came out of you from that watching that? Those are really good conversations to have about their family immigration journey, or they're just their own understanding of their, their own cultural backgrounds.

 

Katie Vernoy  31:14

I want to address a couple of things. I know, we don't have a lot of time, but I want to address a couple of things that you've talked about, because I think they're just so visceral to me. And I think that that element of fear, and dreams are small, and some of these ideas around when you have either an undocumented status, or if your refugee status maybe is at risk, depending on I know, there's a lot of different ways that folks are able to seek refugee status. And I know that there's some folks that have to keep reupping it every, you know, whatever, few years, those types of things. And I think it can be extremely hard to build a life when you don't know if the future is what the future holds. And so maybe a little bit more into that topic, because there's the trauma, of course, and I love how you talked about kind of assessing that and being able to heal that. But I'm a practical person, I'm like, Okay, well, part of our mental health is being able to set a course for our lives and be able to do some of these things. And I know that just doesn't sound like it's completely possible. So maybe if you can talk a little bit about how you walk in that space of finding mental health and wellness, while also knowing that these fears are completely justified. And this temporary status is something that that really does impact folks on a day to day basis.

 

Soo Jin Lee  32:41

Yeah. So when we talk about how fear interrupts their day to day basis, then we're getting into more of the behavior and the cognition of what what it looks like on their day to day and how it impacts their day to day, right. So if the client is interested in working through their decision making, because the fear is getting in the way of making certain decisions of, for example, let's say should I even accept this college? Because I'm not even sure if I'm going to continue into graduation? Why bother? Right? Now, that's a mindset and a cognition, and that belief system that we can work through, within whatever, you know, therapists modality of choice in order for them to achieve the whatever it is that the client wants to achieve. Is it that they really want to go into college, but the fear is getting getting in the way, right. Another thing, I think, on a very practical level, is just the level of anxiety and the threshold that they're living with on a day to day basis. So then the fear response, and the trauma response comes out in a way where it's oftentimes is insomnia, within their relationships. Right. So those are things that I think, as mental wellness practitioners can really provide the tools for, right on a day to day basis of like, okay, what are you eating? What, how are you sleeping? And are these things that we really should be concerned about? Right.

 

Katie Vernoy  34:15

And just the the final question that I have is, is about, you're walking this journey yourself. And so I'm thinking about our audience members, who are also undocumented immigrants or folks who are in this space and you've accomplished becoming a therapist and doing those things, but it seems like it's something where there would be some additional things for our health, mental health providers who are in these spaces to be able to take care of themselves and to think about their journey as a therapist. And so kind of the survivor guide element for our our therapists who are, are grappling with being undocumented or being a dreamer.

 

Soo Jin Lee  34:56

For me, I think I and everyone has their story of why they became a therapist. For me, I became a therapist because of my immigration journey. And that practice of finding myself, my story, my voice, and how to even understand that was the healing journey for me. And I found that through working with others that were telling about their story and was willing to open up their lives, their emotions, their family dynamic issues with me, I think. So oftentimes people find understanding, through relating their stories with others. The theme of what we're talking about today is how we're not being represented enough, that we're not being seen enough, we're not being heard enough, right? In all these different aspects of layers, in the media, in the government, through this whole legal journey. So I think what I want to say is, finding myself was the most healing thing that I could have done for my community at the end.

 

Katie Vernoy  36:28

I love that.

 

Curt Widhalm  36:30

Where can people find out more about you and the work that you're doing?

 

Soo Jin Lee  36:34

So you can find us at yellowchaircollective.com and on Instagram at YellowTreeCollective. We provide individual, family, couples therapy services. But the unique thing that I think we're providing is the cultural specific identity issues. And the support groups that built around those issues. Right, we have a support group, just called the Asian American Experience support group. And although we wanted to make it a little bit of a therapy group, where people can be doing doing a lot of processing, which we do, but we call that a support group, because we realized that a lot of people outside of California were in need of mental health support and community spaces that they couldn't find it within their own states. So that we expanded it to be a support group. That way anyone in the United States can find us and sit in this online space, and hear other people's stories like and connect and relate and find healing and that

 

Curt Widhalm  37:48

We will include links to all of that in our show notes. You can find those over at mtsgpodcast.com. And follow us on our social media, join our Facebook group, The Modern Therapist group. And let us know your reactions to this episode as well as, especially if you are a therapist with a similar story around being a refugee, immigrant. we would love to continue to elevate voices in our community around that. And until next time, I'm Curt Widhalm with Katie Vernoy and Soo Jin Lee.

 

Katie Vernoy  38:26

Thanks again to our sponsor, Turning Point.

 

Curt Widhalm  38:29

Wanted to tell you a little bit more about our sponsor Turning Point. Turning Point is a financial planning and coaching firm that helps therapists stop worrying about money. Dave at Turning Point will help you navigate every aspect of your financial life from practice financials and personal budgeting to investing taxes and student loans. He will help you move through that feeling of being stuck, frustrated and overwhelmed and arrive at a place where you feel relief, validation, motivation and hope.

 

Katie Vernoy  38:58

And for listeners of The Modern Therapist's Survival Guide. You'll receive $200 off the price of any service. Just enter promo code 'moderntherapist' and be sure and visit turningpointhq.com and download the free white paper Seven Money Mindset Shifts to Reduce Financial Anxiety. Thanks again to Turning Point.

 

Curt Widhalm  39:18

This episode is also brought to you by OOTify.

 

Katie Vernoy  39:22

"OOT" or "uth" (उठ) means "lift up" in the Hindi language. OOTify is a digital health solution that acts as an evidence based hub to unify relevant mental health resources. Community connection and collaboration are critical to OOTify as they lift the mental health care system. They ensure providers are part of the process. OOTify is a platform for providers built by providers and owned by providers. OOTify is a process of lifting up mental health care while lifting each other up.

 

OOTify  39:54

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We're gonna go through trials and tribulations. But if we can work on our mental health, proactively our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, Hey, listen, I'm going through this too. Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

 

Announcer  40:35

Thank you for listening to The Modern Therapist's Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

May 02, 2022
Reflections on Content Creation and the Therapy Profession
35:22

Reflections on Content Creation and the Therapy Profession

Curt and Katie chat about our principles and philosophies as they relate to the work we do, including podcast creation. We also reflect on the feedback we’ve received on episodes with large listenership as well as other typical responses we get to the work we do. Considering content creation as part of your business? This isn’t a how-to, but it certainly can give you things to consider before you dive in.

In this podcast episode we talk about how we put together the podcast

We’ve received a lot of feedback recently about our episodes and we wanted to talk about how we make decisions on what we talk about, who we interview, whether we call folks out on the podcast, and how we edit the episodes.

Our Philosophy and Principles for creating content for the Modern Therapist’s Survival Guide

“We can talk about how to navigate the career, but at some point, we become complicit in a broken system. And so, we've been talking about how to balance: how do we give the tools to navigate what is, and then also give the empowerment and/or the validation that advocacy needs to happen.” – Katie Vernoy

  • How to navigate the career as is (tools and strategies to survive in this field)
  • The importance of advocacy in moving forward with our field
  • How to strategically time advocacy for best effect
  • How we take in feedback and respond

Responding to Feedback from our Audience on our “What’s New in the DSM-5-TR?” Episode

  • The concern about the Autism diagnosis changes
  • Whether we should have called out Dr. Michael B. First and the impressions of what was said
  • Grappling with the tension between protecting our audience and getting our guests on record and/or advocating for change in the larger systems
  • How people can impact what becomes DSM 6 (and the efforts we are advocating for)
  • The feedback we received and how we sort through it and improve
  • The limits of our capacity
  • Our plans for additional interviews to address the changes

“It's been my experience in advocacy, that large systems end up ignoring those individual voices. Those individual voices are incredibly powerful when they're used in the right place at the right time.” – Curt Widhalm

A Broader View of the Feedback We Receive on the Modern Therapist’s Survival Guide Podcast

  • The depth of the conversation and our ability to deepen conversations with additional episodes
  • Audience members anchoring on the title or episode artwork and not looking at the whole episode when pieces of the content resonate in a different way

Our Plan Going Forward with the Podcast

  • Advocacy, information, and focus on the profession
  • Not as much of a focus on business building, money mindset, and side hustles
  • Real conversations about the realities of working in this profession
  • Working to leave the profession better than we find it

 

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using THIS LINK if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time!

Melissa Forziat Events & Marketing

Today’s episode of The Therapy Reimagined podcast is brought to you by Melissa Forziat Events & Marketing. Melissa is a small business marketing expert who specializes in marketing advice for businesses that have limited resources. 

Are you looking to boost your reach and get more clients from social media?  Check out the “How to Win at Social Media (even with no budget!)” course from marketing expert, Melissa Forziat.

It can be so hard to get engagement on social media or to know what to post to tell the story of your brand.  It can be even harder to get those conversations to turn into new clients. Social media marketing isn’t just for businesses that have a ton of money to spend on advertising.  Melissa will work you step-by-step through creating a smart plan that fits within your budget. 

How to Win at Social Media is packed full of information. Usually a course as detailed as this would be priced in the thousands, but to make it accessible to small businesses, it is available for only $247.  PLUS, as a listener of the Modern Therapist’s Survival Guide, you can use promo code THERAPY to get 10% off.  So, if you are ready to go to the next level in your business, click THIS LINK and sign up for the How to Win at Social Media course today!

Please note that Therapy Reimagined/The Modern Therapist’s Survival Guide Podcast is a paid affiliate for Melissa Forziat Events & Marketing, so we will get a little bit of money in our pockets if you sign up using our link. Thank you in advance! 

 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

The Therapy Reimagined Mission

Our Patreon

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Relevant Episodes of MTSG Podcast:

What’s New in the DSM-5-TR?

A Living Wage for Prelicensees

Mission Driven Work

Therapists are Not Robots

Why You Shouldn’t Sell Out to Better Help

Advocacy in the Wake of Looming Healthcare Shortages

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


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Consultation services with Curt Widhalm or Katie Vernoy:

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Connect with the Modern Therapist Community:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

 

Curt Widhalm  00:00

This episode of The Modern Therapist Survival Guide is brought to you by Thrizer.

 

Katie Vernoy  00:03

 Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is you don't need to give up your rate they charge a standard 3% payment processing fee. By using the link in the show notes you can get a month of billing without processing fees just to test them out for your clients.

 

Curt Widhalm  00:30

Listen at the end of the episode for more information.

 

Katie Vernoy  00:34

This episode is also brought to you by Melissa Forziat Events and Marketing

 

Curt Widhalm  00:39

Melissa Forziat is a small business marketing expert who specializes in marketing advice for businesses that have limited resources, including the very special course How to Win at Social Media, Even with No Budget. Stay tuned to the end of the episode to learn how you can get the most from social media marketing, even with little to no budget.

 

Announcer  00:59

You're listening to The Modern Therapist Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  01:12

Welcome back modern therapists. This is The Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists and things that we do the things that we have come up in our field, the ways that we want to spread our messages. And if you're not a therapist, welcome and listen to it from the angle of our intended audience being therapists. Katie is laughing at me because she said that this is an episode where we're not supposed to sound defensive.

 

Katie Vernoy  01:53

Oh, dear, we're already off track. Thanks, Curt. No, I think this is an episode where you have to be completely transparent like this is this is an episode that we need to do. And I think that there's positive and wonderful things that we need to talk about. And there's some stuff that we might have some feels about to use the language of the young folks today.

 

Curt Widhalm  02:15

I don't know who you think is the young folks today?

 

Katie Vernoy  02:19

Fine, fine. Let's move forward.

 

Curt Widhalm  02:22

All right. We have a lot of new listeners here over the last few months. And we want to thank you for joining us each week. And it's been a while since Katie and I have clarified a lot of things about our podcast, this is maybe an opportunity for some of our new listeners to get to know us in a little bit different way and for our longtime listeners to maybe be able to have a little bit better understanding of what Katie and my process is. And the working title of this episode is. So you want to be a content creator. This is really less of a how to episode and more of a here's the things that have come up in our process that helps us to define how we largely go about things. Now a lot of our listeners who have joined us recently found us through our DSM five episodes, some of our continuing education content. And what we want to do in this episode is kind of talk about what some of the things are that have come up for us as content creators here over the last few months, and how we made some of the decisions that we've made and kind of some of the principles that we do in making our product, something that hopefully all of you enjoy.

 

Katie Vernoy  03:49

Starting with the principles. I think when we first started and this was way back in 2017, I think the idea was, let's put together a podcast that has conversations that don't typically happen, at least not in public spaces. A lot of therapists, I think, have some of these conversations in the background. But it's not something that is happening in grad school. It's not something that's happening in supervision frequently, and it's kind of the realities, the survival guide tactics of how do we actually navigate this career. And what we've found over the years is that the additional piece is like yeah, we can talk about how to navigate the career but at some point, we become complicit in a broken system. And so we we've been talking about how to balance how do we give the tools to navigate what is and then also give the empowerment and or the validation that advocacy needs to happen. And then each of us can step up in our own ways, whether it's in how we practice individually in our offices, or what we say to our legislators or those kinds of things like how can we advocate true change for our profession, you know, whether it's equity, whether it's pay, whether it's decolonizing, our practices, all of the things that we've wanted to make sure that stay in the forefront, we recognize that it's a hard way to balance because if we completely destroy mental health right now, because it's not working then, there's no mental health. But if we complicitly and complacently stand by and continue to reinforce how it's being done, then we're not making any progress. And so we're trying to walk that line to be able to say, Hey, this is what the profession is, this is how you can navigate it. And this is what we see as a potential future. And let's give you the tools to be able to help us all come together as modern therapists to push towards that new future.

 

Curt Widhalm  05:45

A lot of what our conversations on the back end have been here over the last month or so has been about a lot of the response that we've had, hearing from some of our audience members directly, following some of the online interpretations and reactions to our DSM-5 update episode where we had Dr. Michael be first as the APA, co author of the DSM-5-TR. And our background conversations between Katie and I have been why did we make the decisions that we made with this particular episode? And how does this fit within a lot of what Katie was just describing as our principals here. And Katie and I have been long involved in a lot of advocacy work, and know that some of the reactions that we've seen the immediate petitions to change the autism diagnostic criteria, based on the information that was presented in that episode, to prevent the DSM-5-TR from having those very changes made. And Katie and my work in advocacy, we knew that that kind of an effort is mis timed, because those books were already published in sitting in warehouses all around the world at that point that understanding some of the advocacy process is very much an important piece of this, that you hear us in a number of our episodes across time talking about advocacy. I don't know that the emphasis on how freaking long things take...

 

Katie Vernoy  07:33

So long, so long

 

Curt Widhalm  07:35

...is something that people tend to forget. And there's oftentimes this very reactionary in the moment sort of thing that happens that people lose their enthusiasm, because then there's a next in the moment sort of thing happens. And this is why our principals are so important to us is because it helps us in deciding not only what we address, but how and importantly, when we address them. And if you want to hear in depth kind of discussion about it. We'll link in our show notes over at MTSG podcast about our efforts several years ago to get a mental health professionals organization to make a statement on paying pre licensed therapists a living wage. This is a long term process sort of thing. And I think that this starts to speak into some of the criticisms that we've been hearing about the DSM-5 episode from some of our audience here.

 

Katie Vernoy  08:37

The other element that I think is important is being able to go into conversations with reasonable expectations of what's going to happen in the conversation. And so there's the timing of the advocacy, but there's also getting a full picture of what the actual situation is. And I know for me, in interviewing Dr. First, I was expecting a lot more pushback on the questions we actually asked around inclusion around the discussions with folks with lived experience, around the limitations of the diagnoses. And the fact that he was willing to engage in those made me very excited. Now, as we had the conversation. There were a few different things that I was trying to pay attention to. And this is I guess, this goes into kind of editing choices as well as kind of the advocacy element of it. I wanted him on record about kind of what his perspective was, what his process was those kinds of things and I know that there was some language that he used, it was pretty cringy, there was a lot of outdated language, there was a little bit of editing to try to soften that for our audience as kind of a protective measure for our audience. But we couldn't edit out the cringiness of this individual. My concern, and this is something I've grappled with. And I, maybe maybe we would do it differently if we interviewed him again tomorrow. But I wanted to hear all of the pieces. I wanted it all on record. And so there were things that he said that I might have called him out on in person. But recognize that was potentially risking getting the next question answered. And the next question answered. It potentially risked the interview not happening, him not being recorded and on record with the things that he ended up saying. And to me, I felt like there was this really push pull on how do we protect our audience? And how do we move forward with the advocacy that needs to happen around this outdated medical model book that we all have to use?

 

Curt Widhalm  10:51

I think to that point, this is our protection of our audience, is within the scope of Katie and my principles. And I hope that our principles aligned with a lot of yours. But, you know, being very clear to what Katie said earlier, we are about advancing our profession, we are about better pay, we're about better education. And we incorporate a lot of social justice work within that. And it's very informed by a lot of social justice work. To peel back the curtains a little bit on our process. We do edit our podcasts, we aren't as clear as what our finished product is. We've edited...

 

Katie Vernoy  11:09

Clearly not.

 

Curt Widhalm  11:12

...we edit out ums and coughs, and we allow our guests to be able to say, Hey, I didn't say that correctly, would you edit that back? Let me restate this in another way. And because we develop relationships with a lot of people who come on this podcast, we're very accommodating of that. And in this particular recording, part of what we consider is, is it important to advocate in this particular moment on something that's informative of our principles, and potentially lose the entire interview in the first place, then it becomes Katie and me pissing off one person and not having a podcast, whereas the 1000s of people who have downloaded, listened to, reacted to, made their own commentary, on what was said, is much more important within the advocacy process than us calling out one particular person at one time.

 

Katie Vernoy  12:44

Yeah.

 

Curt Widhalm  12:45

We feel that it's a lot more important to be able to hear, again, the very outdated and potentially harmful ideas of people who are in positions of power, much more so than being able to correct them in a moment by moment basis. And this is part of seeing advocacy as a much bigger unfolding process. And I think that a lot of the commentary that we've seen have separated, Katie and me from the comments by Dr. Michael First. But I see that people are also, you know, kind of holding us accountable on this too. And it's very much a stylistic decision. Just because we didn't push back on it doesn't mean that we agree with it. In fact, hopefully, this gives a lot more emphasis to our calls to action that will be coming over the next few months and several years as it leads up to whenever the DSM-6 comes out, of better being able to advocate for who's on these committees and how their processes are because this is information that had that episode just been. Here's the straightforward updates of what's happening. I don't think that would have ever shown up to the light of day.

 

Katie Vernoy  14:07

Sure. And I think the additional piece, I guess there's more than one piece, but that additional piece to that is I wanted to get to how do people impact this process, and we have him on record talking about that process and how people can take stances and give feedback and all those things. And I also was able to say to him like, hey, yeah, reach out to these lived experience and diagnostic communities to get feedback, like proactively seek it out. And he said, Oh, well, we kind of do that. Actually. That's a good idea. So it's, maybe it's small, but it's still there's things on record that can be used by folks who are advocating with the APA, that who are advocating around some of these changes where it's like, hey, the guy who is running this Committee, said it was a good idea or said this was their process. Here's why this process isn't happening. We need to address it, I mean, I think it's just it's creating a body of evidence. But I do want to go back to kind of our audience and the, and the harmful language. And I want to take that in. I really want to think about that because to me, I, I recognize that there are spots bias, different things that frame what I think is going to be harmful and not harmful. And I and I know we talked about this, Curt, that like the two of us had a larger goal with that that interview. And so I don't want us to lose sight that there were folks who are were harmed by some of the language that Dr. First used. And I'm not sure how to specifically address that. I mean, maybe we put content warnings on on things, you know, I'm not sure. I'm not sure how to do that. I mean, I don't know what what additional thoughts you've had around it, Curt. But I just for me, I feel like there are two things that are happening. And I think we may lean more towards like the let's get stuff done. Let's not worry about the small things in the moment with the larger picture. But for some of the folks that are responding, it didn't feel small, and it wasn't small to them, and it was harmful to them. And I don't know how to I'm gonna be honest, I don't know how to resolve that, given our advocacy efforts and the desire to get someone with that level of power over the next iteration of both the ICD and the DSM on record. And so I'm not sure where to go with that.

 

Curt Widhalm  16:27

It's been my experience in advocacy, that large systems end up ignoring those individual voices. Those individual voices are incredibly powerful when they're used in the right place at the right time. And it's kind of looking at where our experience is where our tools really are effective in being able to affect these larger systems that when Katie and I have been in congressional offices, when we've been talking to legislators, when we've been talking to professional organizations, those voices, when they're expressed at the right time, are incredibly impactful for humanizing what is happening, working in the macro systems doesn't negate that the micro systems are happening. But for systemic change to happen, we have to address the macro systems in the ways that the macro systems have shown that they can be changed.

 

Katie Vernoy  17:30

Sure, yeah. And I think that's it goes back to our principles around recognizing that we have to work within if we want to be therapists, right now, we, we must work at least, you know, sufficiently within the system that's created while also trying to disrupt it. And so it's, it's a hard line to walk I know, we're never, we're never going to say we can always do it, right. You know, like we're gonna have times when we we miss judge or miss title. And I think that, that we, you know, when folks have called us out, when we've missed us in the past, we oftentimes do come back and have deeper conversations. And so please keep holding us to account for the things that are happening in the micro system, so to speak. But recognize that you know, that there are times when we may disagree based on the goals we have in the macro system. Does that make sense?

 

Curt Widhalm  18:20

Yeah.

 

Katie Vernoy  18:21

Okay.

 

Curt Widhalm  18:22

And I think that this also speaks to what we noticed as content creators, is some of the accountability that people feel like they're holding us to, are things that we actually already do. It's just that...

 

Katie Vernoy  18:38

Exactly.

 

Curt Widhalm  18:39

Now, in the aftermath of the DSM-5 episode, one of the comments that I keep coming back to is a one from a deleted now deleted user on Reddit. The comment says, the interview starts talking about autism around minute 13. It's not an in accessible interview, and that it has no transcript or subtitles, so fuck them for that, too. And then, in this post, several people posted links to the episode where the transcripts already existed in the first place. And one of the things that if you're considering going into content creation, helping you potentially avoid some obstacles and these kinds of things, and being clear about your principles, really does help in that. We've been making things accessible for quite a while.

 

Katie Vernoy  19:30

And we haven't always but it does, there's a cost involved. And we're doing this for free for the most part, you know, we've we've been able to start getting sponsors at different points. But we're not making a whole bunch of money where we can have fancy solutions. And so we've, we took this feedback that people couldn't find the transcripts. And so we've we've added a little solution, so they're easier to find now, but we are both two therapists, we both have our own practices. We do some consulting but like this is not our full time job. And so we're trying, I guess maybe this is where I'm sounding defensive, I'm not trying to, but like, we're doing the best that we can. But I think, to me, when I hear this, I see something where we're trying to make a difference. You know, we're trying to do some stuff to bring some things to light to move things forward. And we're not going to always get it right. But we are a way easier target to get mad at than the large system. So don't wait like don't waste your your energy on calling us out for stuff like not having transcript because we actually do, like use that energy towards the actual change you want and not on two random podcasters.

 

Curt Widhalm  20:40

And we got several comments in the first week, after directing, you know, emphasis towards are we going to have follow up episodes about the changes in the DSM, we will, it takes some turnaround time for us, especially on something that that book wasn't even available for three weeks after the podcast aired, which was nearly a month after we made the interview, to Katie's point of we're two podcasters. If you want us to be able to do more, here's our pitch to join our Patreon and make it to where we can have a full time job doing this kind of stuff. But in the meantime, our turnaround and response times is sometimes very much around what we're capable of doing around our regular day to day practices and families and all of that kind of stuff. In the past, we've been sometimes able to turn things around literally overnight. That's not something that can necessarily be relied upon, in this particular space for us and until you join our Patreon and wonderful things. It's something we're we absolutely do do our best. It's that we're in a slow moving profession too. Nothing about you know, really anything is going to be best addressed by a podcast on something that needs to happen in an extremely timely manner.

 

Katie Vernoy  22:13

Sure, and I think to expand out kind of what we're doing as our follow on to the DSM-5 updates is that we've been reaching out to folks in the Autistic community in the grief community in the trans and gender nonconforming community. And as well as people in the trauma community to be able to have in depth conversations with folks with lived experience around, for example, with the Autistic community, we want someone that can talk with us about the diagnosis stuff that's going on to DSM-5-TR but also self diagnosis and, and those types of things. So we can really have a conversation with someone that's living it versus us saying like, yeah, we disagree, you know, or, or we agree with this part, but not that part. I mean, like, we have our own opinions, and we'll share them. But we don't want to be the only voices speaking to this. And it takes time to be able to identify the people or persons, the person or persons that people are people. Yeah, I don't know, to find the right, the right folks to be able to have the real conversation that we need to have, as we've continued forward and our audiences grow we've found it even more important not to just say, like, hey, our friends, so and so is in this community, let's reach out to them, but actually saying like, Who is the person that is making the most noise that has the biggest audience who can actually make a difference in this space, let's amplify that voice on the podcast and whatever way that we can. And so we're still learning, we're still growing. And we don't, we can't... People are not popping on the podcast immediately. Like, everybody's got schedule issues. And and we're we're wanting to have a great conversation versus a fast conversation.

 

Curt Widhalm  23:51

And, you know, this is hopefully where some of the people that we are reaching out to at this point, we'll be able to build and combine our efforts of this community. And their's to elevate some of this stuff. And hopefully, as we get those things organized and recorded in the upcoming months that you'll be able to see that. So here's also your reminder to subscribe and not miss any of our content. One of the other things within this process, though, is also the way that people have anchored on to very slight aspects of the content that we put out whether it's a specific comment within a larger, longer format, whether it's wanting deeper, more informative things out of what is relatively a smaller format, and what I mean by that is, we also try to make our episodes 30 ish minutes. We sometimes wax poetic most of our episodes, I think ended up around 40 minutes or so but it's an incredibly weird balance. Of people on one hand can take one very, very small piece of what is happening in an episode and make assumptions about the rest of the content or ignore the rest of the content based on that, or on the other hand, we've also had some criticisms of, we don't go deep enough and 30 minutes when it's two or three or four voices, depending on how many people that we have on a particular episode. That goes by very, very fast.

 

Katie Vernoy  25:30

What and when especially the one that said we didn't go deep enough, I mean, we did respond with like two or three more episodes to discuss the nuance of what was was being asked for. I think, to me, the thing that makes sense, and I want to take full ownership of this, because oftentimes, I'm the one that's titling the episode. And sometimes we're, we're framing the episode in a particular way, because we think that's what's most compelling. And that seems to be another thing that folks will anchor on. And if I've titled without thought, you know, to a specific element, or it's been framed in a certain way, I think folks have difficulty looking at the whole piece. And so I wanted to, I want to say, I have very much been trying to be thoughtful about titles so that people will get a sense of what's actually on the episode. But there's definitely times when people have have responded to the title only, and either decided they would not listen to the episode because the title was not one that they liked. Or they framed the whole episode based on that title and their interpretation of the title. And so I'm working on it, folks, I'm trying to get better Curt usually helps. But like sometimes we're you know, we divide and conquer, so to speak, he does more editing, I do more of the show notes and episode artwork. And so this is a two to four person, maybe five person, little enterprise here. And none of us do this only, like we all have other stuff going on. And so and even life stuff, like we talked about a couple weeks ago, can get in the way of us being able to do stuff, but like, we recognize that sometimes something resonates, and it's hard to look at the whole piece. But before, before taking too drastic an action like giving us a really bad review. Or blasting us on social like try to listen it to it as a holistic piece if you can.

 

Curt Widhalm  27:28

And it does help and we do respond. She can email Maggie over at podcast@therapyreimagined.com with feedback about stuff and she's not Katie or myself. She's a very wonderful part of our team that, be nice to Maggie. But...

 

Katie Vernoy  27:43

Yes, please be nice to Maggie.

 

Curt Widhalm  27:45

But I think it helps to, once again, just kind of clarify the things that we do. It's The Modern Therapist Survival Guide, we want to encourage and help each of you along your journey, and be able to provide some guidance or put some things within perspective or advocate for some things. It's why we've really started moving away from some of the more coachy aspects of our content. We've done some in the past and part of keeping conversations going is not having the same conversations over and over again. And while we're hesitant to say we're never going to have a coach on here, again, or something like that, we do have a back catalogue with plenty of people to talk to you about how to set up a practice. There are plenty of other podcasts who can have that same conversation over and over again. And that's a great space for them to be in. It's not where our space is. Our space is about advocacy, it's talking about the things that are affecting our practices, it's being able to provide timely, hey, here's your surprise, here's the no surprises act, it's it's being able to help channel some of the energy and emphasis of the conversations that we're having to make change, it's being able to take the action steps. If you want cheerleaders of here's how you go and set up your office. Great, not us.

 

Katie Vernoy  29:30

I think there's like you said there's a lot of back catalogue stuff that has business building and practice building and I am also hesitant to say we won't have a coach on I think the the difference that we want to bring to it is that we want to get into the stuff that's not polished. We want the real conversations, we want this stuff that goes into what it's really like to be a therapist now what it really is to be able to do work and have a private practice and...

 

Curt Widhalm  30:04

Or work in community mental health. And...

 

Katie Vernoy  30:07

...well, let me finish my my thought here just really quickly, but like to be able to compete when there's disruptors in the space like BetterHelp, and all of the tech companies that are coming in and dominating the space, to work in community mental health and identify a pathway forward, to have a sustainable career, if that's where you decide to be. I mean, like, there's, there's a lot that is in there, that's not, here are the five steps on how you market your practice. Now, we certainly have episodes like that. But I think, to me, it's more about the reality of the therapist, as a person and a professional. Not, this is how you build your practice. So I don't think we're going to avoid those topics. It's more that we're not going to have the same conversation over and over again, about money mindset, and how you avoid burnout. And how you start a side hustle like, we have those episodes, you can go back and look at them. But we're not going to keep having that conversation over and over again.

 

Curt Widhalm  31:06

And what we are going to have is, here's the updates as they're coming along in the field. Here's amplifying voices from marginalized communities, whether it's therapists, whether it's the systemic barriers that continue to cause mental health problems, whether it's the systemic barriers to having an appropriate mental health workforce on both an individual and a national and universal level, that at its core, this is a podcast about being able to leave our field in a better place than where it was when we started. And that is going to be an ever evolving conversation. And we're thankful that you're holding us accountable in this process, we just really want to make sure that we're all on the same page so we can actually take these things and make them into change.

 

Katie Vernoy  32:06

I think that's where we finished. That's a good place to stop. Thanks, Curt.

 

Curt Widhalm  32:11

We talked about a number of our episodes in the show notes, you can find those at MTSGpodcast.com, as well as all of our back catalogue and we did make some references to Patreon and you can also support us on Buy me a Coffee and very awesome thank you to those people who are patrons and coffee buyers. And until next time, I'm Curt Widhalm with Katie Vernoy.

 

Katie Vernoy  32:39

Thanks again to our sponsor, Thrizer.

 

Curt Widhalm  32:42

Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinicians should earn what they're worth. Every time you bill a client through Thrizer an insurance claim is automatically generated and sent directly to the client's insurance. From their Thrizer provides concierge support to ensure clients get their reimbursements quickly, directly into their bank account. By eliminating reimbursement by cheque, confusion around benefits and obscurity with reimbursement status they allow your clients to focus on what actually matters rather than worrying about their money. It's very quick to get set up and it works great in complement with EHR systems.

 

Katie Vernoy  33:21

Their team is super helpful and responsive and the founder is actually a long term therapy client who grew frustrated with his reimbursement times. Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit therapy. If you want to test Thrizer completely risk free our very special link is bit.ly/moderntherapists, you sign up for thrice or with the code 'moderntherapists' you will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.

 

Curt Widhalm  33:56

This episode is also brought to you by Melissa Forziat Events and Marketing.

 

Katie Vernoy  34:01

Are you looking to boost your reach and get more clients from social media? Check out the How to Win at Social Media, Even with No Budget course from marketing expert Melissa Forziat. It can be so hard to get engagement on social media or to know what to post to tell the story of your brand. It can be even harder to get those conversations to turn into new clients. Social media marketing isn't just for businesses that have a ton of money to spend on advertising. Melissa will work you step by step through creating a smart plan that fits within your budget.

 

Curt Widhalm  34:30

How to Win at Social Media is packed full of information. Usually a course as detailed as this would be priced in the 1000s. But to make it accessible to small businesses, it is available for only $247. Plus as a listener of The Modern Therapist Survival Guide. You can use the promo code 'therapy' to get 10% off. If you are ready to go to the next level in your business. Click the link in our show notes over at MTSGpodcast.com. And sign that for the How to Win at Social Media course today.

 

Announcer  35:04

Thank you for listening to The Modern Therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Apr 25, 2022
What is Eco Anxiety? An Interview with Dr. Thomas Doherty
42:48

What is Eco Anxiety? An Interview with Dr. Thomas Doherty

Curt and Katie interview Dr. Thomas Doherty about Eco Anxiety. We look at the history of eco anxiety, what therapists should know about the environment, the concept of environmental identity, and how we can support clients with Eco Anxiety in therapy. We look at ways to bring these topics up with our clients as well as empower them to take action.

An Interview with Dr. Thomas J. Doherty

Thomas is a clinical and environmental psychologist based in Portland, Oregon, USA. His multiple publications on nature and mental health include the groundbreaking paper “The Psychological Impacts of Global Climate Change,” co-authored by Susan Clayton, cited over 700 times. Thomas is a fellow of the American Psychological Association (APA), Past President of the Society for Environmental, Population and Conservation Psychology, and Founding Editor of the academic journal Ecopsychology. Thomas was a member of the APA’s first Task Force on Global Climate Change and founded one of the first environmentally-focused certificate programs for mental health counselors in the US at Lewis & Clark Graduate School. Thomas is originally from Buffalo, New York.

In this podcast episode we talk about what therapists should know about Eco Anxiety

In preparation for Earth Day, we wanted to understand more about Eco Anxiety and what therapists can do to support our clients and the planet.

What is Eco Anxiety?

  • The history of Eco Anxiety, including worry about the use of chemicals, climate change
  • The importance of words, personal experiences, how the client sees the world
  • The diagnoses that align with this area, the types of impacts on clients

What Should Therapists Know About the Environment?

  • Resources related to climate change
  • How to explore Environmental Identity
  • Understand our own Environmental Identity
  • The 3 basic psychological impacts from the environment (disaster, chronic, or ambient)
  • The benefits of nature and how people in all environments can access them

What is your Environmental Identity?

“Our environmental identity is really all of our values and experiences regarding nature, in the natural world.” – Dr. Thomas Doherty

  • Relationship to the natural world
  • Significant experiences in the outdoors
  • The nuance of bringing these ideas up in Urban areas
  • What “nature” means to each of us

“One of the things I tell people is that, around the world, there's millions of people that are working on climate change issues, and all these different areas, and people are studying things, and they're building things. And it's really inspiring to be around some of this stuff. So that's an important message to get out to people it. Yes, it's a big issue. But there's a ton of people working on this, think of all the people even in the Los Angeles area that are going to work every day, on climate and public health.” - Dr. Thomas Doherty

How Can We Support Clients with Eco Anxiety in Therapy?

  • Understanding the basics on the environment and climate change
  • Building capacity to be with these issues
  • Reeling in the anxiety, imagination
  • Understanding the waves of emotions and completing the anxiety cycle
  • Giving clients permission to talk about the environment and how to open up the conversations
  • Coping strategies specific to Eco Anxiety
  • Suggestions for activism and what clients can do to improve the environment
  • Helping clients to identify if they are doing enough
  • Where to find resources on environmental efforts
  • How therapists can employ climate awareness in their practices

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time!

Melissa Forziat Events & Marketing

Today’s episode of The Therapy Reimagined podcast is brought to you by Melissa Forziat Events & Marketing. Melissa is a small business marketing expert who specializes in marketing advice for businesses that have limited resources. 

Are you looking to boost your reach and get more clients from social media?  Check out the “How to Win at Social Media (even with no budget!)” course from marketing expert, Melissa Forziat.

It can be so hard to get engagement on social media or to know what to post to tell the story of your brand.  It can be even harder to get those conversations to turn into new clients. Social media marketing isn’t just for businesses that have a ton of money to spend on advertising.  Melissa will work you step-by-step through creating a smart plan that fits within your budget. 

How to Win at Social Media is packed full of information. Usually a course as detailed as this would be priced in the thousands, but to make it accessible to small businesses, it is available for only $247.  PLUS, as a listener of the Modern Therapist’s Survival Guide, you can use promo code THERAPY to get 10% off.  So, if you are ready to go to the next level in your business, click THIS LINK and sign up for the How to Win at Social Media course today!

Please note that Therapy Reimagined/The Modern Therapist’s Survival Guide Podcast is a paid affiliate for Melissa Forziat Events & Marketing, so we will get a little bit of money in our pockets if you sign up using our link. Thank you in advance! 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Dr. Thomas Doherty's Practice Sustainable Self

Climate Change and Happiness Podcast

Dr. Thomas Doherty’s Consultation and Training Program on the Environment

The Psychological Impacts of Global Climate Change by Thomas J. Doherty and Susan Clayton

NY Times: Climate Change Enters the Therapy Room

Climate Psychology Alliance

Project Draw Down

Relevant Episodes of MTSG Podcast:

What’s New in the DSM-5-TR with Dr. Michael B. First

What You Should Know About Walk and Talk Therapy part 1

What You Should Know About Walk and Talk Therapy part 2 (Law and Ethics)

Shared Traumatic Experiences

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


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Therapy Reimagined Homepage

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Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

 

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm  00:00

This episode of the Modern Therapist's Survival Guide is brought to you by Thrizer.

 

Katie Vernoy  00:04

Thrizer is a modern billing platform for private pay therapists, their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is you don't need to give up your rate they charge a standard 3% payment processing fee. By using the link in the show notes, you can get a month of billing without processing fees just to test them out for your clients.

 

Curt Widhalm  00:30

Listen at the end of the episode for more information.

 

Katie Vernoy  00:34

This episode is also brought to you by Melissa Forziat Events and Marketing

 

Curt Widhalm  00:39

Melissa Forziat is a small business marketing expert who specializes in marketing advice for businesses that have limited resources, including the very special course How to Win at Social Media, Even with No Budget. Stay tuned to the end of the episode to learn how you can get the most from social media marketing, even with little to no budget,

 

Announcer  00:59

You're listening to The Modern Therapist's Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  01:15

Welcome back modern therapists. This is The Modern Therapist's Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about literally at this point, just everything that we come across in our practice in our field. After a couple of 100 episodes, we continue to find new areas that we're hearing conversations in the background and wanting to be able to put you our audience in touch with the people who are leading some of these conversations. And as close as we can tie this into Earth Day, we wanted to talk about eco anxiety and those clients presenting with concerns about climate change. And this being an area that we've been aware of for a while but figured we would get somebody who's really, really smart about this. So welcoming to the podcast today Dr. Thomas Doherty, a psychologist up in the Portland area, and with his podcast, also Climate Change and Happiness. We are very happy to have you here today. Thanks for joining us.

 

Dr. Thomas Doherty  02:25

Thanks, Curt and Katie, I'm glad to be here.

 

Katie Vernoy  02:28

We are so excited to have you here. And to have this conversation. The first question that we ask everyone is who are you? And what are you putting out into the world?

 

Dr. Thomas Doherty  02:38

Yeah, that's a great question for all of us to think about every day, you know, today I'm thinking about being a parent of a parent of a 14 year old and getting her out to school, I have my day, I work from home, mostly these days, because of the pandemic, a lot of my practice has shifted to my home office. And so I'm, and I'm a psychologist and I have most recently been really immersed in this area of environmental identity and people's connections with nature and their concerns about nature and the natural world and climate change. And that is something I've been interested in. But now, you know, the world has caught up to me a little bit on this, and a lot of other people are interested in it too. So it's really, that's kind of where my where my focus is these days and exploring some of these issues.

 

Curt Widhalm  03:23

So let's start from the basics here and kind of work our way up into some of the bigger ideas. Let's start with defining what is eco anxiety and maybe how that's a little bit different than kind of passing concerns around environmental transition sort of stuff.

 

Dr. Thomas Doherty  03:40

I'll make a point that we can cycle back to about this because people, we have anxiety when we're concerned about some, you know, we're apprehensive about some potential threat in the future. But you know, there's a saying in therapy, you know, you've heard where we care. And so anxiety is a signal to us. But it's also a signal that we have values and we have things that we care about and things that are important to us, right. And so very quickly into the eco anxiety conversation, I like to pivot to that value piece because it helps to ground people. And we can get to that. But eco anxiety is a term that started by my reckoning, it started to be used in the media around 2007, give or take. And it was originally describing people's concerns around just these kind of insidious environmental issues that we know about that are that are hard to track, like plastics, in the food chain or chemicals, or various kinds of you know, these kind of forever chemicals that are floating around. And it really insidious kind of feeling that that's kind of where that that term first originated in my research of it. And then of course, it's more recently been attached to people's concerns about climate change, and the potential changes that could happen to the environment and other species. So it has It has a history and then it you can go back to say, even people's concerns about nuclear war and during the Cold War, or people's concerns about chemicals in the environment, going back to Rachel Carson's Silent Spring, which was published in the early, early 1960s. So it does have a little bit of a history if you dig this idea of being concerned about the state of the world. But in the last couple of years, it's really been amped up because of the predicted, you know, disasters and events associated with climate change have been happening to people, and they've been happening close to where you live. And we've been seeing this on the news or even personally, experiencing in terms of heat, smoke, fires, severe storms, flooding. And so that's, that's kind of taken this, this kind of general, you know, existential concern that all of us have at one time or another, and really, really amped it up for people.

 

Katie Vernoy  05:55

It's so interesting, because when you talk about that, I feel like especially for those of us on the West Coast, it feels very present related to the fires. You're up in Portland and I, before we were started, I gotten to Portland a couple of times, and, and I think it's an amazing city. And the first time I really got to explore it, it was under ashes. And air quality was pretty, pretty gnarly. And it was something you know, well, before the pandemic, folks were wearing masks just to try to get through day to day and it, it felt very apocalyptic to be there, the sky is this horrible color, or maybe, you know, in a weird way, a beautiful color, but then there's also just ash raining down and, and to me, it feels very logical to say like, this is going to impact all of us. And for some folks that might impact more dramatically. This this idea that the world is failing is coming to an end that we're destroying the planet. And so what's it mean? Is there is there a kind of subclinical, like, I'm worried and care about the environment? And there's clinical eco anxiety? Like, is there a discernment there, that we can make for our audience?

 

Dr. Thomas Doherty  07:08

Yeah, I would say so. And it's really neat that we're, we're, you know, the, the listeners are therapists, because we can get into this kind of thing. So a lot of it is, it's really juicy, it's about our meaning, it's about the words that we use, you know, so when I start to when I start to talk to people, I'm immediately being very observant to what they what their language is, what their personal experiences are, you know, even using terms like apocalyptic and stuff like that, it gives us a clue to how we're seeing things, right. And then there's that people, I have some control over my words, and I have some control over what language I use. And so they immediately were, were started, just like any other kind of therapeutic issue, whatever, whatever it happens to be, we're just really listening for the narrative, you know, and therapists, of course, themselves have been influenced by this as well. So that's also been a tripping point is that the last couple of years therapists themselves have been, they're human, and they're, they live in Portland, or whatever. And they're dealing with the smoke and the heat. So they're going through it also. So all the therapists that were listening, that are listening are going through this as well. So we're not sheltered from this, there's no special eco anxiety diagnosis, as you know, there's, and I know you were talking to DSM experts. And so it's really touchy about, you know, what's in the DSM. And there's really important rules about diagnostic categories are made. So what we're dealing with is, and we don't need a new diagnosis, we we have the tools, we can diagnose someone's feelings of depression, or anxiety or trauma, with quite amply with existing DSM. And so anxiety is a normal emotion, we all feel it, it's a healthy, useful emotion we were, that's how humans survive, we, you know, anxiety keeps us alive. And also we have social anxiety and different other kinds of anxiety about our performance, and how we fit in with our tribe of people and all that sort of stuff. So, so we have to remind ourselves that anxiety is normal and some anxiety about the future. And there's so many things to be anxious about in the, in the, in our global interconnected world, all of us sit with some anxieties, from time to time, that's quite normal. And it helps us to be the best people that we can be like with any other kind of anxiety issue. To me, there's three levels, there's normal feelings, there's adjustment level problems, that would be kind of adjustment disorder level. And then there are, you know, more diagnostic problems, like, like someone might meet criteria for an anxiety disorder. So if someone's concerns about the environment are affecting significantly affecting their sleep, or their diet or their relationships or their work or going to school, you know, if there's that significant impact on activities of life, then, you know, if the patient or client is, is amenable to that, I mean, that's, that's, we can use that label to help them. Yeah. So, and I think our goal is to allow I think a lot of people myself maybe yourselves as well, we all of us will move into that adjustment disorder category from time to time, you know, in the sense of wow, we're really needing to do some extra work to adjust to this stressor that we have. And it could, it could be temporarily affecting our sleep or things like that. So that part of the goal is to keep people in the adjustment. And, you know, keeping them toward health, and helping them to not fall into the deeper diagnostic issues.

 

Curt Widhalm  10:25

I'll maybe for spicing this up a bit come at this from more of the alarmist side then, you know, this seems to be, you know, following all of the climate predictions, everything else seems to be getting worse and worse. And in managing some of these conversations with our clients, we're going through this too. And it's, it feels like it's so much bigger than what any one of us individuals can do. And it seems like a lot of us are managing these conversations, it's just kind of like well, put your head down and hope for the best and focus on the positives. But I'm imagining that that is not the only things that we should be doing here.

 

Dr. Thomas Doherty  11:08

Yeah, yeah, it is. And that's part of it is bearing witness to this, you know, it is scary, it is overwhelming, I will go through moments of overwhelm, too, I mean, and it, it's a paradox, the more you know, ignorance is bliss. And if you don't know much about this, you don't, it's not concerning you, because some of these things are far away, for you don't necessarily have to link, you know, weather changes to the climate. So certain people are more vulnerable. Even traditionally, people have been more vulnerable people that are environmentally minded, in general, people that are environmental professionals, or conservation professionals, or teachers or scientists, public health people, you know, so those people have been vunerable are more vulnerable, because they know a lot, putting your head down for a moment is fine, you know, that's okay. But, you know, it's about building capacity, you know, it's about building capacity to be with these issues, you know, some basic kinds of cognitive behavioral and other kinds of therapy techniques are helpful about just helping people to, to kind of grade what is the true danger today, like, how are things going right? Today, when you walk outside your door, it just keeping you know, getting people into the present moment, helping people to be more mindful, essentially reeling in, reeling in the anxiety, I say, you know, your your horses are going to one of my chair therapy sayings is that your horses are going to ride like you, if I My imagination is going to go on, on anything, just don't, your horses are gonna ride, but just don't ride them, you know, so let your imagination is going to do what it's going to do. But let's come back to the present moment. And so I feel like there's a wave function here where people get really stressed, and we kind of help just pull it together, build some capacity to take in a little more. And then, you know, so this ride, you know, there's this kind of despair, empowerment curve that happens in environmental work in general. But in any kind of important work, you know, you're trying to write a novel or anything, you're gonna go through periods where you're up in periods where you're down. And so it's helping people just to get into that little longer flow. But not sugarcoating it either. I mean, that's not helpful. It is, it is scary, and it is dangerous. And ultimately, people do need to find a way to take some action, you know, because that's the way to complete the anxiety cycle is, is to take some action. So so it gets really existential gets political, we need to be like really upfront about all that.

 

Katie Vernoy  13:27

You said that folks who don't know kind of can keep their heads down or not even know they need to keep their heads down, that that kind of ignorance is bliss.

 

Dr. Thomas Doherty  13:36

Yeah.

 

Katie Vernoy  13:37

And it feels like in, in these times, therapists can't be ignorant to these issues, because so many folks who are walking into our doors or are opening up our virtual office windows, I think that they are worried about these things. And so what do you think are the basics that all therapists should know about this?

 

Dr. Thomas Doherty  14:00

Yeah, yeah. And it is becoming it is becoming a competency, right, either a sub competency that everybody needs to know a little bit about and then some people are choosing to, to make this more of a subspecialty we're just in the new territory for that. I mean, I do a training program like a 10 week, Zoom based program for therapists, eco and climate conscious therapists that I've been doing, I started last fall and I'm into my third round of doing that. And then I have people I have therapists in from around the US and also from Canada and Australia and England and Germany. And so people are reaching out to me about that. And they are because there are very few resources. There's the climate psychology alliance in the US and in the UK, and they're they're really working hard to try to bring things together so it's it's not a it's not a barren territory. There's there's things happening, but it's it's still new. And so what should all therapists know? That's a good question. On the positive side, I think the most positive thing, and the thing that I tend to go to with clients is this idea that I mentioned earlier of environmental identity, right. So this is an idea that really is, is, is, is ready for primetime, it's the sense that we have it, all of us have an identity in relation to nature in the natural world, how we see ourselves in relation to nature and other species and places, it's similar to our other kinds of identity, like our gender identity, or cultural identity, or sexual identity, these kinds of identities, we need to give people some information about them, so they can think about them and articulate them, and then kind of take pride in them and, and enact them, right. And so our environmental identity is really all of our values and experiences regarding nature, in the natural world. Climate change, and environmental issues really, really threaten some of that to us. And, and one of the big problems in the modern world, you know, is that people haven't been, unless they're sort of Environmental Studies student or nature writer, or, you know, an outdoor educator or something very few people have been taught to really get clear on their environmental identity, we pick it up, and it's kind of tacit, and it's kind of in us and we could either of you, we could talk about your your significant experiences, you know, whether someone's an urban person or a rural person, or they have done outdoor, they feel comfortable doing outdoor camping, or they have pets, or they have connection with other species, it's everybody's story is slightly different. But you know, that that's the value. And that's the base where we would then take action in the future to be the person we want to be. So as you know, I think, hoping that all therapists can help people to help clarify their environmental identity, why is this important to you? Where did you come from? What does it mean to you? And this becomes a base that you can get really strong on. And then I think it calms people down and it says, Okay, this is this is a real thing. This is part of mean, this is why I'm concerned, and some of that free floating anxiety will come down. And so that's, that's one, that's one piece. The other the other piece, I would say is there's three basic impacts from mental health, mental health impacts of climate change that people should be aware of. The first one is kind of obvious as disaster impacts when you're really affected by a specific situation, like a heatwave, or, or fires or any kind of thing. And there's a whole range of, you know, disaster psychology research and Mental Health First Aid and things like that, that you can, you can learn about. The second is the more chronic impacts, which would be being displaced, like being a climate, refugee, chronic chronic economic problems, you know, things that last a long time and then are that aren't easily solved. And then that immediately dovetails with all environmental justice issues, and people's placement and things like that. So it brings in, you know, social environmental, justice, focus. And then the third category is the, the kind of ambient impacts the subjective emotional impacts of just watching things from afar. And depending on where you are, as a therapist, you might find clients in any of those boxes, or multiple boxes. And so the approach is slightly different.

 

Curt Widhalm  18:05

And you've written an article on this it for American Psychologists that will link in the show notes that goes into those features a lot more deeply than here in a minute on our podcast here. I want to go back to your first point that you were just talking about, in Katie and I both have practices in very urban settings, that Los Angeles, we end up with a few people who really have some access to some of the greater outdoor activities that we have around here. But how do you bring these conversations up to clients who maybe not quite verbalizing some of their relationship to the environment yet?

 

Dr. Thomas Doherty  18:48

Yeah, that's a good point. And, and that's, that brings up the larger question of how to bring these ideas up in general. And so, you know, like, with any other kind of focus that someone has, therapeutically, we have to give signals about what we're doing. Because, you know, this isn't about necessarily putting something on someone, you know, clients come in for a service. And so we want to help them solve their problems, people that I work with, you know, I know in the, in the, in the branding of my my practice, sustainable self, and I talk, they know a bit about my work, and I've done teaching and research so people already come in, or are drawn to me because Because of this, and it actually, you know, so it's important, I think, for therapists to have multiple levels of signaling, like say, if you want to work in this area, put it on your website or your or your, your materials that this is an area that I'm interested in, and that gives people permission because people don't necessarily know they can talk about this kind of stuff. You know, I say one of my another one of my therapy sayings is we have issues and we have Issues so it's, you know, capital I issues like the big things we want to take on in the world and concerns about justice or climate change, or you know, whatever our destiny is to that we're working on. And then we have our lowercase I issues, which is our baggage, our neuroses, our weaknesses, our, you know, traumas and things like that. And so, you know, being clear, we're open to both of those things like Yes. What do you want to achieve in the world? But also how what's what's what's holding you back? And what are some of your issues because they they're kind of related together. And so to come back to your thing about your, your question about nature, there's a lot of consciousness raising, and a lot of sort of psychoeducation, you could do in this area, because again, a lot of people haven't really study this or broken this out. And so even the term nature, you know, the way I think about it, at least from my, you know, work and in broader areas of environmental psychology is nature's is a big term, that means a lot of things to a lot of people. And there's practically in our lives, there's a spectrum of nature, connections from indoor nature, like plants, and even virtual nature, like artwork and things like that, but you know, plants and pads, and then there's nearby nature, which is parks and gardens and green spaces, and, and then there's more, you know, manage nature, like forests and seashore and then there's, you know, wild or perceived wild, there's, there's a whole spectrum. So you can be living in Manhattan, and still be part of that spectrum of nature. And arguably, I would say, many of your clients have a lot of nature around in their lives, but it might be more of that indoor nature in terms of plants and paths, or their imagery and their art or their nearby nature, like their parks or gardens and green spaces. And so there's, and you get benefits, you know, another doorway here is just talking about all the health benefits of connecting in in safe, you know, outdoor green spaces in terms of stress reduction, and in terms of mental restoration, and creativity, educating people, and then they become more empowered to say, oh, okay, I can claim some of this for myself, because, you know, sometimes urban people feel like, Oh, I can't be that, I can't be that eco person, or I can't be that outdoor person, I didn't grow up doing that, or I don't feel comfortable, you know, camping. And so then they, they, they cut themselves off from from the switch. But that's not necessary. There's a space for everybody. So and then this grades, just generally into basic self care.

 

Katie Vernoy  22:07

When we look at folks with different levels of connection to nature, or different types of of environmental identities, it to me, it feels like the the conversation saying like, this is how you would have the conversation seems a little bit daunting, because there's such a different experience we all have. And and I guess the question that lends to me is for folks who men or their big I issue is not related to the environment, are we missing something, if we don't introduce the topic?

 

22:41

It is daunting. I mean, some of these issues are politicized. And we have to kind of be aware of, you know, the culture of who we're working with, and things like that. But I find over time, that, you know, when I open this up in a general way, people, what I actually find is when you when you start to scratch the surface on this, people often have a lot to talk about, around all of these issues, because they just don't, they have very little opportunity to speculate or talk about any of these kinds of things. One of my environmental identity exercises, like just a simple lifetime line, and just from birth to the present, what are significant experiences in nature, the natural world or paths or things like that, and that opens up all kinds of all kinds of things. But, you know, I think one way to bring up the environmental identity piece is just again, in terms of general discussion of other kinds of identities that people have, you know, so, you know, in my work, I help people think about all different kinds of identities, they have their, their cultural identity, their gender identity, or sexual identity, their environmental identity, how they think about nature and natural when you could just add that in there as part of the suite of things. That's, that's a kind of a fairly benign way to just put that out on the table. Or when someone is concerned about, you know, or if they're, if there is a environmental stressor that's happening, like heat, or smoke, or some sort of issue happening regionally, someone can say, well, these kind of outdoor stressors sometimes affect our identity and who we are and our and our values. And is that happening for you? And I can guarantee you if you'd ask people that in Portland, during that, when the ash were falling, there would be a lot to talk about there. Oh, yeah. And so having that in our tool belt, had all therapists having that in their tool belt was really helpful. And then of course, for the therapists themselves as part of their life as well because they have their own environmental identity and that in like with a lot of things, like in the work that I do with therapists when we're doing this training, I lead them through their own environmental identity They do all the exercises themselves, and it's really rich and really fun and people get really into it, but you know, it's like doing your own work essentially, like in any other kind of therapeutic issue, you you push your own boundaries and see what what affects you doing a family tree diagram but having an environmental identity family tree so you think about all The environmental identity of all the people in the family through your parents and your siblings and your grandparents and the generations, people get really wow, that's this is really neat. I never thought about this. And I know we're talking about the anxiety and coping, but it's also it's also a growth opportunity. And I think therapists are particularly well positioned for that, that growth opportunity aspect.

 

Katie Vernoy  25:22

And I was thinking even, you know, when you're, when you're opening that up, and someone does say, yeah, it freaks me out. I don't like to think about it, you know, the world is dying. And you know, and I'd rather just focus on X, you know, how do you address that? Because I think that there are folks, it feels daunting, and maybe this is me needing to do my own work, but it feels very daunting to think about a planet dying. And, and or becoming uninhabitable. Maybe that's a more accurate way to talk about it at this point. But it's something we're that's, that's overwhelming. That's, you know, there's there, it feels like there may not be ready at hand solutions, and and the advocacy efforts seems like that could be helpful. You said kind of those types of things, but I guess I'm just searching for, where do these conversations go, when you identify that someone is really freaking out, because there's ash falling from the sky, or the levees have broken? Or, you know, their house was burned down? You know, like, it seems like some of this stuff, you know, if we if we move away from the crisis, you know, like disaster and direct effects to the more indirect effects, like, how do we have these conversations in a productive way?

 

Dr. Thomas Doherty  26:33

Yeah, well, obviously, if someone's going through a true disaster than we we're, then we're really in disaster mental health territory was really about affecting, helping people with activities of daily life, like, how are you doing in terms of, do you have food? And where are you sleeping and clothes. And so that's, that's kind of that red cross level of work. And some of it is it is basic sort of trauma work. So you could have, you know, really, for a lot of just stabilizing, you know, mindfulness and relaxation, and really helping people to get stabilized, and all that sort of stuff. I mean, one of the things I tell people is that, you know, once you get into this work far enough, you also start to meet all kinds of neat people that are doing all kinds of things. And there's 1000s, or millions of people. I mean, around the world, there's millions of people that are working on climate change issues, and all these different areas, and people are studying things, and they're building things. And it's really, there, it's really inspiring to be around some of this stuff. So that's an important message to get out to people it. Yes, it's a big issue. But there's a ton of people working on this, think of all the people even in the Los Angeles area that are going to work every day, on climate and public health and things like that. And so that's important. You know, one of my images is this, I call it the upside down pyramid. And people get really upside down, it's like this pyramid is like over the top of them pointing at them. And they have very little resources in this, the scope of the issue seems so huge, they just are crushed. And just naming that as an experiential thing that we feel that is important. Because that's validating for people. But then we say, You know what the reframe is, let's flip that pyramid on the ground. And let's put it on a base. And let's stand next to the base, like what do you need to do every day to take care of yourself? So it brings the conversation back to basic self care, what are the bricks in your foundation, diet, sleep, exercise, your family, your work? And let's focus on that. And let's build some organic energy. So you can work on some of these issues, you know, some of it is, that's a kind of a stabilizing thing that I would do. And a big culprit here is media use and media intake, people get really immersed in the news. And of course, with the pandemic, and with the war in Ukraine, there's so many things out there that are troubling, and that there's nothing wrong with being an informed person. There's nothing inherently wrong with news media in itself, but it's the overwhelming immersion in it that really, really affects people's nervous system. So I'll often say let's, let's do a bit of a news. Let's look at your news diet, because it's usually lurking there. And let's let's let's think about where you went where and how and when you're accessing news, particularly digital news, news on your phone. And, you know, like, Henry David Thoreau would have said, you know, a few 100 years ago, you know, like, the news is your life like that, like go outside the door. And that's the news. So I help also help people to get into more into their daily life and pulled out of the news and that, that will very quickly help help our nervous system to change a little bit. So some of that, that overwhelming, apocalyptic thing is kind of a perception that happens when we're really jacked up and have a stress and a fight or flight response. And so, these are truth threats and we don't want to again sugarcoat things, but our perception of them can really change, if we can kind of pull ourselves together and come down into the present moment. So it is it is, again, it's this, this this process, and it's engaging, you know, bearing witness and sitting through it, when people are really, you know, really impacted we have we feel it, you know, so there's, we have to take care of ourselves well, because then we get the compassion fatigue kind of issue that can happen as well.

 

Curt Widhalm  30:29

Moving beyond the individual that, you know, a lot of what we look at systemically is individual reactions to systemic problems. I'm sure that there are clients that want to get involved in more activism type things that help to take this on in a broader way. What kinds of things do you find yourself suggesting to clients is maybe taking this beyond kind of their own individual reactions to the world going on around them?

 

Dr. Thomas Doherty  31:00

Yeah, and that's a huge piece, because we get so many messages to do action and to take to take action and people feel, you know, again, people are like climate hostages, I say, because we're in this big system, but we really can't affect what the US Senate does, or what corporations do. And so it does feel people are trapped. But it does feel good to take action. And so it really it really, it's kind of a bespoke kind of custom approach to each person, like, who are you? Where are you? What, what kind of actions would you do? Where are you placed so it really becomes a conversation. You know, there's a front line there of direct action, you know, terms on picket lines around the protest lines, and there's about behind the lines, where people are doing all kinds of other things, websites, and fundraising and research and helping the community. And so it really freeing people up to say, Well, where do you fit on that spectrum? And what what are you drawn to? What are you curious about some of it is education, like, you know, we might just need you're curious about a certain area, well, then maybe just educating yourself about it, it's, it's kind of, beyond the kind of simplistic, you know, these are 10 things you can do for the environment, you know, helping people to find something that's, you know, authentic to themselves, they can do for a while that fits into their, their gift. And then there are, there's, there is a basic sense of sustainability, that's good for therapists to know, it is, you know, making major life changes about how you get your power in your home, or how many cars that you own, or your diet, or how many children you have, these are the big ticket items that do do affect our carbon footprint. And so trying to, you know, just educate people, they can make their own choices, obviously, and it's not that easy to say, install solar panels on your house or do whatever, because it depends on how much money people have, and whatever. So we don't want to shame people or guilt people. But we do want to give them some good information. So if you do want to make changes, you know, your light bulbs are less important than whether you have an efficient water heater, you know, that kind of thing. So there are some basic sort of sustainability, things to know about. But in terms of the climate, that's a large, it's a life thing, like in all of our life. For the rest of our lives, climate change is going to be an issue. So it's like engaging with something like poverty or injustice, it's something that we're going to we can engage with in various ways through our life. And when people are younger, they might be more on the frontline. You know, when you want to encourage people we need, we need people on the front line. And if you're a frontline person, let's let's get you there. I was a frontline person when I was younger, now I'm a parent and I'm more of doing other things. So you know, it's going to there's a you know, if we have future conversations, we there's a whole developmental thing here we can think about what elders and adults and parents that's a whole nother that's another lens to lay over this kind of thing that therapists are really good at. But in the short run the the the action is something that it's authentic for you. And you might already be doing enough. You know, you if you're a parent and you're working, you might be doing enough, you know, that's the other message to give people ultimately, in a good in a good world, experts in government are going to be dealing with this kind of stuff, not your average person. So that's where we're trying to go go with this as well. So I do want to liberate people a little bit to say, you know, you don't you might be doing enough right now. And that could be that might be important for people to hear.

 

Katie Vernoy  34:34

To that point. I think there's kind of an implied knowledge that I don't know that I have exactly, and maybe you can direct me specifically to some reputable resources. But as far as you know, kind of the basic sustainability those types of things are there go to resources that you would recommend to make sure to kind of do a self assessment around basic sustainability.

 

Dr. Thomas Doherty  35:01

That's a good question. The first place I think about in broad terms is Project Drawdown, which is a organization and an linkages of a bunch of people that are really working on, you know, a comprehensive approach to climate change. And the Drawdown website is just a wealth of information, it can be a bit, you know, there's a lot of different areas there. But if you really want to kind of see a comprehensive approach to climate change across society, in different areas, and styles, that's, that's the kind of the place to go. And it's also can be actually inspiring to see all the things that people are doing, I think, each state, if you look at each, each state, I mean, in terms of state departments, you know, the sustainability county, city, I think that's also a good place, you know, check out what's happening in your region, because then it makes it more local. So whatever town like, you know, because I think that's, that's a place where you can start say, Oh, wow, this is my, my territory, and people are working. So that's, that has a social aspect to it as well.

 

Curt Widhalm  36:06

Any last suggestions as far as ways that therapists can incorporate more climate awareness in their practices with their clients?

 

Dr. Thomas Doherty  36:16

Yeah, I think as therapists, again, all of you, you've both been therapists, for all the people that are listening, you know, if you've practiced enough new things come onto the scene, and we learn about them, you learn about new therapy modalities, you learn about how to do how to work with different kinds of clients. And so I would encourage therapists to just make space in their repertoire, to start bringing these and just experiment with it. It's not, it's okay to ask some of these questions and do some learning and practice. And so I think that's probably the as therapist, I think, are careful. And they don't want to work outside of their comfort zone or outside of their competency. And so that sometimes holds the field back, I think, from doing innovative things. And so I would encourage therapists to surface some of these questions in their work and share selectively maybe some self disclosure about what they're doing. And just experiment and just see which clients it lands for. Because it could open up some, it could open up some interesting conversations, you'd be surprised. And if people have other things they're focused on, and this, you know, environmental climate isn't the thing, that's perfectly fine, too. But I'd encourage people to experiment with this, because therapists have all these tools to bear, they don't have to learn a lot of new stuff. If you already know how to help people with anxiety about work and social anxiety you can, you can also help people with their anxiety around environmental and climate issues as well. So I'd encourage people to just to add, add a line in their repertoire about this and to see, see what happens.

 

Curt Widhalm  37:46

This doesn't have to be in your face sort of stuff. One of the things that I appreciate from your website is even putting things like bus lines that are close enough to your office that are accessible for people that can be front of mind sort of things that this does not have to be necessarily explicitly thrown at every single client. But even just kind of when you're considering this. I mean, no, not every office location is going to have these kinds of things. But ways of just kind of also leading by example seems to be right.

 

Dr. Thomas Doherty  38:19

Yeah. And Curt, that you're speaking to sort of like a green business, and so we can think about our practices as a business. And is it? Is it a sustainable business? Is that a green business? And so that's another angle for therapists, even if they're, even if they're dealing with another specialty, you know, maybe they're dealing with pediatric mental health issues, or ADHD or whatever that isn't it is, but doesn't, it doesn't mean they still can't think of their life, their own lifestyle, their own practice in a sustainable manner as well.

 

Katie Vernoy  38:50

Thank you so much. This has been really, really helpful, a great conversation that I feel like we've just started, where can people find you and learn more about the work that you're doing?

 

Dr. Thomas Doherty  38:59

Yeah, yeah. Thanks, Katie. I really appreciate the conversation too. Well, people can find me, my my website, selfsustained.com. And my podcast is climatechangeandhappiness.com. And if therapists are interested in some of the training that I'm doing, you can find information about my consultation groups at selfsustained.com. This is an adventure things are going to be growing and changing. Even this year, I'm looking at the different writing and different kinds of ways to maybe do groups that can reach people outside of my region. So yeah, please seek me out and I'd be happy to happy to chat with people.

 

Curt Widhalm  39:40

And we will include links to those in our show notes. You can find those over at mtsgpodcast.com. And please also follow us on our social media, join our Facebook group, The Modern Therapist Group to continue this conversation and share ways that you are addressing this in your practices as well, and until next time, I'm Curt Widhalm with Katie Vernoy and Dr. Thomas Doherty.

 

Katie Vernoy  40:05

Thanks again to our sponsor Thrizer.

 

Curt Widhalm  40:07

Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinicians should earn what they are worth every time you build a client through Thrizer. An insurance claim is automatically generated and sent directly to the clients insurance from their Thrizer provides concierge support to ensure clients get their reimbursements quickly directly into their bank account. By eliminating reimbursement by cheque confusion around benefits and obscurity with reimbursement status. They allow your clients to focus on what actually matters rather than worrying about their money. It's very quick to get set up and it works great in complement with EHR systems.

 

Katie Vernoy  40:47

Their team is super helpful and responsive and the founder is actually a long term therapy client who grew frustrated with his reimbursement times. Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention, money won't be the reason they quit therapy. If you want to test Thrizer completely risk free our very special link is bit.ly/moderntherapists. You sign up for Thrizer with the code moderntherapists you will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.

 

Curt Widhalm  41:22

This episode is also brought to you by Melissa Forziat Events and Marketing.

 

Katie Vernoy  41:28

Are you looking to boost your reach and get more clients from social media? Check out the How to Win at Social Media, Even with No Budget course from marketing expert Melissa Forziat. It can be so hard to get engagement on social media or to know what to post to tell the story of your brand. It can be even harder to get those conversations to turn into new clients. Social media marketing isn't just for businesses that have a ton of money to spend on advertising. Melissa will walk you step by step through creating a smart plan that fits within your budget.

 

Curt Widhalm  41:56

How to Win at Social Media is packed full of information. Usually a course as detailed as this would be priced in the 1000s. But to make it accessible to small businesses it is available for only $247. Plus, as a listener of The Modern Therapist's Survival Guide you can use the promo code therapy to get 10% off. So if you are ready to go to the next level in your business, click the link in our show notes over at mtsgpodcast.com and sign up for the How to Win at Social Media course today.

 

Announcer  42:29

Thank you for listening to the Modern Therapist's Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Apr 18, 2022
Therapists Are Not Robots: How We Can Show Humanity in the Room
35:58

Therapists Are Not Robots: How We Can Show Humanity in the Room

Curt and Katie discuss how big life events (a big diagnosis, a huge personal loss, injuries and medical conditions) can show up in the room. We explore how much humanity is okay to share with our clients. How do we decide what we tell our clients (and how do we manage their reactions)? We also look at how we take care of ourselves while also taking care of our clients. Therapists aren't robots, but we certainly need to be aware of our clients when life happens. 

In this podcast episode we talk about appropriate self-disclosure practices for modern therapists going through life events

As therapists it’s important that we hold a professional exterior during therapy. But can it be helpful to share with clients the big moments in our lives? How can we be human in the room?

What are some considerations for therapists when deciding to self-disclose?

  • Showing your humanity can help bond a client with the therapist.
  • Self-disclosure may be different for planned or unplanned life events and whether they come into the room or private/hidden and in the background of your life
  • Deciding when and whether to tell clients
  • Clients often will use the therapist as an example on how to handle big life events.
  • Not all settings are appropriate for therapist disclosure.
  • Clients do not have the same confidentiality requirements as therapists; if you self-disclose to a client, it could be known by others or other treatment team members.
  • In self-disclosing, the therapist will need to process the disclosure with the client.
  • Processing difficult personal material with multiple clients could be difficult for the therapist.
  • How much you disclose will depend on the client, but you might share more with a long-term client than a newer client.

“In evaluating both the psychotherapy relationship and the actual relationship you have; I’d guess you’d probably be looking at some of the clients and how long you working with them as a part of the decision-making process. If it’s a brand-new client, it’s probably not a great thing to say ‘hey I’m going through this super emotional and vulnerable thing on my own right now.’  It’s a lot different if this is a long-term client you’ve been with for several years”
- Curt Widhalm

Are there ethical considerations for therapists sharing about our lives?

  • There are no BBS outlined ethical considerations for sharing personal disclosures in therapy.
  • The therapeutic environment should encourage a client to question the therapist.
  • The therapeutic environment should encourage clients to participate in self-advocacy.
  • Remember that certain self-disclosures might be triggering for clients; be mindful of what you share with who.
  • Document all ruptures in relationships in your note and what you did to help heal the rupture.
  • Be mindful - clients could be retraumatized or try to care take after a therapist’s disclosure.
  • Not all clients need to know everything; know your population.

“We harm the client if we don’t acknowledge, we don’t apologize, we don’t repair. If we try to pretend something didn’t happen, that’s where we can get into trouble and that’s when we get in trouble.” – Katie Vernoy

What should new counselors and therapists know?

  • Therapists are human! Life will continue to affect you even while working.
  • It is important for therapists to take time off when they need it.
  • Ruptures in the therapeutic relationship will happen; it’s all about how you handle it.
  • New counselors often want hard rules for how to act, but it gets easier with experience.
  • The most damage happens from not acknowledging or apologizing for ruptures.
  • When ruptures occur, be honest and accountable to your clients.
  • Sharing our human moments with clients can create a deeper and richer relationship.
  • Don’t forget you don’t have to do this alone – always consult if unsure on disclosures!

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using THIS LINK if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time!

Melissa Forziat Events & Marketing

Today’s episode of The Therapy Reimagined podcast is brought to you by Melissa Forziat Events & Marketing. Melissa is a small business marketing expert who specializes in marketing advice for businesses that have limited resources. 

Are you looking to boost your reach and get more clients from social media?  Check out the “How to Win at Social Media (even with no budget!)” course from marketing expert, Melissa Forziat.

It can be so hard to get engagement on social media or to know what to post to tell the story of your brand.  It can be even harder to get those conversations to turn into new clients. Social media marketing isn’t just for businesses that have a ton of money to spend on advertising.  Melissa will work you step-by-step through creating a smart plan that fits within your budget. 

How to Win at Social Media is packed full of information. Usually a course as detailed as this would be priced in the thousands, but to make it accessible to small businesses, it is available for only $247.  PLUS, as a listener of the Modern Therapist’s Survival Guide, you can use promo code THERAPY to get 10% off.  So, if you are ready to go to the next level in your business, click THIS LINK and sign up for the How to Win at Social Media course today!

Please note that Therapy Reimagined/The Modern Therapist’s Survival Guide Podcast is a paid affiliate for Melissa Forziat Events & Marketing, so we will get a little bit of money in our pockets if you sign up using our link. Thank you in advance! 

Support The Modern Therapist’s Survival Guide on Patreon!

If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings, and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more. If you don't think you can make a monthly contribution – no worries – we also have a buy me a coffee profile for one-time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Struggles of the Novice Counselor and Therapist  by Thomas M. Skovholt and Michael H. Rønnestad

Abstract: Shared Trauma: The Therapist’s Increased Vulnerability by Dr. Karen W. Saakvitne

Relevant Episodes of MTSG Podcast:

Impaired Therapists

When is it Discrimination?

Navigating Pregnancy as a Therapist

Infertility and Pregnancy Loss

Document Every F*cking Thing

 Getting Personal to Advocate for Compassion, Understand, and Social Justice: An Interview with James Guay, LMFT
Walk & Talk and Other Non-Traditional Therapy Settings: Part One

Walk & Talk and Other Non-Traditional Therapy Settings: Part Two

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

 

Katie Vernoy  00:00

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Curt Widhalm  00:26

Listen at the end of the episode for more information.

 

Katie Vernoy  00:30

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Curt Widhalm  00:35

Melissa Forziat is a small business marketing expert who specializes in marketing advice for businesses that have limited resources, including the very special course How to Win at Social Media, Even With No Budget. Stay tuned to the end of the episode to learn how you can get the most from social media marketing, even with little to no budget.

 

Announcer  00:55

You're listening to The Modern Therapist's Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  01:08

Welcome back modern therapists. This is The Modern Therapist's Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast about all things therapists for therapists the things that we do how we are in the world. And today's episode is about our humanity, of the things that come up in our personal lives that may end up affecting the things that we relate to clients. And we've touched on this in a number of episodes before but potentially having a little bit more nuanced conversation here today. This is a topic that's been discussed in the literature for quite a while. And Katie and I have heard varying pieces of advice, we've given different advice. And I think that we're going to summarize this a little bit later in the episode. As we're going into this, Katie when you think of humanity, at least from the therapist side, what comes up for you?

 

Katie Vernoy  02:12

A lot of things come up. I mean, when I first started as a clinician, I talked with a supervisor about some of this stuff about being a human about things that come up. And at one point I was I was having physical ailments, that meant that there were times I may not be able to stay present in the session, and even in talking about how to manage that, you know, I'm sorry, I got to quickly take care of something and another room, you know, whatever it was there always felt like and this was obviously like 20 years ago, there was always this thing of trying to hide anything that might be bothering me physically wrong with me anything that was happening to me and so I have that element of it, which is like okay, you know, the the training on the blank slate and and being completely neutral in session, which we've talked about a million times around, that that's just can't exist. And we'll we'll link to a lot of these episodes in the show notes. But then I also reflect on how much time I spent in kind of mileu settings at client's homes. We even talked about some of this in the non traditional therapy settings episodes related to walking and falling down or having some of those situations. And so to me, being someone who's had life happen over the last 20 years, and we'll talk about some recent stuff as well, as well as someone who's got physical ailments. And is just super clumsy. I show up as me in session all the time. And that's not something that I can hide. And so I'm looking forward to this conversation today. Because I think it's something where a lot of therapists struggle with sorting through how much humanity can they bring into the room or into the relationship and I something, I feel like I've managed until recently, and I feel like I'm grappling with it again. And so it's a tough one.

 

Curt Widhalm  04:18

The framework that we're gonna follow here in our episode is from an article from apaservices.org, called occupational vulnerability for psychologists. This was prepared by Karen Saakvitne, I'm hoping that I pronounced that right. And this is from 2008. I think it holds up still pretty well. And speaking to some of the nuance of we're humans in this fields that we are going to have like things that come up things that are going to affect our work, things that are going to affect ourselves and potentially impact our clients. This is a proposed framework that looks at a lot of different dynamic factors that I think it helps to maybe frame this, as I think a lot of the advice that we get early on in our career is, err towards that blank slate side.

 

Katie Vernoy  05:19

Sure.

 

Curt Widhalm  05:20

And it's potentially because there's maybe a belief that new therapists don't know what they're doing. And therefore, they're safer advice in not risking sharing too much in order to not put an emotional load onto clients. I'm also going to make a suggestion that there's probably some patriarchal gender bias in that that a lot of theories and stuff are based out of men who are socialized to not share a lot of emotions, that having even more straightforward rules of not sharing things. And it doesn't surprise me that potentially over the last 30 or so years, as the demographics of our field have shifted, that the conversation around this has shifted. And, and I think that it's probably more likely that those who practice in settings like Katie was describing those who practice for more humanistic models or social justice oriented models might be more open to sharing things. First and foremost, I think that we have to talk about you as the individual, and you as the individual therapist, and that's what's outlined first here in this APA article, we each have our own personal histories. And that is going to affect a lot of things, it's going to affect our choice of where to work, the clients that we work with how we work. And part of it's really just taking ownership of yourself first.

 

Katie Vernoy  06:54

When when we're talking about our personal histories, I think they're the things that we're still working on and need to be aware of, and continue to show up for ourselves, whether it's in our own therapy or in other things, there are things that are in our personal history, or part of who we are now, that may may may lead us to be impaired. And we have a whole episode on impaired therapist, so I won't go there. But there's that argument that some folks have that if we can't be perfectly healed, we shouldn't work with any clients. And I think that we can still be impacted by our personal histories and work with our clients.

 

Curt Widhalm  07:31

Sure.

 

Katie Vernoy  07:32

The nuance is determining does that impact which clients you take? So some of it may be about whether or not we can kind of curate our clients to be able to support who we are competently, confidently able to work with? We go into some of that nuance in Is it Discrimination that episode as well. But to me, I think that acknowledging and being very aware of ourselves, helps us with some of this personal history stuff.

 

Curt Widhalm  08:00

This takes a lot of our own internal process in order to get to that point. And I think that, you know, this is something where we are not as a field, very good at encouraging emotional discussion, from therapists from, you know, trainees from supervisees, that if you over share in therapy, then or in supervision, then you're going to be seen as not predictable enough. But if you under prepared, then, you know, you're at least going to be towards that blank slate end of things. And that's at least going to make things nice for clients. But how often do we hear from each other and from our audience as far as just like, oh, some of those vulnerability sort of things are what actually humanized you and made me want to work with you more. There's such a gatekeeping process around emotions just that are allowed to even come up. And it's that we're not taught how to reflexively demonstrate those in supervision that can then have some sort of an enactment in our therapy sessions that teaches us how to do this well. And so we get kind of this vague advice of like, you know, go and do your own work, go and go to therapy, figure your stuff out, when really, some of this stuff could be modeled a little bit better in the way that we teach people of like, here's, here's the how of how you show up. I think we're focused too much on like, the what, of what you're allowed to say, and therefore it becomes kind of restrictive rather than supportive in this process.

 

Katie Vernoy  09:51

We've gone through that supervision relationship and these things and other episodes and I think there's there's so much nuance there that we can't dive deeply into that. But I think kind of summarizing that point, I think we're saying know what, what impacts you have emotional conversations, get consultation or supervision that allows that to happen. And and be aware that you can't avoid it. And so if we move on to other elements of things that could be vulnerable in session, we're really looking at what's happening now. Right, like the things that happen as they go along. And I think those things are harder, because sometimes they can be predicted, like we had a conversation on, you know, pregnancy, and therapists preparing for that, and subsequent episodes around pregnancy loss and those kinds of things. But I think it's something where we've talked about predictable things. But there are also things that are very unpredictable that can happen in our lives, family emergencies, I recently had a personal family emergency, and a death in my family. And so I've been recently dealing with something that's very sudden, very surprising that I've had to then navigate with my clients. And I think, to me, what was surprising about it is this is I think, one of the most impactful things that has happened in my life. And I had had other deaths happen while I was a therapist, I've had, you know, my own fertility journey as a therapist, I've had so many things, but this one was surprising because in trying to be present, I had to navigate different elements of my relationships with my clients. And to me, I think, it felt a little bit like I was starting fresh. And so I know you've had other big things happen in your life as well, I think we've mentioned in previous episodes that you had a major bicycle accident, what was your experience in trying to navigate those things, because I think when we can prepare for it, when we know when it's something we're bringing to the table, I think we have, although not enough guidance, we have some guidance. But when there's something all of a sudden that happens in our lives that deeply impact us, I think that's where it becomes much harder, because we're so human, in those moments.

 

Curt Widhalm  12:03

It definitely brings up the humanity, and those things that are hidden, the relational things, the grieving things that you're talking about. And then they're the things that absolutely make it into the room, you know, my bike accident, I had my jaw wired, I've had other surgeries in the time where I've had, you know, bandages on my hands that are obviously different things from the last time that I've seen people, and this comes down to personality and work styles too is, you know, I'm somebody that, hey, alright, you're bringing it up, let's talk about it. Or I know that you're the kind of person who's gonna bring it up. So I'm gonna bring it up at first just to kind of alleviate the discussion about it as much as possible. And it's kind of with that reassurance of like, I'm alright, I'm getting treated for this, this is me showing up in my humanity, that the vast majority of my clients were like, Oh, you're not making a big deal about it, we'll spend a couple of minutes and then move on with our lives, I think it's a lot harder when it comes to those hidden or covert sort of things that are going on in our lives. With those particular things all of my clients could see what was going on with me, it's some of the other things that they can't see, they fill out the rest of my life, I'm okay talking about it now. But several years ago, I got a phone call from my wife right before going into sessions. And she said, hey, the test results are back and I have cancer. Not having really the opportunity to process that, on my own time, even before going into sessions. But it's something that I really didn't share with clients until after her treatment was over. That it was something that my population didn't really have the need to know that, that if I had to rearrange appointments to you know, to help be a part of treatment, or any of those kinds of things. It was just kind of business as usual, as far as my clients were considered and it wasn't so much a, you know, super conscious, like, I'm not wanting to talk about this. It was more of a selective like, this really doesn't impact my clients right now.

 

Katie Vernoy  14:21

Yeah, when I got the call recently, I knew I needed to cancel everything for the next couple of days. And I basically just cancelled and said I'm there's a family emergency I'm dealing with. And so there were folks that knew was an emergency. And then there was also folks who were scheduled who I sent out an email or a text or those kinds of things, saying that I had an unexpected death in the family. And I only told folks who were scheduled or trying to schedule in those weeks. And that felt very strange to me, because those folks there's a conversation about it. It is one of those things that's a little bit more private. I don't know hidden or covert sounds like I'm trying to purpose had something but it's something that's more private, where me grieving and going through that is not something that necessarily is relevant to my clients, as long as I am paying attention to my own level of competence and being able to be present for my clients. But it's interesting because there's, I'm seeing the difference between the clients who know, and the clients who don't. And I, I feel like as a therapist, I'm present, and I'm taking care of myself, but for the clients who know. And some clients know exactly, you know, not exactly what happened, but more detail than others, just depending on the relationship. And that was more in the conversations, but I'm finding clients checking in with me, I'm, you know, there are definitely clients who this has brought stuff up for them, which is not necessarily certainly something that I want to process with them. I feel like I know my limits of capacity there, I don't want to be processing this major loss with my clients. And I also understand that they may have their own stuff that I'm trying to figure out how to help them process. But I'm also finding with some of my clients that they're wanting to check in. And they're seeing this as an example of how to manage a big loss. And so I'm talking about structure and meaningful activity is helpful to me, and I'm making sure to pay attention to my energy, and I'm focusing in on this, and this is how I'm doing it, and I'm okay. But this is clearly a loss, that's going to be hugely impactful. It's life changing. And some of them know what that is. And so I've had clients get teary, actually start crying, there was times when I've had to redirect because they feel like, well, but what I'm bringing to you isn't even as important as what you just are going through. So how do I even be, you know, how do I even be a client here? And I've been able to successfully redirect those clients. But I, I feel like it's been such an interesting process, because I'm having such a wide array of experiences in navigating this. All the while, grieving and trying to sort out how do I be a therapist during this time, and I feel like I'm doing it, okay. But I also, this is a traumatic loss, this is something that I don't even know what's going on for myself, and so. So it's really, it's really interesting.

 

Curt Widhalm  17:11

So a couple of things from the APA article that you're highlighting here is, in evaluating both the psychotherapy relationship, that the actual relationship that you have, I would guess that you're probably looking at some of the clients and how long you've been working with them as part of this decision making process. Like if there's a brand new client, like, not a great thing to just be like, Hey, I'm going through this super emotional vulnerable thing on my own right now, it's a lot different if this is a long term client that you've been with for several years, part of it's, you know, as you know, some of the clients that if this is going to be something that, you know, potentially as a possibility of triggering, or re traumatizing them about something going on in their lives, that you're gonna be a lot more selective about.

 

Katie Vernoy  18:06

Yes, and I think that it's interesting, because I did have, I've had some newer clients that I've had to navigate this with, who I did have to cancel knew that there was a loss, and I was able to do it at a very high level, where it's like, I'm okay, I'm managing it, this is how I'm taking care of myself, and we moved on, whereas longer term clients are more interested in exactly what happened and taking care of me. I think the other thing, and this is in this article is the clients who typically seek me out, you know, we've talked about I do sacrificial helping syndrome and, and I have caregivers. And so I also was very aware through this process and continue to be aware that there are some of my clients that will want to take care of me, because that's why they came for therapy. And so I'm, I'm trying to very actively engage in some of that dynamic with them, to help them to see how they get their needs met, how I'm taking care of myself, and being able to do that, because it's, it just it's very interesting to be able to sort this out. But it's, it is very much case by case for my clients.

 

Curt Widhalm  19:13

And, you know, part of what we also have to talk about here is you and I both work in private practices that can tend to be more intimate just in their expectations. It's potentially different than higher need work settings where some of the vulnerabilities just might not be as appropriate, just due to the needs level of clients in those particular situations.

 

Katie Vernoy  19:45

And I think with those situations, oftentimes when I've had bereavement or other kind of big things going on in my life, I had, you know, 27 clinicians who could take on each one of my cases and have that covered. And it was something where there was structure set in place for there to be a full treatment team and other people available now. Everybody's overwhelmed and busy. So that's never a good plan. But But there wasn't something where it's like I see them, or I have a colleague who has a little bit of capacity who could potentially see them or be available to them. And they're not likely to actually take me up on it, it's it's that planning is very different in private practice versus an agency because in an agency, there are a lot of other people that have their eyes on the case.

 

Curt Widhalm  20:36

Part of this speaks to just kind of the roles that we have, as you're demonstrating here that, you know, if you're in those case managers situations, you can step in, you can assign other people to it, that there's a universality of experiencing vulnerability, there is not a universality of how to handle it, especially with these unexpected situations that arise. That kind of nuance is what's sorely lacking in the way that we talk about this in our fields, because we tend to, especially earlier in our careers want nice, structured here's, you know how the answers are. And the longer that we practice, the more that we understand kind of the it depends of the situations and that it depends isn't necessarily the same from one client to the next. Now, some of the risks that come along with that, though, is that what you're talking about your clients are not bound to the same confidentiality that you are. And another, you know, consideration just as far as your workplace goes, it's just going to be that one person finds out whether it's another staff member, whether it's a client, potentially everyone knows, even if it's not something that you necessarily know that some of your other clients can and should be aware of.

 

Katie Vernoy  22:00

With social media, and all of those things like I typically am fairly private, but I have been a little bit more open sharing obituaries, for example, or the things that are going on, I still try to keep it with just friends, but you know, friends of friends and screenshots and all that kind of stuff. And so I think it is important to remain aware of those things. And it is important to, to continue to kind of take care of myself within those things. Because a client may pop up and say, Hey, I heard about death in your family. Why didn't you tell me and I, I honestly am trying to both take care of myself and my clients in doing so because any moment of talking about the death in my session can be clinically appropriate, but maybe more challenging for me to be able to refocus on the session. And so it's it's a weird, it's a weird balance that I'm trying to strike. And it's said in this context of in society, especially Western society, US society, we don't know how to manage grief as it is there's expectations either that you were destroyed and can't do anything, or that you are out for three days, and then back to work with no problems, or anywhere in between. But the nuances of this becomes very hard to navigate. And different clients know different things. There's stuff publicly that people can find. And there's also the strangeness of the relationship as a therapist with a client on what actually is in that relationship. What do we what do we owe our clients? What information do they need to know how well do they need to know us? And that's also an it depends based on client by client. But it's, it's just such a strange thing to navigate. Because there's not I don't think there's clear guidance as society on how we talk about these things much less, as therapists we're supposed to have this higher level of functioning, because we have to take care of our clients.

 

Curt Widhalm  23:56

You know, kind of one last point is as far as how we're talking about the way that this is expressed in early career clinicians. Skovholt and Ronnnestad had a 2003 write up that talks about how novice counselor struggled to find the balance between porous and rigid emotional boundaries. New counselors try to work on that balance between rigidity and under involvement with the client and softness and over involvement with the client. And I think that part of this is, again towards that, when in doubt, be safe. But as you're highlighting here, there's a lot of just other available information about us. I think as we become more seasoned in our work, and part of this as some of these things end up happening and coming up, we get better at handling the awkwardness of situations when clients who might not want this information might not be ready to handle this kind of information about us that we get better handling those ambivalent situations that could be therapeutic ruptures, if it wasn't handled gracefully, or in those times when it's not, that we're better at being human in our responsiveness to some of those mistakes.

 

Katie Vernoy  25:18

I really want to highlight the rupture element, because I think that there are times, you know, being a therapist for 20 years, or more than 20 years at this point, there have been ruptures based on my own humanity. And there certainly have been things where I've not been able to be as present for my clients, because what's going on with me. To really highlight the point you just made, I think there's that element of, we can be human, there are times when our humanity is going to mean that we are doing unethical or illegal work, you know, and so we have to do the best that we can to not show the humanity in that way. You know, that's the impaired therapists thing. That's the the other episodes that talk about that element. But but there are times when my physical health has not been up to snuff. And I've not had the spoons or the bandwidth to be able to interact appropriately with clients and have had and said things that were not helpful. Sometimes they actually were disruptive. And we can reach back to the the notes episode on on documenting things that are disruptive, because you're overwhelmed. To me, if you are unable to be fully present and vulnerable and recognize within yourself. This was about me. And is that okay with a client? And if not, how do I get to a place where I can actually process that with them, and be available to them in a way that's helpful. I think that's where we get in trouble, we harm the client, if we don't acknowledge if we don't apologize, if we don't repair, if we try to pretend something didn't happen, I think that's, that's where we can get into trouble. And that's where we can actually be harmful. But there will be ruptures based on our humanity, hopefully not gigantic ruptures. And certainly if your humanity is your drunk in session, or you're sleeping with your clients, no, thank you. That's not what we're talking about here. We're talking about you're grieving or you're worried or you're jacked up on hormones, or whatever it is, that is going on that means you need to be extra aware, extra available to your clients and have the conversation with your clients of, if I'm doing something that's not helpful, or you're not sure what's going on, in how we're interacting, let me know and actually seek that feedback and have those open conversations. I think that's when the the blanket, don't share anything is more helpful. Because if you if you can't sit with clients telling you like, Hey, I didn't like your response to that, or you seem really spaced out right now, or, you know, your, the way that you're talking about these things don't make sense to me. If your clients can't say those things to you, you have to be more accountable to your humanity than if they can.

 

Curt Widhalm  28:04

And I like that you're bringing up the the ruptures can also happen in the absence of saying anything when your clients are picking up that there's something going on with you that you're not available that you're not, you know, following up on extra resources between sessions. Do you have any suggestions as far as like, when those clients do set up, like, Hey, I've been expecting more of you, you're not showing up or you might feel compelled to disclose something more than what you're prepared to share at that time?

 

Katie Vernoy  28:37

When I've had more of those types of conversations with clients. I mean, it always goes to it depends. There's been some clients where they've read into things that weren't there. And so I've talked about I'm sorry, I had a headache, you know, and it was, it was not something that was personal. It was, Hey, I didn't mean to do harm, I see what you're saying. And it really was a headache. And it's not some other thing that you're talking about. And that doesn't always work, like just kind of say like, Hey, it is something but not what you think let's move on. But recently, I had a client that disclosed something really personal to me that hadn't been shared in long standing client. And it was something where I had my own response to it. And I was kind of busy trying not to over emote about what I was hearing because I was so heartbroken for this client. And I was disconnected. And when this client reached out to me and said, Hey, I felt really invalidated because you were disconnected. We were able to have the conversation, I was able to say, hey, my intent was to take care of my own emotions in that situation. It was something where I was also exploring my own potential responsibility of not being able have you not feeling comfortable to share that with me prior. And now let me share with you my responses and what that gave was an opportunity for me to actually process through, and it was something where I was able to then say, hey, this was what was going on for me without it being so raw in the moment. But in truth, I think it's it's hard to have a blanket like if someone says, Hey, you're not present, you know what's going on with you, because I think there is so much nuance for some folks, it could be as simple as saying, like, Yeah, I've been, you know, really overwhelmed, or I've been working on something, and it was distracting to me, I apologize. Let me get back on track. For others it might be, what you're bringing up is something that really is very resonant for me. And so I'm working hard to manage my reaction so I can be present for you. And other folks, you know, like I said, there's clients that have asked what exactly happened, and how are you handling it. And I've been saying, like, this is what happened, this is what's going on. And this is how I'm handling it. And needed that true humanity and self disclosure that then allowed them not to kind of make up their own stories in their head about what I was doing and how I was taking care of myself. And so I don't think there's one answer, but I think being present to your clients in those situations and reaching out, and sometimes it's even like, Hey, you're having a reaction, what's going on? And then that gives them an opportunity to say, well, like, I didn't like what you just said, right there. You know? So I don't know if that answers your question completely. But I think it's that that element of being as present and human as possible in the room, recognizing that there is the therapist version of humanity that kind of sits there that that has some of these extra boundaries in place. So that you're not saying like, yeah, I, I'm really pissed at my spouse, or I'm, I'm having a moment, or I don't know that I want to be a therapist anymore, whatever that is, you know, I think there are things that we don't there's, there's humanity, we don't share with our clients. And there's humanity that if we can curate, that's maybe that's not the right word. But if we can thoughtfully and deliberately choose how we share our humanity with our clients and open ourselves to them being available to that, then we can, I think, have deeper richer relationships where clients feel truly heard and seen and connected.

 

Curt Widhalm  32:18

I think to maybe give you a direction to go here on this is, if you're going through something don't feel like you have to make the decisions yourself. You're allowed to be human but consultations, always great idea and get some other perspectives and join our modern therapist community and know that we have a pretty good following of people that understands thinks in very much similar ways to the way that Katie and I do and rely on those who have been there before to help you guide you through some of this process. You can find our show notes over at MTSGpodcast.com and you can also join our Facebook group the modern therapist group, follow us on social media. And until next time, I'm Curt Widhalm with Katie Vernoy.

 

Katie Vernoy  33:17

Thanks again to our sponsor, Thrizer.

 

Curt Widhalm  33:21

Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinician should earn what they are worth every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the clients insurance. From their Thrizer provides concierge support to ensure clients get their reimbursements quickly directly into their bank account. By eliminating reimbursement by cheque, confusion around benefits and obscurity with reimbursement status they allow your clients to focus on what actually matters rather than worrying about their money. It's very quick to get set up and it works great in complement with EHR systems.

 

Katie Vernoy  33:59

Their team is super helpful and responsive and the founder is actually a long term therapy client who grew frustrated with his reimbursement times Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit therapy. Our very special link for Thrizer is bit.ly/moderntherapists you sign up for Thrizer with the code moderntherapists you will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.

 

Curt Widhalm  34:32

This episode is also brought to you by Melissa Forziat Events and Marketing.

 

Katie Vernoy  34:37

Are you looking to boost your reach and get more clients from social media? Check out the How To Win at Social Media, Even with No Budget course from marketing expert Melissa Forziat. It can be so hard to get engagement on social media or to know what to post to tell the story of your brand. It can be even harder to get those conversations to turn into new clients. Social media marketing isn't just for businesses that have a ton of money to spend on advertising. Melissa will work you step by step through creating a smart plan that fits within your budget.

 

Curt Widhalm  35:07

How to Win at Social Media is packed full of information. Usually a course as detailed as this would be priced in the 1000s. But to make it accessible to small businesses it is available for only $247. Plus, as a listener of The Modern Therapist's Survival Guide, you can use the promo code THERAPY to get 10% off. So if you are ready to go to the next level in your business, click the link in our show notes over at MTSGpodcast.com and sign up for the How to Win at Social Media course today.

 

Announcer  35:39

Thank you for listening to The Modern Therapist's Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Apr 11, 2022
What You Should Know About Walk and Talk Therapy and Other Non-Traditional Counseling Settings – Part 2
01:07:52

What You Should Know About Walk and Talk Therapy and Other Non-Traditional Counseling Settings – Part 2

Curt and Katie chat about non-traditional therapy settings like outdoor walk and talk therapy as well as home-based counseling. In the second of a two-part, continuing education podcourse series, we look at law and ethics, accessibility, informed consent, navigating confidentiality, dual relationships, and what therapist might want to consider before getting started.

In this continuing education podcast episode, we look at the laws and ethics related to non-traditional therapy settings

For our fourth CE-worthy podcourse, we’re looking at the laws and ethics of bringing therapy into non-traditional settings, including walk and talk therapy and home visits. We cover a lot of topics in this episode:

Debunking the hesitations of using non-traditional therapy settings

  • Minimizing liability and concerns related to these environments
  • Is it unethical to not consider these environments?
  • Access and payment, including insurance/managed health care concerns and fee setting
  • Unpredictability in the environment
  • Scheduling and permission for services
  • Business practices and systems that support this type of dynamic practice

Accessibility of walk & talk and home-based therapies

  • Financial, physical or other types of accessibility (and navigating those)
  • Ways to make sure you clients can access the service and are prepared for the environment
  • Extending boundaries and the consequences of these situations
  • Documentation of any concerns that arise
  • Clinician comfort and preference, do no harm, and do good

Informed Consent for non-traditional therapies

  • Client choice and appropriateness, including informed opt-in (and opt out)
  • Health conditions, screening or attestation related to risk and liability
  • Clinician safety and how to talk with your client about these concerns
  • Cancellation policies and back up plans
  • Ability to terminate (both passively and actively)
  • Collaboration and communication

Confidentiality when you’re meeting outside of the therapy office

  • Managing the risks of the limits of confidentiality in these other settings
  • Collateral consent forms for additional members of the treatment
  • Release forms for others in the home
  • Co-creating the plan to manage these situations
  • Ideas for how to explain the relationship, if needed
  • Active and passive loss of confidentiality (and how to talk about these risks)
  • Boundaries versus confidentiality (for example where in someone’s home to meet)
  • Documentation and consultation

Dual Relationships that can happen during walk and talk or home-based therapies

  • Professional therapy never includes sex
  • Casual nature of the relationship in these settings and the threat of friendship vibes
  • Not all dual relationships are problematic
  • Host/guest dynamics as something to pay attention to, but not necessarily harmful
  • Navigating the potential medical needs of home-bound clients (helping and/or advocating for more help)

What therapists should assess before getting started

  • Liability and malpractice
  • Logistics and planning
  • Assessing client vs clinician benefit
  • Assessing competency for these types of services
  • Training, consultation, supervision, documentation

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using THIS LINK if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That’s right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time!

Melissa Forziat Events & Marketing

Today’s episode of The Therapy Reimagined podcast is brought to you by Melissa Forziat Events & Marketing. Melissa is a small business marketing expert who specializes in marketing advice for businesses that have limited resources. 

Are you looking to boost your reach and get more clients from social media?  Check out the “How to Win at Social Media (even with no budget!)” course from marketing expert, Melissa Forziat.

It can be so hard to get engagement on social media or to know what to post to tell the story of your brand.  It can be even harder to get those conversations to turn into new clients. Social media marketing isn’t just for businesses that have a ton of money to spend on advertising.  Melissa will work you step-by-step through creating a smart plan that fits within your budget. 

How to Win at Social Media is packed full of information. Usually a course as detailed as this would be priced in the thousands, but to make it accessible to small businesses, it is available for only $247.  PLUS, as a listener of the Modern Therapist’s Survival Guide, you can use promo code THERAPY to get 10% off.  So, if you are ready to go to the next level in your business, click THIS LINK and sign up for the How to Win at Social Media course today!

Please note that Therapy Reimagined/The Modern Therapist’s Survival Guide Podcast is a paid affiliate for Melissa Forziat Events & Marketing, so we will get a little bit of money in our pockets if you sign up using our link. Thank you in advance!

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: Walk &Talk and Other Non-Traditional Therapy Settings Part 2

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Cooley, S. J., Jones, C. R., Moss, D., & Robertson, N. (2022). Organizational perspectives on outdoor talking therapy: Towards a position of “environmental safe uncertainty.” British Journal of Clinical Psychology, 61(1), 132–156. https://doi.org/10.1111/bjc.12315

Boland, K. M. (2019). Ethical Considerations for Providing In-Home Mental Health Services for Homebound Individuals. Ethics & Behavior, 29(4), 287–304. https://doi.org/10.1080/10508422.2018.1518138

 

For the full references list, please see the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

Walk and Talk and Other Non-Traditional Therapy Settings Part 1

Field-Based Private Practice with Megan Costello, LMFT

Dual Relationships: Pros and Cons

The Balance Between Boundaries and Humanity (an interview with Dr. Jamie Marich)

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is a member of the California Association of Marriage and Family Therapists ethics committee, an Adjunct Professor at Pepperdine University, lecturer in Counseling Laws and Ethics at California State University Northridge, a former Law & Ethics Subject Matter Expert for the California Board of Behavioral Sciences, and former CFO of CAMFT. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, with a Master’s degree in Clinical Psychology from California State University, Fullerton and a Bachelor’s Degree in Psychology and Theater from Occidental College in Los Angeles, California. Katie has always loved leadership and began stepping into management positions soon after gaining her license in 2005. Katie’s experience spans many leadership and management roles in the mental health field: program coordinator, director, clinical supervisor, hiring manager, recruiter, and former President of the California Association of Marriage and Family Therapists. Now in business for herself, Katie provides therapy, consultation, or business strategy to support leaders, visionaries, and helping professionals in pursuing their mission to help others. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

www.mtsgpodcast.com

www.therapyreimagined.com

www.moderntherapistcommunity.com

Patreon Profile

Buy Me A Coffee Profile

https://www.facebook.com/therapyreimagined/

https://twitter.com/therapymovement

https://www.instagram.com/therapyreimagined/

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

 

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm  00:00

This episode of ModernTherapist's Survival Guide is brought to you by Thrizer.

 

Katie Vernoy  00:04

Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee. By using the link in the show notes, you can get a month of billing without processing fees just to test them out for your clients.

 

Curt Widhalm  00:30

Listen at the end of the episode for more information.

 

Katie Vernoy  00:34

This episode is also brought to you by Melissa Forziat Events and Marketing.

 

Curt Widhalm  00:39

Melissa Forziat is a small business marketing expert who specializes in marketing advice for businesses that have limited resources, including the very special course How to Win at Social Media, Even with No Budget. Stay tuned to the end of the episode to learn how you can get the most from social media marketing, even with little to no budget.

 

Announcer  00:59

You're listening to The Modern Therapist's Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  01:15

Hey modern therapists, we're so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you've listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that's all completed, you'll get a CE certificate in your profile, where you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com.

 

Katie Vernoy  01:47

Once again, hop over to moderntherapistcommunity.com for one CE once you've listened. Woo hoo!

 

Curt Widhalm  01:54

Welcome back modern therapists. This is The Modern Therapist's Survival Guide. I'm Curt Widhalm with Katie Vernoy and this is our second in a two part episodes for our CE content on doing therapy in non-traditional therapy settings. Part one was a lot about the logistics and clinical concerns. Part two, we are looking more at law and ethics concerns. We had made reference to a number of things as far as precautions to take. And if it's not written down, it's probably not something that you had thought about ahead of time or so the lawyers who are suing you would say. So, some of the concerns and stuff that we're going to talk about here today is about, you know, avoiding any liability, minimizing liability that we can take into this episode. So Katie, what are the most important things for us to talk about now? What are you hearing from some of the people who are consulting with you? And let's dive in from there.

 

Katie Vernoy  03:05

Sure. And just to clarify for folks that this is the first one I would recommend going back to the previous CE episode, it's kind of a 101 on what walk and talk and home based therapies are and clinical considerations, benefits and how to do it. So definitely check back to that one. The most important thing is that we think about what we're doing ethically. And that's kind of what this conversation is going to be about. But I think the first place to start is to look a little bit at why there's been such a hesitation around employing especially therapies like outdoor walk and talk kind of therapies. I think home based has been around for a while, but there's been hesitation just in any kind of non-traditional setting. And part of it really stems from provider anxiety, or kind of the rigidity that we can have around what therapy looks like. Is it just in my office in the safe space where I can control everything? And I think there's a lot of stereotypes around what therapy is. And one of the articles I was reading Cooley et all 2021 put together an article 'Organizational Perspectives on Outdoor Talking Therapy' in the British Journal of Clinical Psychology. Cooley's done a lot of these things. In looking at the systemic pushback on this, what they really posited is that we need to get to a place of environmental safe uncertainty. And what that means it's a position of openness, curiosity and collaboration regarding the therapy environment, including the possibility of other environments being more conducive to therapy, other environments meaning not the office. And that leads me to kind of the first point which is: Is it unethical not to consider these environments because they maybe more conducive to treatment, then sitting in your nice little office?

 

Curt Widhalm  05:06

We have talked about in some of our previous presentations about how much of our field is modeled around clinician comfort and clinician principles, rather than necessarily what's best for clients. And some of those are logistical concerns, you know, we can't always just, you know, stack six or seven clients in a day back to back if it means that we're having to also travel to different parts of a city or county or, you know, much further if you're working in rural practices. If what we're going to is kind of the core principles of have the first stance of like, do no harm, but our second stance is do good.

 

Katie Vernoy  05:47

Yeah, exactly.

 

Curt Widhalm  05:50

And, you know, this is that push pull between those two concepts. Is the environment of our office is one that is hopefully set up best for do no harm. And it's kind of in that good enough for like, doing good. Now, what I'm hearing is the aspirationally, doing best is doing therapy, where it's going to most benefit the client.

 

Katie Vernoy  06:18

Yes.

 

Curt Widhalm  06:19

And we do have, you know, some examples of this that, you know, for instance, Italy, as an example, here is a country that does not have mental hospitals. That it is about being able to work with people with mental illness, in the environments that they live, that kind of thrusts them into needing to have the right approaches to clinical intervention that leads them best into their day to day lives. On the other hand, we have America where we throw people in jail and ignore that mental illness might be a factor. And that's not today's episode.

 

Katie Vernoy  07:01

No, no. But I think that that really hits at the crux of the argument here, which is, there are people for whom home based or walk and talk therapy is the best form of treatment. And so the best way we get to a system that supports it is holding this environmental safe uncertainty, which is being able to be open and safely open to the idea that we can be in an uncertain environment. Another systemic concern, which I think gets in the way and dances around with some of our our ethics and laws, is payers and payment. Now, insurance coverage, you know, Medicaid, for those of you in the United States, oftentimes covers a lot of this stuff. But there are concerns around driving time, and is that billable? I know, we had a huge argument around that when I was completing mental health but if you are a private practitioner, and you're needing to then charge extra to drive to a client's home, for example, or do you on the flip side, decrease your fees, if you let go of your office, and you're only seeing people in these non traditional spaces. And it really puts this thing of around payment of are we being limited by payers, whether it's insurance payment, or how much someone can afford to pay on what treatments we can offer. And we at least there's a CAMFT ethics code three point eleven or 3.11, that says we actually have to tell people about options for treatment, even if their insurance company doesn't cover it.

 

Curt Widhalm  08:47

So much around payment is going to be in the: we charge for services that we actually provide. We let our consumers know what we're actually going to provide. So that way, they can opt into what is best for them. And that's going to take a couple of different forms here. Like you know, on one hand, you're talking about, you know, managed care system, but keep in mind that these ethics codes are written in a way that helps to maybe hit kind of the best catchment of every type of practice in being able to write them. And so, I'm going to start not with managed care systems here first, I'm gonna start with, you know, those private practices that are all cash payer or doing super bills. You might, you know, have a client where you say, alright, I can go and see you at your house. But it's also going to take me time to drive there. And this is roughly how long it's gonna take me to drive here. Here's my driving fee. You cannot put that driving time as session provided time on something like a super bill, those are actually two separate line items. And so this is that recommendation of charge appropriately for the services that you're providing, out what you're speaking to, and going back to the manage healthcare part of it is that drive time isn't an option. And so therefore, it kind of thrust some of the business practices to, if they're going to operate efficiently, maybe not allow for that kind of time to sit there in the middle. It is a possibility with maybe things like, you know, a private health insurance company that you can still tack on that drive time to those clients, that's just being able to get to a different service, insurance probably isn't going to reimburse it. But I think that, you know, in my limited knowledge of some of the federal health care systems, I don't think that that's going to be an option there.

 

Katie Vernoy  11:01

Well, and I think with some of the the systems that require those things like Medicaid, Medi-cal, Medicare, you know, some of those payers, they're gonna have their own rules, and whether drive time is billable or not, I think is something that you want to pay attention to. I think the challenge is, is when it's your own private practice, and do you have it as a separate line item? Or do you just charge more for the service? You know, is there is there an issue with saying, I'm going to raise my fee, X amount, and I'm going to spend 30 minutes driving to client a, and zero minutes driving to client B, but they're both point paying the same amount? Is there a concern there?

 

Curt Widhalm  11:49

Yes. And it's gonna fall under those usual and customary amounts. And, again, there's probably going to be people who do this kind of stuff anyway, and just kind of all lump it into one sort of payment and don't pay much mind to it. But when clinicians are being examined for what is your actual usual and customary be prepared for questions like how do you figure that out? If somebody is to look at client A where it's alright, you've got this 30 minute drive time incorporated into this fee? What's the justification for the exact same type of services just being provided in your office having a completely different fee? And you need to be able to reasonably and prudently explain the differences between those two, because when it comes to what your usual and customary fee is, it's also the justification for those fees that needs to be explained.

 

Katie Vernoy  12:48

And I think the equity and the ability to do a fair payment for all clients, there's arguments in both directions in that if, if on average, I spend X amount of time driving, and I don't charge individual clients for driving, you're saying that's not okay.

 

Curt Widhalm  13:07

Correct.

 

Katie Vernoy  13:08

If I go, if I go all over town, and client a is typically a 30 minute drive, sometimes they're a 90 minute drive, client B is usually a 10 minute drive, but sometimes they're a 40 minute drive, I need to charge them differentially is what you're telling me.

 

Curt Widhalm  13:22

You need to charge for what you're actually doing. And you need to do that appropriately. And you need to have that kind of stuff set up, up front.

 

Katie Vernoy  13:32

Okay.

 

Curt Widhalm  13:33

And especially with our no surprises act being introduced in America here in 2022, is there's a potential that if you're having kind of these traffic concerns, as you're describing, that it's a separate line item that you're going to need to put in your good faith estimates to clients. Because the whole point of this is that it's not to surprise clients with your billing. And the best way of protecting yourself on that is putting that information in writing ahead of time and having clients see it and agree to it.

 

Katie Vernoy  14:13

Yeah. And I think there's there could also potentially be an argument just having a specific fee for home based services. So here's the session fee. Here's the home based services fee. But you're saying if somebody is further away, I got to charge more.

 

Curt Widhalm  14:30

Saying that it needs to be commensurate and clear with your policies.

 

Katie Vernoy  14:34

All right. All right. All right. We don't want to get stuck there.

 

Curt Widhalm  14:37

That results in a higher fee, then that's commensurate with whatever policies you have.

 

Katie Vernoy  14:43

All right. So there may be some fee stuff to sort out if you're doing this, especially if you're driving a lot of distance most days. Some of the recommendations that I've given to folks in the past is setting up what I would call catchment areas. So on Monday, I'm in this area of town On Tuesday, I'm in this area of town on Wednesday, I'm this area of town. And on Thursday, I'm at the walk and talk location by my office or whatever, right like you, you know, just so that you diminish those differences. However, regardless of setting that up, and potentially putting systems in place, there is still going to be unpredictability. And that can be due to a lot of different things. So you've got the unpredictability of the environment, which we talked about in detail in our previous episode. But there's also this unpredictability on, if you're outside what the weather's like. If you're going to someone's home, if they have visitors. And I think there's those types of things where when you have so little control, the system says, "No, don't do this, don't do this. This is scary."

 

Curt Widhalm  15:50

So as a resident of Southern California, where our weather is usually 75, and sunny, I don't find myself traveling to other places in the country, sometimes where I forget that weather is different. Like...

 

Katie Vernoy  16:04

There's... weather is a thing in places Curt. I know, it seems weird to us, but there's actually weather in other places.

 

Curt Widhalm  16:11

So, my informed consent is being cognizant that people are not fragile little beings, and that they can make their own decisions about things. So it does make mention of weather does happen, and it's your responsibility to be dressed appropriately for it. And that's at least, like this is a foreseeable thing that can happen.

 

Katie Vernoy  16:43

Yes, we'll go into more of this and the informed consent section, because we could dig into this very deeply, especially the the fragile little beings. But, um, but I think just as far as kind of the overarching systems concerns, just to close this out, I think the other pushback that often happens is scheduling and getting permission for the services that are provided. Whether it's getting permission to go into someone's home, school or office. Whether it's scheduling to get to a certain location, I know I've had to shift clients by 15 or 20 minutes to get to walk back to my office between sessions. And I think the difficulty with that means that you have to be able to navigate those things with your clients. Because, well, if we're in the office, it'll be at this time, if we're at the park, it'll be at this time. And if we're in video, it'll, you know, like, it's, it's something where navigating those concerns, I think, can be very hard for some clients, because they want their exact time, every single week.

 

Curt Widhalm  17:46

And as we mentioned, in the first episode, this is a little bit more of that dynamic practicing that you need to be able to respond in any sort of given situation and, and it's having backup plans, you know, in the days where there is inclement weather, it might change that, alright, we're not meeting at the park, we're actually meeting at an office instead, or, and...

 

Katie Vernoy  18:10

We're doing video, doing telehealth.

 

Curt Widhalm  18:12

And that might affect a start time. And I think it's prudent of therapists to make sure that we revisit that as a possibility fairly frequently with our clients so that way, it's not a surprise when and if it does come up.

 

Katie Vernoy  18:29

Yes, yes. And I think just allowing for that in the conversation. So. So that's kind of the high level systems concerns. I think we've addressed those well enough. I think that the brunt of our conversation is really going to be around the legal and ethical concerns that a lot of people bring up that are kind of more individual with your client, the things that you have to grapple with not just as a system, can we say it's okay to do this thing. Some of the thoughts I am sharing are from an article, Boland 2018, 'Ethical Considerations for Providing Home Based Services for Homebound Individuals.' It's obviously there's some specific things to folks who are homebound. And I want to mention those things. Because if you're doing home based therapy, it could be for someone that is homebound for mental health reasons or physical reasons. But it also talks I think sufficiently around the types of things that you might encounter in an environment that is not yours that you don't control. Accessibility, I think is is one of the reasons that people say to do this to go to people's homes, meet them where they're at, they don't have to, to drive, those kinds of things, but it's also a complaint, especially around walk and talk therapy. And so there is a value in a lot of the ethical codes around accessibility, about providing therapy across the board and in my thoughts, you know, like there's physical abilities and accessibility that you want to make sure if you're doing a physical activity together, you know where we can make sure that you're able to walk together or if you if someone is not able to walk that, that, if they would like to be outdoors, you can provide them space to do that, whether it's in a wheelchair or in other types of settings or primarily sitting outdoors, those kinds of things. But it is, I think, a harder concept around, okay, if I've got someone who is disabled, or who has another challenge that outdoors might not work for, this may not be an accessible modality for them. There's also just the physical concerns. And you'd already mentioned, like they need to wear the right clothes and to do the things but but there is making sure that when they show up, they can access the service. So I wear a hat. And oftentimes during the summer, I wear sunscreen, and you know, I make sure that I've got the right shoes on. And so one of the things is looking at if someone comes unprepared for what you're signed up for, what do you do with that? I mean, you kind of just said, I leave it up to them.

 

Curt Widhalm  21:00

So I'm looking at the American Counseling Associations Code of Ethics here. And this is A6C documenting boundary extensions. And I'll paraphrase this, but it's if counselors extend boundaries, they must officially document prior to the interaction when feasible, the rationale for such an interaction, the potential benefit and the anticipated consequences for the clients. When unintentional harm occurs, the counselor must also show evidence of attempt to remedy such a harm. And I think that this is a really good and dynamic ethical code here because it says that what we talked about in the last episode and and what we're going to get into with our informed consent discussion here in a little bit, is that we need to anticipate what the consequences of situations are. But these are also things that are going to be dynamic, that if a client is showing up doesn't have the right footwear, for example, you know, is going for a walk on a trail in flip flops is going to be something that is doable for them is you need to then document that you're having that conversation. And that it's up to them to be able to continue to opt into it. And if they do end up getting hurt, you do need to document like, what it is you're doing. So you can't just be like, "Well, alright, if you want to walk in flip flops that's on you," like, really, like you don't, there's just there's a potential, like there's a long walk, these might not be stable enough shoes, you know, the person gets a blister halfway around the loop, like, you know, you gotta be like "You need me to get your band aid?" like "You want to wait here until, you know, you paramedics come?"

 

Katie Vernoy  22:59

I think it's I think all of those things are really important because to me, there's also the other element, when you talk about extending boundaries, just the element of I'm wearing those kinds of clothes, I may be in not as good physical shape as my clients as far as how fast I can walk, how long I can walk, I fell once and my client helped me up. We'll talk about that in dual relationships a little bit later. But I think it's it's something where this is a little bit harder to, to kind of cleanly say is that are these forms of treatment accessible or not? And so the the question I have here is, do you need to be able to provide these options for all people?

 

Curt Widhalm  23:47

Going back to what I said at the top of the episode, is that sometimes you're going to provide therapy that is just based on clinician preference to. You know, what, when we talk about accessibility sort of things, we, as individuals, and especially in private practices don't need to absolutely make ourselves 100% available in every single direction for every single possible type of client. And this is where we do the good enough approach. And we take steps to address situations that are more accommodating as those situations arise. And it may not be immediately, you know, you're talking about clients with disabilities or something that might affect mobility. Well, that might be a consideration that you look at as far as your office building or whether or not you participate in therapy outside of the office. Some of these situations are also going to come up with some of our able bodied clients. You know, if you have have a client who breaks their ankle in between sessions that this is now something where you may not be prepared for that. What you're going to want to do is then stop, evaluate the situation, go through what the new risks and consequences of things are. We like, 'Alright, man, like, you got to hobble along on your crutches faster along with me. So that way we...' Probably not a good recommendation there. But it's, you know, all right, we might not be able to have a full, you know, loop of sessions, you might be like, left out there, would you rather sit on a bench instead?

 

Katie Vernoy  25:41

Or would you rather meet via video? There are those types of accessibility. And then I think there's also some of the things and we started talking about this in the last episode, but for home based clients, where do we only provide these things for folks living in certain neighborhoods? Where we feel safe? You know, do we only provide home base for people that have a specific payer? I mean, or who can afford it? You know, I think it's, it's something where I agree with you, I think we do the best that we can. And some of it has to have some boundaries around our own needs, you know, we can only afford what we can afford to, as far as, you know, lowering fees, we can only do what we can do around our own safety, and we want to protect our own safety. But I think there's that element of being aware, are you providing a service that is inaccessible in a way that is discriminatory? And I think in this situation, I think it's very much case by case. And I don't think that this is a reason that you would not consider using these ever. I think, I think accessibility issues are pretty navigatable in this situation.

 

Curt Widhalm  26:56

Sure. And to be a little bit more open about this. There's a couple of citations here that I want to point out, Lazarus all the way back in 94, said one of the worst professional or ethical violations is that of permitting current risk management principles to take precedence over human interventions, and very much advocating for we should take these considerations into account. And that it may be unethical to not open our practices to being able to serve in a wider variety of communities. And the goal of this is to free therapists to intervene with client's specific situations in presenting problems, rather than just kind of sitting back and playing it in the safest way possible.

 

Katie Vernoy  27:55

Exactly. But speaking of being safe, I think it's time for us to jump in to the informed consent, because I think it's truly important. I think all of the ethical codes, talk about informed consent, and we definitely in these situations needs a very strong informed consent.

 

Curt Widhalm  28:12

Yes.

 

Katie Vernoy  28:13

So I think first off, we want to look at making sure that this is truly the client's choice. That the plan is created together. I know, there were times at least during the pandemic for me, when I was ready to be face to face with folks, I was not ready for being in the office. And so I started doing walk and talk. And there were some clients that I told it to. And after I set it, I was like, that was just for me. We did not end up doing walk and talk, I will I will put that out there. I was able to dial it back. But there was something was like, Hey, you want to meet me at the park? And they're like, "Umm, that seems weird." And so to me, because we've talked about in the previous episode that there was clinician benefit for being outdoors and walk and talk, mental health, wellbeing all that good stuff. And, and also efficacy because you're more creative and your brains working better. But that is not a reason to do it. Like it has to actually be co-created. And the treatment plan needs to be collaborative. And I think that's something where it can be very easy to say, well, this is my new thing, and we're all doing it. Or this is the only thing I do and you're gonna do it versus let's see if you're a match and I'll refer you out if I don't do other forms of therapy.

 

Curt Widhalm  29:33

So there's two things that you're talking about here. One is the creating the plan together. And some of this is also going to be based on clinician competence and actual services offered that, you know, the client may come in with ideas of what they want out of therapy, but if it's not something that you provide, you are still free to say no.

 

Katie Vernoy  29:56

Of course.

 

Curt Widhalm  29:58

And so I don't want anybody to feel like they have to absolutely twist themselves into knots in order to do something, if it's not something that you yourself are comfortable with. And you know, as far as the place where you provide therapy, you're free to say like, you know, I only work out of the office, or I'm only doing virtual sessions right now. And giving those referrals like Katie's talking about.

 

Katie Vernoy  30:24

And I think the point for the informed consent is to be very clear within the informed consent, how you're doing treatment and making sure that the client is opting into that, versus what they imagine therapy to be because you if you don't know how to describe it, how can they really know what they're opting in for? The other thing too, is, especially with some of these more non-traditional therapy spaces, they really need to recognize it's voluntary. And that they can opt out at any time. And I think... what it seems obvious, you know, to us, but there is the power differential. And I think there's also this element of when someone's doing a treatment that's specifically aligned to their location: ERP, desensitization, all the different kinds of things where somebody's kind of walking through something really challenging with their therapist, they need to know that they can opt out that they have some control.

 

Curt Widhalm  31:22

That's just good therapy and not abusive therapy in the first place.

 

Katie Vernoy  31:29

Of course, I mean, some of this is going to be like,duh, this is the normal thing that we would do in an informed consent, it just is, it's a bit different if you and your client are on a trail, and letting them know, you can opt out and walk back. And I will, I will finish the loop or I will follow you back. You know, whatever it is, I mean, I think people need to know that they have control and autonomy, and this is their treatment and not the clinicians dictation of what's going to happen.

 

Curt Widhalm  31:58

And in addition to that, you as the therapist leading the conversation on 'how is this working out for you?' that extends that action to not just waiting for clients to then passively opt out and just like leave you standing in a park the next week when you're supposed to be meaning there.

 

Katie Vernoy  32:18

Sure. Yeah. Specifically to the outdoor therapy, there are the health issues. And I think one of the things I looked at, talked about doing a health screening questionnaire, I feel a little concerned about scope of practice there, potentially a physician note or some sort of approval. But I've also seen consent for treatments that just have an attestation that I'm taking my own risks, and I'm healthy enough to do this. Where do you stand on that, Curt?

 

Curt Widhalm  32:47

I think that it's important that considerations be factored into it. And again, where I'm always a little weirded out that our profession treats people as both incredibly fragile and capable of making every decision in their life at the same time. So I like that the informed consents have: you're opting into this and you're taking care of your physical health as part of that consideration. It at least speaks to us thinking of, well, this could be a risk, and especially in more litigious areas, you know, if you're gonna get sued by somebody, this is again, reducing liability, because you can always imagine that opposing counsel in a deposition saying, "Well, why didn't you consider that this client might be not a good candidate for getting physical exercise?" So it at least is something that allows for you and your attorney in that situation to say, they attested that they could and that they were medically cleared for it, you know. Oddly, I see the same kind of language in things like sporting events like marathons and 10, Ks and five K's where it's like, you've you physically fit person, theoretically have cleared that you're medically okay to come in and do this. At worst, it's a line to check off in your informed consent. And at best, it's something that really does help to limit some of that liability for you.

 

Katie Vernoy  34:30

Another element with that is potentially like someone who is allergic to bees, or to bee stings or or some of the things that you may want to be aware of if you're outdoors with someone. I feel like that could be a separate conversation and/or something that goes into the informed consent. I have mixed feelings there.

 

Curt Widhalm  34:53

There's always going to be, no pun intended. There's always going to be something that inevitably gets left off of a list like that, you know, and there's got to be a natural line, like, you know, how specific you have to be with things like allergies, like, you know, you're going to be exposed potentially to tree pollen and, you know, if you're walking by a dog park, you know, animal dander say. So I like that there's at least something that points to you attest to, you know, if you're speaking to a client, you attest to that you are medically and physically capable of being in these environments as cleared by a medical professional. And you accept all risks that go along with being outside where you're potentially exposed to nature.

 

Katie Vernoy  35:48

I would almost add and this was this was something suggested in one of the things I was reading is that you kind of encourage them to tell you if there's anything you should know. I think if someone's allergic to pollen, and it's spring, I think, okay, I don't need to know that. But if someone is deathly allergic to bees I want to be aware of that. So that I know to call the ambulance when/if someone gets a bee sting. Now, granted, they could tell me that in the moment. But I don't know if I raise my liability if I'm aware that they have that concern.

 

Curt Widhalm  36:26

Most attorneys will do a very good job of finding some way to make you know, that you should have been aware. And, you know, so it's kind of that naivete is not a protection, and especially intentional naivete. So, yeah, it's a basically a longer version of the question that you asked: any concerns about you being outside and walking around physically, you know, that this is the kind of terrain that we're going to walk on, generally, well maintained sidewalks, at times, sidewalks with cracks in them, you're potentially crossing the streets in a couple of areas, or walking on the street for sections without sidewalks. If you're walking on a trail in a park, it's unpaved, maintained grounds that, you know, has potential tripping hazards. You can put some of those language things in there that, again, you're going for reducing liability, you're not going to be expected to protect against everything here.

 

Katie Vernoy  37:36

And I think just for to close that one up, I think I would put something to the effect of you're attesting that you're fine medically, and that you will inform the therapist if there's anything they should know.

 

Curt Widhalm  37:49

Yes.

 

Katie Vernoy  37:50

So another thing that should go into the informed consent are confidentiality challenges and how you're going to manage those. But we're going to do a whole section on that. So I want to skip that one really quickly. And go to clinician safety, because I think this is one that I was surprised in reading through the informed consent suggestions, that clinician safety was there. I don't concern myself with this prep for walk and talk therapy, I think that probably is something where I'm having at least a little bit of control over the environment and so I'm opting in. This is more for home based, where you're contracting basically, with your client, if there's anything that they need to manage for clinician safety, so this: is locking up pets, this is: potentially if there are family members that are very much against treatment, and maybe have even threaten the clinician, or if there's or if there are family members that just are going to be mean... I don't know. But that there are some safeguards in place, and talking about how the clinician is going to be remaining safe in those situations.

 

Curt Widhalm  39:05

And I think that the more clear that you can be with any of these things, the better because, again, you're looking for an open collaborative process here. In order for me to be able to help you know, again, coming back to like allergies, things for clinician has a strong allergy to something like perfumes, that might be a barrier to treatment when it comes to a clinician visiting someone's household. Yeah, and these are the things where yeah, you move up to having pet secured, if there has been a threat from a family member, you're gonna have to address that with your clients as far as "alright. I can't be in that environment and provide you therapy. We need to find something else to do." So again coming back to that problem solving alleviating this the the part of the problem and developing a new treatment strategy from there.

 

Katie Vernoy  40:07

And I think exactly what you said, I think that the biggest piece of that is maybe not even delineating all the clinician safety concerns. I mean, if there are specific ones, like I have these kinds of allergies or whatever, you may want to have that in there. But even just say if the clinician is not able to ensure/secure their own security, the session may be discontinued. I know for myself, it seems obvious. And I think this is something that actually is good both for kind of newer clinicians or clinicians under supervision as well as clients to think about this. But if you're in a client's home, and something happens, where you feel like your life is at risk, or if you feel like you're in danger, you should leave. Immediately.

 

Curt Widhalm  40:57

Absolutely.

 

Katie Vernoy  40:59

Whether or not the client is in a high state of risk, whatever, the clinician must protect their own safety immediately. And I think clients should, should know that, that they this is what they can do to mitigate the risk for the clinician. And if that risk is not sufficiently reduced, or if there is a risk there that the clinician is not comfortable with adult in the session, and/or suggests an alternate location to have that session.

 

Curt Widhalm  41:23

Because no matter how ineffective you may be, you will be more ineffective if you are dead or incapacitated.

 

Katie Vernoy  41:36

True story. And along the lines of plans, I think it's also important to have whatever plans you know for you know, that you can have for handling known risks for me COVID precautions, I've definitely incorporated those into all of my informed consents. And so, if you are only doing home visits for folks who wear masks, or only have certain levels of vaccination status, or whatever, I think those things need to be very clear. I think that there's the plans around the uncertainty of the weather, backup plans, and then I think a big one that I think all of us have been playing around with our cancellation policies. I know that many of us have shifted our very stringent cancellation policies to basically say, if you're sick, do not come and see me in person. But I think other cancellation policies around rain, you know, or if it's raining, we will switch to video. If you've got a visitor, what are you going to do, I think being able to talk about ways that you can minimize the negative impact on the practice, because we are businesses, we need to be able to run and we need to make our money. But also that makes sense and that are clearly stated in your informed consent.

 

Curt Widhalm  42:58

And one thing that I noticed with some of my clients that I was seeing outside of the office, is what you do when the time changes, and it gets dark way earlier and is...  an appropriate place. So again, this all falls under that foreseeable consequences and adapting to them and documenting that these processes have happened all along.

 

Katie Vernoy  43:23

Yeah, yeah. And I think all of that stuff is, is really important to be in the informed consent just to kind of run through just for for those of you who are taking notes, you want to make sure that they're aware of voluntary participation, that they're actually consenting for treatment. And actually, you may need collateral participation, consent for treatment. If you're doing stuff in home, if like a sibling or a fit parent or another family member is going to pop in time to time, making sure they know what they're opting into, health statements and potential plans around taking care of that, confidentiality and how to handle it, which we'll go into more detail on, clinician safety. Any plans for handling known risks. I think those are really important. There may be other things, but those all need to go into informed consent. And I think the question on this topic that I think, well, the first one was: Can people really know what they're opting into? And I think we've talked about Yes, I think we need to understand it and explain it to them. Yes. But you talked about kind of being left standing, the therapist, you know, kind of forlornly standing in the park by themselves and the client doesn't show up. And that's called passive termination. Right? The client just ghosts the therapist.

 

Curt Widhalm  44:45

Yes, exactly.

 

Katie Vernoy  44:46

But the interesting thing, and this was in the article around the homebound therapists or homebound clients where that if you were going to a client's home, they cannot passively terminate because: She just keeps showing up. I mean, I guess they could not answer the door. And I'm sure you had those. I've definitely had those long ago or they could not be there. But it's very hard, especially for someone who is completely homebound and cannot leave to passively terminate services. And is that, okay?

 

Curt Widhalm  45:18

We have a responsibility as therapists to ensure that the services that we're providing are effective with our clients. And one of the best ways of doing that is talking with our clients about it. And well, the situation that you're describing may not allow for that passive opting out. There should be some sort of approach that therapists are taking to regularly evaluate how the treatment is going. For my feedback informed treatment listeners out there, this is already built into just about every session that you're doing things. But for those who aren't engaged in that, we do have the responsibility of coming back and evaluating how are we doing on our goals? How's our treatment plan looking? And that should be done with some regular sort of interval, whether it's time based, whether it's number of session based, that if we're aware that clients can't passively opt out of sessions, we should take on some of that responsibility of giving them more of an active opportunity to opt out of sessions.

 

Katie Vernoy  46:37

Absolutely. And I think the other piece is also for us to continue to assess appropriateness, because another thing mentioned in there was that they may not want to terminate due to loneliness. And so we have a responsibility to make sure that treatment still necessary and that we're providing them with only the services that they need. And not just being a buddy that comes to see them every week. So moving on to bigger stuff. But that was kind of what needs to go what kind of the issues around informed consent. But now looking, I want to spend a little bit of time on confidentiality, as well as the potential for dual relationships. Because I think those are the big things. When we think about these types of services, I think those are the big things that are the big juicy things that we should be paying attention to. And starting with confidentiality, I think we cannot completely guarantee confidentiality, I don't think. But I think there's a lot of ways we can mitigate the risks. And so what are some of the things that come to mind when you think about confidentiality in either these public spaces or in someone's home?

 

Curt Widhalm  47:45

So the biggest things, and again, looking at it from limiting your liability standpoint, is talking about the potential risks and benefits of what this is. And so the risks are other people can overhear what we're talking about, we might need to speak in a more coded way. And really talking about that the limit of confidentiality, much more fluid when it's outside of the office, and when it is inside the office, because there is just that potential of being overheard.

 

Katie Vernoy  48:19

And I think what can compound that at home is that you might be overheard by the person that you're talking about. Or they may come in, or they may do the things, or you may want to introduce them, or there may be, you know, kind of a fluidity of them coming in and out of sessions. And so I think just being very clear on that, but I think as far as the cya elements of it, I think if they're going to be part of treatment, you do the collateral consent form. But I think making sure that if there are folks that are going to regularly be interacting, you want to get release forms. You can't obviously, you're not going to do that for the folks at the park, those people are just walking by. But like people in the home, you know, you may want to consider that.

 

Curt Widhalm  49:00

Well, and it's also part of what we're talking about into, be specific about it. Is asking our clients how they would want us to handle those situations where there are other people in the house, or where we are walking by other people outside. Help the client be able to make their own informed decision of and take some ownership over those situations as well.

 

Katie Vernoy  49:27

Absolutely. The big pieces outside, I think clients don't necessarily know and don't have the experience to think about how they want to handle it. Because it could be just let's, you know, we'll just pay attention. If somebody walks by maybe we either speak more in a more coded way or we break for a second and then pick back up once we pass these people or whatever. But I think if someone comes up to you or to your clients, people they know or people that know you, actually having the conversation is if someone comes up and talks to us, what are we going to say? You know, and I've heard you know, like, you can say this as a colleague, this is someone I work with. It can, it can be a lot of different things. Maybe it can be this as my babysitter, or this is my teacher, it could be this as my therapist, "Hey, meet my therapist." I mean, they get to decide. But I think if you have some ideas around how to manage that, then it can feel a little bit a little less daunting for them. Because I don't think that they necessarily immediately like, oh, yeah, I live in this community. And I'm walking around with my therapist. Oh. Oh, now I have to think about I don't think that's the first thing they think of when they commit to walk and talk therapy.

 

Curt Widhalm  50:42

And I've noticed this kind of trend change. And again, I work with younger population teens. Earlier in my career, it was just kind of like, oh, I, I don't want to necessarily, you know, let people know that I'm getting help. And teens these days are just kind of like, you're basically shouting out like, "I'm with my therapists," like this, "You need help this guy's great." Like, I point this out that there has been kind of a lot of these principles and guidelines that were written when therapy was a lot more hidden in the shadows. And I think with a lot more emphasis on mental health, that it's still important for us to have these conversations. My experience and the experience of a lot of the colleagues that I know has been that it's less and less of a concer. We still need to ask the questions, but people aren't is shamed by it in the general population. I know that there's still some cultural considerations where still getting therapy, in some cultures is going to be a sign of mental illness. That's why we still ask, but the trends are pretty positive on this.

 

Katie Vernoy  52:04

And I think that's very fair. And I think that there are going to be different things based on age differences, on what your role in the world is, I think some folks are fine saying that they're in therapy, but maybe not like "this as my therapist." And so I think, definitely ask, and I think the other element of this is, the confidentiality may be lost more passively. So it's not just somebody coming up to you, but maybe someone noticing that you and your therapist are walking the park every week at the same time, or you're coming to their home every week, you know, in your particular car with your particular, you know, kind of characteristics. And so it's something to consider, because people will be will need to be aware of the types of confidentiality that they're losing by having these types of services. But I'm sure that people that go into your building, most of the people sitting around and going like they're going to therapy, because like how many therapists are in that building? Like a bazillion.

 

Curt Widhalm  53:09

Yeah.

 

Katie Vernoy  53:10

And so people may lose confidentiality by going to their therapists office. And so I think the location thing I feel a little less concerned about, but I do think it is something to be aware of, and for clients to be aware of, as well.

 

Curt Widhalm  53:26

And a lot of the confidentiality factors, as a reminder to our clinicians, and to any clients who are maybe hearing this is, confidentiality is only the strongest where you have the expectation of not being seen or heard by a third party. And our discussions up to this point are really that even in the waiting rooms of therapy offices, there's not an expectation of privacy there. So you know, your points of even walking into the building or or walking around, we can point out like, hey, there's not that guarantee of confidentiality, like if we were in my office.

 

Katie Vernoy  54:11

Sure. I think the other thing and this is kind of a juicy question for us to dig into for a minute or two is boundaries versus confidentiality, and walk and talk maybe you're you're standing closer than the COVID guidelines were and that kind of stuff so you can keep close but really the one that I think is the toughest is if you're going into a client's home, they don't live alone. And I guess if they live alone, there's a whole other thing but the the option for meeting privately is in the client's bedroom. And I think that becomes very complex. It also speaks to the next one we're going to, the next section on dual relationships. But I think this is a really it's it depends for me on the client, sometimes it'll be a meeting with the client in their room, but with the door open, and we're talking quietly, so there's a little bit of space, sometimes it's I'm in the room with the door closed, you know, I think it really is client by client and the type of boundaries that need to be held. But I think there's a lot of a lot of risks that could be in this particular negotiation, because you're either like, hey, we have to be in a public space, and everyone can hear us, or we're in your bedroom and the door is closed.

 

Curt Widhalm  55:27

And this is also got a whole lot of needing to negotiate things with clients, potentially with parents. And that is something where, you know, being in a child client's bedroom and doing play therapy on the floor, sounds a lot more reasonable. But being behind a closed door with the child's might also be something where their poses risks. So this is not just a matter of any one particular characteristic of a client. And it's something that you need to thoroughly evaluate every single time that you do it and take and document the proper precautions. Document people. Document.

 

Katie Vernoy  56:12

Just document. And I think the other thing, if there are more than one private room, I think if you can be in a room with the door closed without a bed in it, I think that actually is quite helpful. I think it is a little strange sitting on a client's bed, if that's the only place to sit and you're with an adult client. It just it gets really complicated. And so I think being really aware of what the situation is, documenting it, and if you can't find a good space inside, maybe you just kind of, your head outside. But dual relationships: clearly do not have sex with your clients, there is no sex in professional therapy, or professional therapy does not include sex. That is obvious. That's one of the things about you don't sit on the client's bed, you don't even want to get close to that right. Or maybe you do but you document why it's okay to do that. But we've talked about this before, you also cannot become your clients friend, which can feel very easy if you're hanging out at the park, there's a nice breeze and you're, you know, shooting the breeze and or you're you're hanging out at their house, and they're serving you up a little bit of tea and crumpets. I don't know, there was a lot of British articles when we were reading this, but like, there is a lot of ways where we become very casual, and it can feel very much like a friendship if we don't watch out. And that's, that's potentially a very unhealthy and harmful dual relationship.

 

Curt Widhalm  57:46

Yeah. And I see this from time to time. And it's really when the therapist stops holding the boundaries. It is not coming back to talking about therapeutic goals, it's relying a little bit too much on the personal shared experiences, rapport building in session, 78, that's, you know, already been well established. That makes it very hard for clients to be able to really differentiate what actual therapy is happening there.

 

Katie Vernoy  58:27

As we've said before, not all dual relationships are problematic. Of course you don't, you cannot avoid all dual relationships. And in this case, you're going to have some dual relationships that you just have to make sure to navigate becoming their friend or having sex with them, No! But you will be a fellow travele, a fellow walker down the path. You will be potentially in their home. And there may be some host-guest dynamics that you end up having to navigate there. Those things are not necessarily harmful. There's certainly things to pay attention to. And there's a humanity that comes into it. It's just you have to keep coming back to the therapeutic alliance, the professional relationship and the treatment goals. One other thing before we move on is that there are specific needs I think, for folks who are homebound due to medical reasons. And one of the things that they were paying attention to were if you're with a client and doing a therapy session, and they need to roll over and they can't do that themselves, or if they have any other physical needs. There's that that confidentiality boundary thing again, it's like do you keep their home health aide in there with them? Or do you not? And you, you roll them over or you plump up their pillow or those kinds of things. And I think really being comfortable with being a human and holding that with your professional identity I think it's really helpful. I worked for a while with folks who had HIV and AIDS and there were definitely times when, if they were very sick, the relationship by nature needed to shift. And so when I was sitting with them at their bedside, it was going to be something where I might help, I might fluff up their pillow. And it felt particularly connecting, rather than a boundary crossing.

 

Curt Widhalm  1:00:18

A lot of our traditional advice in this particular area of practice has been, don't do something that is not part of your role. And that's most of, most of the time still going to be the best advice to follow here. And, again, it's consults, it's being able to not take the sole responsibility of these decisions. It's being able to document those boundary crossings and what the effects of them were. But in some of these healthcare type situations that you're talking about, it may end up being where you also then need to advocate for the client to get the kind of help that they need. That is just falling upon you, because you may be the one who's visiting them at that time.

 

Katie Vernoy  1:01:10

Sure. And I know we talked about when I fell and a client helped me up. But I think if your client falls... Well, I can't touch them. There's no physical contact NASW 1.10 says no. I mean, like, I think we we can be humans and helps up as well. And we can help them across to a curb or something. I mean, I think that there are things that are going to be a little bit different. And I think, certainly consult, don't sit in this in isolation and document. But I think it's more harmful not to be a human in the space, than it is helpful to stick with these really harsh, strong, professional boundaries. As we're running low on time, I want to just mention some therapist concerns, things that we should really consider before getting started. Because I think, you know, that's kind of the last piece. And as we said, we'll we'll make sure that we can put together some ideas around informed consent. And we'll include those in the course that you can get over at moderntherapistcommunity.com. But truly, you want to check on your malpractice insurance as well as liability, make sure that your insurance coverage is complete, so that you can do what you need to do. We've talked about kind of your own logistics around commute or those types of things. Make sure that you think about those things so that you're not unduly burdening yourself or your clients. Certainly make sure that you are doing this for the client's benefit and not solely yours. And truly make sure that you are competent to do these services. It means dig into what we did here. But there's a lot more that can be, can be said about doing these types of services. But also make sure that if part of the reason you're doing these services is due to them being home based, there may be a different different diagnosis, a different type of thing that's happening. And so really consider all the comorbidities, all of the co-occurring disorders. And again, training, consultation, supervision, make sure that you're really doing what you need to do to show up for you in the ways that you can fit these clients.

 

Curt Widhalm  1:03:20

And document all of your decisions. Continue to consult even if you think that you are an expert in all things non-traditional therapy settings. Don't go at it alone. And check out our show notes. You can find our references there at MTSGpodcast.com. And follow us on our social media, join our Facebook group, The Modern Therapists Group, and listen just a little bit longer. You'll find out how to get your CEs for this episode if you desire. And until next time, I'm Curt Widhalm with Katie Vernoy.

 

Katie Vernoy  1:03:58

Thanks again to our sponsor, Thrizer.

 

Curt Widhalm  1:04:02

Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinicians should earn what they are worth. Every time you build a client through through Thrizer an insurance claim is automatically generated and sent directly to the clients insurance. From there Thrizer provides concierge support to ensure clients get their reimbursements quickly, directly into their bank account. By eliminating reimbursement by chequ,e confusion around benefits and obscurity with reimbursement status. They allow your clients to focus on what actually matters rather than worrying about their money. It's very quick to get set up and it works great in complement with EHR systems.

 

Katie Vernoy  1:04:41

Their team is super helpful and responsive and the founder is actually a long term therapy client who grew frustrated with his reimbursement times. Thrizer lets you become more accessible, while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit therapy. Signup using the link in the show notes if you want to test Thrizer completely risk free you will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time. Check our show notes over at MTSGpodcast.com. To get the very special rate at the very special link for our modern therapists. That's MTSGpodcast.com.

 

Curt Widhalm  1:05:22

This episode is also brought to you by Melissa Forziat Events and Marketing.

 

Katie Vernoy  1:05:26

Are you looking to boost your reach and get more clients from social media? Check out the How To Win at Social Media Even with No Budget course from marketing expert Melissa Forziat. It can be so hard to get engagement on social media or to know what to post to tell the story of your brand. It can be even harder to get those conversations to turn into new clients. Social media marketing isn't just for businesses that have a ton of money to spend on advertising. Melissa will work you step by step through creating a smart plan that fits within your budget.

 

Curt Widhalm  1:05:56

How to Win at Social Media is packed full of information. Usually a course as detailed as this would be priced in the 1000s. But to make it accessible to small businesses it is available for only $247. Plus, as a listener of The Modern Therapist Survival Guide you can use the promo code 'therapy' to get 10% off. So if you are ready to go to the next level in your business, click the link in our show notes over at MTSGpodcast.com and sign up for the How to Win at Social Media course today.

 

Katie Vernoy  1:06:29

Just a quick reminder if you'd like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you've successfully completed the steps.

 

Curt Widhalm  1:06:44

Once again, that's moderntherapistcommunity.com. Hey everyone, Curt and Katie here. If you love this longer form content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education, events and a whole lot more.

 

Katie Vernoy  1:07:13

If you don't think you can make a monthly contribution, no worries. We also have a Buy me a Coffee profile for one time donations. Support us at whatever level that you can today it really helps us out. You can find us at patreon.com/MTSGpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

 

Announcer  1:07:34

Thank you for listening to The Modern Therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Apr 04, 2022
What You Should Know About Walk and Talk Therapy and Other Non-Traditional Counseling Settings
01:05:52

What You Should Know About Walk and Talk Therapy and Other Non-Traditional Counseling Settings

Curt and Katie chat about non-traditional therapy settings like outdoor walk and talk therapy as well as home-based counseling. In the first of a two-part, continuing education podcourse series, we look at the basics, including why therapists should consider these settings (and may not), clinical and cultural considerations, and best practices.

In this continuing education podcast episode, we look at non-traditional therapy settings

For our third CE-worthy podcourse, we’re looking at the basics of bringing therapy into non-traditional settings, including walk and talk therapy and home visits. We cover a lot of topics in this episode:

What are non-traditional therapy settings?

  • The focus of this episode is walk and talk and home-based therapy
  • Client’s locations like home, school, or work; community-based settings
  • Anything beyond the typical therapy office or telehealth settings are worthy of consideration
  • Creativity and collaboration in creating the space
  • How different the therapy can be when opening up more settings as possibilities

Why should therapists consider these non-traditional therapy settings?

  • Logistical considerations that can lead to these settings being the ideal choice (or only choice)
  • Clinical indications that walk and talk or home-based therapy is a better choice
  • The impact on changing settings on the therapeutic relationship and the therapeutic work
  • Specific modalities that are best served by client-centered spaces
  • Assessment, treatment teaming
  • How access, attendance, and attrition are impacted
  • The therapeutic impact of the settings and movement

What are the hesitations therapists have in considering alternative settings for therapy?

  • The challenges in creating systems and managing the logistics
  • Lack of alignment with the medical model
  • Lack of training and guidance
  • Legal and Ethical considerations (that will be talked about in next week’s episode)

What are the clinical and cultural considerations when doing therapy outside or in someone’s home?

  • Navigating the shifting relationship and boundaries
  • Cultural differences between therapist and client, and assumptions made about the relationship
  • The importance of leading the conversation about these relationships
  • Hospitality and others who may be present at a client’s home
  • The unusual space, the level of confidentiality, and emotional containment and depth of conversation
  • Treatment planning based on where you meet and how the client interacts with the space
  • The importance of the clinician holding the therapeutic space and attention
  • Creating the space and the contract for how therapy will happen
  • Cultural norms for the activities and for the client and family – more complexity to discuss

Clinical How-To for Non-traditional Settings

  • Assessment considerations
  • Client and clinician characteristics
  • Alignment with treatment goals and presenting concerns
  • Presenting issues can vary and assessment can be important
  • Initial assessment appointments and making the decision early in treatment
  • Treatment Formulation related to active versus passive interaction with the space
  • The importance of true informed consent and the dynamic nature of process contracting
  • Introducing predictability
  • Risk assessment
  • Knowing your scope and what types of professionals you might consider consulting

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Dr. Tequilla Hill

The practice of psychotherapy is unique, creative, and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

If you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill a mindful entrepreneur, yoga, and somatic meditation teacher has curated How to Stay Well While You Work Therapist Wellness Guide to support providers that are struggling to manage your own self care.  Subscribe to Dr. Hill’s Stay Well While You Work! Therapist Wellness Guide and you can find many of the inspiring offerings from Dr. Hill’s 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

Support The Modern Therapist’s Survival Guide on Patreon!

If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings, and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more. If you don't think you can make a monthly contribution – no worries – we also have a buy me a coffee profile for one-time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: Walk &Talk and Other Non-Traditional Therapy Settings

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Cooley, S.J., Jones, C.R., Kurtz, A., & Robertson, N. (2020). ‘Into the Wild’: A meta-synthesis of talking therapy in natural outdoor spaces. Clinical Psychology Review, 77, 101841. ISSN 0272-7358, https://doi.org/10.1016/j.cpr.2020.101841.

Donachy, G.S. (2020). Psychotherapy outside the consulting room: ending therapy during the global pandemic, Journal of Child Psychotherapy, 46:3, 373-379, DOI: 10.1080/0075417X.2021.1903065

For the full references list, please see the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

Dual Relationships: Pros and Cons

Post Pandemic Practice

What Clients Want

Shared Traumatic Experiences

The Balance Between Boundaries and Humanity (an interview with Dr. Jamie Marich)

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is a member of the California Association of Marriage and Family Therapists ethics committee, an Adjunct Professor at Pepperdine University, lecturer in Counseling Laws and Ethics at California State University Northridge, a former Law & Ethics Subject Matter Expert for the California Board of Behavioral Sciences, and former CFO of CAMFT. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, with a Master’s degree in Clinical Psychology from California State University, Fullerton and a Bachelor’s Degree in Psychology and Theater from Occidental College in Los Angeles, California. Katie has always loved leadership and began stepping into management positions soon after gaining her license in 2005. Katie’s experience spans many leadership and management roles in the mental health field: program coordinator, director, clinical supervisor, hiring manager, recruiter, and former President of the California Association of Marriage and Family Therapists. Now in business for herself, Katie provides therapy, consultation, or business strategy to support leaders, visionaries, and helping professionals in pursuing their mission to help others. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

www.mtsgpodcast.com

www.therapyreimagined.com

www.moderntherapistcommunity.com

Patreon Profile

Buy Me A Coffee Profile

https://www.facebook.com/therapyreimagined/

https://twitter.com/therapymovement

https://www.instagram.com/therapyreimagined/

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

 

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm  00:00

This episode of The Modern Therapist Survival Guide is brought to you by Dr. Tequilla Hill.

 

Katie Vernoy  00:05

The practice of psychotherapy is unique, creative and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

 

Curt Widhalm  00:26

Dr. Tequilla Hill a mindful entrepreneur, yoga and somatic meditation teacher has curated How to Stay Well While You Work! Therapist Wellness Guide to support providers that are struggling to manage your own self care. Stay tuned at the end of the episode to learn more.

 

Announcer  00:40

You're listening to The Modern Therapist Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  00:56

Hey, modern therapists, we're so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you've listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchased this course pass the post test and complete the evaluation. Once that's all completed, you'll get a CE certificate in your profile, where you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com

 

Katie Vernoy  01:28

Once again, hop over to moderntherapistcommunity.com. For one CE once you've listened.  Woo hoo!

 

Curt Widhalm  01:35

Welcome back modern therapists. This is The Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy and this is one of our continuing education eligible episodes. Today we are doing a dive into therapy in non traditional settings.

 

Katie Vernoy  01:55

So when we were thinking about doing a continuing education podcast episode, one of the things that I was thinking about are the types of questions that I get a lot. And the topic for today is non traditional therapy settings. This is something I've done for most of my career, I worked in milieu settings. I've done walk and talk therapy. I've done playing at a playground and a school therapy, I've done home visits. And so I wanted to make sure in this first episode that we have the foundational knowledge of what it is. So I get a lot of basic questions about what do you do? How do you do it? What are the logistics? And then I also think there are folks who just aren't going to consider it because they don't know why to do it, and what benefit it has. And so for folks who are listening, we have two episodes this week is a basic 101, what are these non traditional settings? How do you do them? What are some best practices? Beginning level course. And then next week, Curt and I are going to really dig into the ethics and nuance. But we wanted to make sure you had the basics before we dug into it further. For folks who've been doing it and aren't sure they're doing it right. This is a great reminder of like, these are the things to consider. And these are some of the logistics that might go into place and making this a clinically appropriate service for your clients. Even before the pandemic hit many different types of therapeutic programs are happening outside of the office. I know we've all heard about kind of like the adventure camps and different things for folks. You know, oftentimes kids, troubled teens, there was a lot of different things going on. I mean, I in researching this, I found a lot of folks doing walk and talk therapy. Certainly when I was coming up in community mental health, we were doing home based therapy. But I think because of the pandemic, I think it gave a lot of us an idea of like, wait a second, if I don't want to keep my office and/or if I want to be outdoors and not inside with someone, what are my options for therapy if someone just can't handle the screen of telehealth? And so I think it's it's something where, to me, I've started doing this, I thought it was really exciting. And I wanted to share with everyone kind of I've get lots of questions about how do you do this stuff. And so I figured, why not do a deep dive on it.

 

Curt Widhalm  04:12

We're actually going to make this part one of a two part series here. This first episode is going to focus more on the hows and the whats of doing. Our second episode is going to dive into some of the legal and ethical considerations. You'll get a flavor of that in this episode. But this is really more of the hows of going about this. So Katie, first let's start with talking about like, what kind of therapy settings are we talking about here?

 

Katie Vernoy  04:46

I think the primary thing we're going to talk about in the episode will be home based and walk and talk but I want to reiterate that there is so much flexibility on where we can do therapy and so some of the types of settings that you might want to be considering and kind of extrapolating out to, could be home/school/work. So kind of the clients locations, outdoor therapy can be walk and talk, but it can also be like groups and and retreats and different things. I mean that that's probably a little bit beyond the scope of this. But I've gone to medical facilities, I've gone to social services buildings with folks, wellness centers, out in the community, when there's just not a great place to meet, you can meet at a restaurant or a library or a church or a YMCA. I've actually done therapy with folks in the car on the way somewhere. And when I was working in substance abuse treatment, this is something that's been around for a long time, too. There's kind of the milieu setting, but there's also like camping and other things. And so there's, there's a lot of times when therapy can be happening and a lot of places where therapy can be happening. But it has a lot of things to consider, especially within relationship and confidentiality. But we'll dig deeper into that.

 

Curt Widhalm  06:03

I'm hearing this just from the get go as not in the traditional office setting, basically anything else goes and it speaks to just that so much of what we're allowed to assume can happen is in the nature of a four walled sort of office someplace. And that's the reason to look at that even with many of our listeners, possibly having done non traditional therapy, during the course of the COVID 19 pandemic, that there might be some considerations in here or to be able to evaluate some of the effectiveness of how we're going about that. So this isn't just going out and doing what we've been doing in the office outside, though, it's not like, you know, I'm not doing EMDR and just waving my hand in front of somebody while they're walking.

 

Katie Vernoy  07:00

I think that would be tough. That would require a lot of coordination. I think it really varies. But I think, and we'll go into a lot of this more in depth, but I want to get a kind of a higher level overview. I think it always is important to start with kind of a collaborative assessment of appropriateness. And so it's a conversation you have with your client, you want to make sure that you're doing all of these things. We'll talk about that later. And then once you've decided, yep, this is for my client, or the client says, "Yep, this is for me," you meet wherever the designated place is that are, which could involve logistics and timing, it could be two people meeting in a single place. I mean, there's some stuff there that can be interesting. You could meet in a place and you could kind of passively engage with it, meaning I'm doing regular therapy, but it's outside or I'm doing regular therapy, but it's at the client's home, or you could engage with a space, you know, you're interacting with nature, you're interacting with the family or setting something up at their home. There's also a huge shift in the treatment relationship and so there's, and again, this is high level, we'll go into this in more detail. But there's more of an equality there, because you're experiencing something together, potentially even there's a shift in the power dynamic. If you're going into their home, you want, there's always going to be the planning for confidentiality, which if you've got your little office and your noise machine, like you're pretty clear that you're keeping confidentiality. And then there's also the environment, which could be very uncertain. I think that for some folks, they have a modality that they do. And so some people are just home based, or some just do walk and talk, I find I've not added homebase to my current practice. But I find having a flexibility there can be interesting, but then it could be that you're like, navigating with the client, are we meeting at the park today, are we going to be on video or we're going to be in my office. And so there can be some systems and different things in your business practice that you want to consider. It's an interesting type of therapy, because there's a lot of possibilities. But there's a lot of uncertainty that can come into play, because it's not an environment that you've carefully curated with all of your professional certifications and your comfy chair, or it's not that video setting that you've potentially done the same and then the client has created their own space too. So it's it's a different type of treatment.

 

Curt Widhalm  09:19

I've done some of this kind of work mostly back when I was pre licensed and newly licensed and part of it was the agency job that I had. But one of the things that you're talking about that brought back some memories is just the client approach to therapy can be a lot different when you're coming into their space than it is with them coming in. I noticed that my clients were a lot more cooperative when they started coming to my office. There was almost kind of like, alright, I'm buying into needing to be in the space. But some of those clinical factors that come up, some of what might be called defenses, would maybe show up when therapist is coming into their space. I'm guessing these are some of the things that we're going to be talking about as far as just kind of the hesitations that we have of approaching therapy in a different way. And also just kind of needing some interventions or conceptualization differences when we do approach therapy in this way.

 

Katie Vernoy  10:21

Of course, yeah.

 

Curt Widhalm  10:22

Before we get into that stuff, though, why might we be put into this situation in the first place? Why? What are some of the either client or world factors that might be reasons that we need to see clients outside of our traditional offices?

 

Katie Vernoy  10:39

Well, I think the reason that a lot of folks potentially are revisiting these thoughts are because the office doesn't work and in person is needed. And so for me, sometimes it's been lack of efficacy with telehealth or privacy, it could be just kind of needing to get your eyes on a client and not feeling comfortable in an in office setting. Maybe you don't even have an office anymore. A lot of people gave up their office and so having this possibility of either meeting them at their home or in a public space can be really helpful. I think the other thing, and this is something where you say like, why would we be in this situation, it actually can be a situation where a client is not comfortable with telehealth and not comfortable being in an enclosed space for an hour, because of COVID or because it's feels too constraining or the eye contact is too weird. And so like walk and talk can be actually a better option for them. With home based, sometimes there's this, you know, sometimes it can be mobility and transportation issues, it could be like, my client can't leave their house, I need to get my eyes on them, I'm going to go out there. But sometimes it can be a clinical issue, where being in the home makes sense, you get to see their full, you get a full assessment of their environment, how they interact with their environment. I know when I was working in community mental health work, there was this notion of like, if you're providing interventions, that requires two or three rooms, and they actually only have one, you know, like set up a homework station or whatever. Like, there's a lot that you don't know, especially if your clients aren't telling you when they come into your office, or even they don't show you on your on your screen, right. They're just in this little curated space, maybe with a a filter in the back. And so I think oftentimes it can be a client choice because of what the other options are, as well as a clinician choice. It also shakes things up. And so it can, it can decrease the stuckness that you're feeling or they're feeling in their treatment. There's a hesitance, and we'll go into hesitations a little bit more, but there's a hesitance to break out of kind of that expert cocoon, but it can decrease formality and distance and it can make things less curated and professional. So it it shifts the relationship and then for a lot of folks that can be very positive, and it may be more aligned with a theoretical orientation.

 

Curt Widhalm  13:04

I'm also imagining some of the client considerations that might come up, might end up being a more effective way of bringing some interventions to life and thinking of things like exposure and response prevention, OCD, or even potentially working with clients with eating disorders, who might need more clinical support in environments where it's either making food or generalizing some of the food related issues into eating out and other examples like that.

 

Katie Vernoy  13:38

Absolutely, I think it's something where there are different benefits, obviously, to the different math methods. But sometimes it is an obvious clinical choice, if you open up your mind to I could be with my client in another space, I can be with them at their home, I can be with them in a public space. I mean, like talk about specific phobias of bugs, I mean, like, you can actually be with them in these spaces, you know, there were clients with social phobia, that you go to the home and you slowly move them back to the office or slowly get them to the office and and help them with those things. So I think it's really something where being very, very, very thoughtful can be helpful. But I did do a little bit of research, and I'll share some of that with you for the two specific environments that we're talking about. Because I think it's helpful to recognize some, some efficacy that goes beyond like, oh, well, we could do ERP together in the right setting. Right? So with the home environment, like I said, you can do a better assessment of them in their environment, but you can also recruit community members to support the client and treatment if it's appropriate. So you can have family, you can have the school or a treatment team, you can you can pull folks in who are more likely to attend in that space than making the trek to your office, because they might just be there. Or it might be more of a comfortable setting. It increases access and attendance. It also can decrease attrition. So there were there were a study done with children and and vets where the efficacy of telehealth and in home in person were pretty similar. But people who had in home therapy were more likely to complete the treatment they were they stayed in it longer. And so there was a higher level of efficacy there. For homebound clients that are homebound for medical reasons, you can actually get treatment to them. And then you can also when you use this for crisis management, and you're coming to someone's home, you can do I think, obviously, better safety planning, and all of those things, but it actually decreased hospitalizations. On the walk and talk side that was really interesting. There, I was looking at a lot of different articles. And one of my favorite articles was Coaching Whilst Walking In Nature or something. And there was a lot of these use of the word 'whilst' which really made me very excited.

 

Curt Widhalm  16:07

Very British. Oh, yeah.

 

Katie Vernoy  16:08

Very British. So when you walk and talk, whilst outdoors, the setting itself was seen to be very, very beneficial. Just being outdoors being in nature. And some studies showed this as the most beneficial element that people identified was just being outside, kind of being in nature. And so that, in and of itself has a clinical benefit, just going outside doing nothing else just going outside. And some people actually would like, walk out of their office and just sit outside like, that was their outdoor therapy. And that showed benefit. If you also do kind of the physical activity, there's going to be more blood to the brain, there's better processing, and even though walking side by side, I'm sure as an EMDR person, you understand the bilateral movement here? But they were saying that experiential processing is also enhanced while doing that activity: increased creativity, learning and memory, I mean, all these things are amazing, right? You might have new insights, or even like the physical release and being more embodied, because you're actually moving while you're talking and doing those things. I think the other thing is, I don't walk the whole time. But during the time that you're walking, you don't have eye contact, you're still connected. And there's there's some downsides to that. But there's also this, it's less intense. And there's a different energy in that, that I think some clients find more beneficial. I think that the the biggest piece that is really for both of these, but especially in walk and talk is that you... you're really... there's a different way you're relating to each other. When we're sitting together and either we see on the screen just a little bit of space, or we just kind of walk into a room and sit down. There's there's information we don't get. And so when you walk together, there's just a whole different level of relational embodiment, that happens in the relationship. And I think for some clients, the the lack of formality, especially in the outdoor setting can be very helpful. So those are the reasons why to do it. But there are some hesitations. But I'm curious, before I jump into my list, what hesitations do you have, in thinking about doing these types of therapies, or these types of settings.

 

Curt Widhalm  18:26

I can come up with a number of them, but I know that we're going to address a lot of them in the law and ethics part two part of this conversation. But some of the concerns that are going to come up is just like, how do you manage, like getting all of this stuff set up? That whether it's client or therapist familiarity to just kind of the way things always have been. But clinically, I'm also having some concerns of like, if it just ends up becoming being in an environment that's too distracting, and clients don't end up retaining the information that actually gets talked about because they're more focused on walking.

 

Katie Vernoy  19:11

And that's fair. And I think that's part of the assessment. I think, the the logistical pieces, we'll talk about that next time. But I think there are a lot of logistics that may seem daunting, that actually aren't that daunting, especially if you've got good systems to start out with. But a lot of folks are really hesitant because it's not aligned with the medical model. And so this really pulls away from that, you know? If I'm telling the psychiatrist or medical doctor, "Yeah, I'm meeting my client in the park," depending on their perspective, they may lose respect for me and the work that I'm doing, right? There's not a lot of research, I think that's changing but the lack of training and guidance can be pretty daunting for folks because it's like, well, how do I get myself to a place that I'm doing this right? And of course, you know, confidentiality, dual relationships, informed consent... to be continued in the next episode. But I think that there's a lot of hesitations around it. But I think if you address them clinically, you know, some of the stuff you're talking about, I think it can be pretty effective. It's not effective for everyone. And I think there's different settings that are better for different folks. But I think that's the reason to make sure that you truly understand what you're doing so that you can get a handle on that.

 

Curt Widhalm  20:28

And, you know, if we can segue here for a quick moment is that, well, a lot of what we get taught ends up being in that traditional therapeutic talk space. I don't think any of us are actually inventing, doing walk and talk therapy, this has been around in some environment or another that while it might not be the most, you know, clinical trials, you know, replicated sort of things, there's plenty of qualitative studies that indicate what makes these things successful.

 

Katie Vernoy  21:00

Yeah, and I'll put links to some of the stuff that I found in the show notes. I think there's more and more lately, especially with the pandemic, especially for walk and talk because of people transitioning outdoors, and there's all kinds of positive kind of tales of how effective this is. And yet, I think that there are some clinical and cultural considerations to keep in mind, because I think as I was reading, I was getting super excited, I'm like, "Okay, I'm gonna do more of this, this is gonna be amazing!" And then I, you know, then you calm down and think about, you know, but it's not really right for every client. And there are things to think about.

 

Curt Widhalm  21:40

So what might be some of those considerations of who would be a good candidate for it? Or who might not be a good candidate for it?

 

Katie Vernoy  21:51

Well, there's, there's a few different times I'll address that because I think that's a really good question. I think the first one is, you want to make sure you have a client that can navigate the shift in the relationship, I think there are clients who may become, I don't know if confused is the right word, but they might, they might have a challenge in really being able to navigate the shift to a more informal relationship. There's a lot of boundaries that could be crossed. I think about when you're outside, for example, like you're going to be wearing different clothes, most likely, so that are appropriate to get dirty in or appropriate to sweat in or walk, like wearing tennis shoes. So even in kind of how you're showing up, that would be very interesting. I mean, there's, there's the whole hospitality, if you're going to a client's home, and they become the host to you, or their parents do, or, or they don't, and you're kind of stuck trying to navigate a home environment that isn't yours. And so with those, all of those boundaries, I think the client has to be able to hang with that. And the clinician does, too. I think I was reading somewhere that clinicians or a clinician, it was one of those qualitative studies was talking about how they felt this impulse to become a friend of the person they were hanging out with. And so it's something where as a clinician, and we'll definitely go into this in the law and ethics portion of this, but those strong boundaries, and that professional persona that can kind of be in every setting. And I think that's the thing that maybe this is important, too, for a little bit of a side note.. But what I learned a lot of in my community mental health was really strong professional boundaries and professional presence in every setting, while still being personal, still showing up as myself, you know, whether I was camping, or whether I was walking with someone or playing basketball out on the court outside and at their school, like, I would show up as a professional while still being me and personal. And I think there may be another podcast episode on just how to do that. I think we actually did talk about some of that at some point. So I'll look through and we can put some of those other episodes in the show notes. But the boundaries are so dynamic and fluid, that it becomes very different to manage than just coming into your office and sitting down or popping onto a screen. I think another thing that it was very stark for me in public mental health, but maybe stark for others in different settings, is that there's there's potentially very strong cultural differences between you and the person that you're showing up at their house or you're walking in public. And so I think being able to navigate what is it going to look like if the two of us are walking around outside? Or what is it going to look like if I show up to your house every week? Like what are what are the assumptions going to be made? What impact is that going to have on you? And we'll talk about the confidentiality elements of that on the next episode, but the clinical and interpersonal or kind of therapeutic relationship elements of that, it becomes more obvious the cultural differences, potentially even socio economic differences that show up when you're experiencing things together.

 

Curt Widhalm  25:22

Tell me more about that because I didn't work in community mental health and B: when I was doing this kind of work, it was more local to neighborhoods that I was already in. So maybe some of those cultural differences weren't quite as apparent in the way that this showed up.

 

Katie Vernoy  25:40

Well, I think about clients who are racially or ethnically different from me, or very different ages, so if I have an older person walking with me, who is ethnically different from me, are there assumptions that are being made? If I'm a, you know, a white person in formal attire, in a nice car coming into a neighborhood that typically is, you know, below the poverty line? And there's a lot going on, am I... do they assume that I'm a social worker, or caseworker of some sort? You know, more like, are they getting in trouble? You know, I think there's can be assumptions made and and I've even thought about with certain clients, like, I hope that there is an acceptance and an inclusion and everybody can be seen together and all those things, but people are more and less likely to be seen together. And there was a situation where a client of mine, a black woman, and I were walking, and someone came up to us and talked about how beautiful it was that the two people together, friends, you know, and the assumption, I'm glad the assumption was not that I was her social worker or her therapist. But it was interesting, because it certainly brought the conversation of race into that session, as we moved along, away from that person to talk about, like, what does it mean that there are the two of us here? And how do we feel about what he said, and, and so it definitely is something where any differences really show up. And it becomes, unless you try to avoid it, it becomes clinical fodder, which I think can be very helpful.

 

Curt Widhalm  27:25

I guess that's something that I didn't really experience in my work, because for a lot of the community outings that I was doing, it didn't seem like it was necessarily a therapist, it was maybe more observable as being a, I don't know, a babysitter or something like that, because of working with kids, or, you know, just being somebody who's out, you know, on a basketball court or a playground with somebody. Yeah, I'm sure that these days, if I was to do the same thing, it might look more like a dad or... But what I am hearing from you is lead some of the conversation or at least open that up to make it clinically relevant to help deepen what the therapeutic goals might be.

 

Katie Vernoy  28:14

Well, I think, sure, deepen the therapeutic goals, but I think it truly is, is really address the relationship. Because to me, if you don't, a client may feel uncomfortable saying, like, I don't want to be seen in public with you, or I don't want you coming to my house. And so I think having that, that openness and directness, and this is what like, this is what it'll look like and this is how our relationship may change. The client can opt into that. I know, there's other things besides the relationship, but let me see if there's any other points that I want to make on that. I think the other clinical consideration around the relationship, I think, is truly how you navigate. I mean, maybe it's the hospitality. But it's, but it's, it's whether it's hospitality, and like they want to offer you food and drink or, you know, they want to, to invite someone else and introduce you to someone or those kinds of things, or if there's a potential for kind of an advocacy and a dual role, where you're all of a sudden, you know, kind of standing up for them...in a situation, I guess, this goes into more like family therapy, but like with a with a family member that pops in or whatever or or how you navigate if someone comes up. So I mean, I think there's the relationship becomes more fluid and you're more experiencing things together on an even level. And you have to make sure that your client can roll with that. Because if they can't, if they're a little bit more rigid, or if they'll be confused by where the boundaries actually lie, it could be something that you have to kind of manage clinically ahead of time before you even consider these types of settings.

 

Curt Widhalm  29:57

This also seems to be another place where some of those cultural differences would come in, because, you know, in many cultures, just kind of that host role is going to end up really being something that, well, we might have kind of our traditional therapists kind of, you know, needing to evaluate every little thing. That might mean that we need to be more accepting or need to be more open to some of the different things that are unexpected. It's like being able to kind of roll with the punches here a little bit.

 

Katie Vernoy  30:35

Oh, absolutely. I mean, I think if therapists can't roll with the punches, they probably shouldn't consider these types of therapies. Because if you're in someone's home, unless it's a gigantic home with a specific space dedicated for your therapy treatment, you know, people might barge in, there might be phones ringing, there might be pets, I mean, there's, there's a lot of stuff that could be happening. But in an outdoor space, unless it's a private space that only you own, you're gonna be interacting with other folks. And there's, there's a lot of things that can come up. I mean, that segues nicely into the next kind of consideration that I put down here, which was kind of the unusual space. I mean, to me, this is a big one, you know, I think navigating the relationship, I think you and I both are fairly informal, I think a lot of our 'modern therapists' are more authentic with their clients. So this is not, that's not a big stretch. But navigating this space. My goodness. That is a tough one, I think, sure, there's confidentiality issues. And we'll talk about those in depth as far as how you cover the base there. But the depth of conversation is actually a consideration. If it's a very private outdoor space, maybe someone can really kind of maneuver into deeper conversations. But in some ways, it may be more of a practical conversation, it may be more of a coping skills conversation, at times, it could be a little bit more cerebral, and, and my style is a bit more cerebral, so it works for me. But in an article I was reading, and it was a case study, it was talking about how when he moved his client into an outdoor space, she was actually more emotionally contained and able to engage with a treatment more versus kind of this uncontained emotion of either being in his office or being on the phone in her own home. And so the, the moderating effect of the environment is one that is really important to consider, because, especially if you're going to use more than one environment, because you can have a more contained conversation out in public, you might have someone completely boundaryless in their own home, because it's my own home, and they're laying around and doing what they do normally in their own home. And then in your office, it's your setting. And so they may show up and be like you said, a little bit more compliant, a little more bought in. And so to me being able to figure out how is this client going to respond to this setting. And that may be something you don't know until you actually go there. And then how it's going to impact the types of conversation, the types of emotional reactions, regulation, you know, all of those different things like the level of emotional containment, I think, is really important to consider.

 

Curt Widhalm  33:32

And I think once again, you're gonna see where diagnostics probably are a consideration as far as the kinds of material that you end up talking about out there. That, you know, well, being more contained with something like anxiety and being able to operate out in the environment in a way that's, you know, self edited in case somebody sees what's happening. That's quite a bit different than working on deep childhood trauma.

 

Katie Vernoy  34:03

Of course. And I think it's something where, as part of the treatment planning, for some of my clients, I've talked about going back and forth to the office or telehealth based on what we're working on. And I think that there are also some folks who are actually more likely to dig deeper outside, because we're walking and it's just two people walking, you know, we're keep moving, and they're more comfortable, and there's more of a free flow. And so it can almost even be client by client, sometimes. The most important thing about being outside or being in another space that's not your own clinical curated space, is that you have to be able to hold the clinical space while facing the uncertainty of the experience. Like that is your job.

 

Curt Widhalm  34:54

Tell me more about what kind of risks that that brings up?

 

Katie Vernoy  34:59

Well, it is something where it's kind of like you becoming your own transitional object. And I just made that up. So, so bear with me if it sounds ridiculous, but when your client is with you and you're outdoors, the space that you're holding is really more emotional, because you're walking. So it's, it could be the distance that you're apart from each other, it could be, I actually walked slower with some clients, so that they don't speed through and are out of breath and distracted by the walking. And so I moderate the pace a little bit. In a home setting, it could be identifying with the client, how you're going to hold that space together. But you have to remain present, while walking, while interacting with pets if they're not locked up, while paying attention to birds flying by or planes flying by. But like you have to stay present and keep the setting in place. Because if you're distracted, or you're too worried about walking, or whatever, you're not holding the clinical space.

 

Curt Widhalm  36:06

How could you see someone not doing this well, like and what the potential impacts that that might have on therapy going forward?

 

Katie Vernoy  36:16

I think if people are really distracted, and in truth, when I first started walk and talk therapy, we were wearing masks and walking. And so it can be hard to hear. Being in a home and being in a setting where there's constantly noise or someone coming in and there's constant distractions, it's equivalent to having therapy on Zoom, with a really bad internet connection... I know a lot of people can can relate to that. But it's this thing where you have to keep coming back and keep coming back. Which is weird, because when you're in a space together, there's more verbal fluency, you're not waiting for the connection to pick up. And there's also a lot of physical interaction that you're having, as far as you can see their nonverbals. And so if you're really really distracted and worried about how you're stepping or those kinds of things, the the ability to miss the really important things is very high. Or to be too impacted by the environment. So you know, there's some loud noise that happens, you both interact with it. And if it's not, like, hey, they were their anxiety shot up, and blah, blah, and it's clinical, but like being completely distracted, kids are playing at the park, it triggers them, and you keep watching the kids and you're not really actually processing what the trigger is, you're just enjoying the kids, you know, playing. You know, I think it's something that could be harmful if you're not paying attention to what's actually in the environment, how we're interacting with it. And what I need to bring up.

 

Curt Widhalm  37:53

In doing this, it's having a plan, it's kind of being able to plan ahead, it's not just kind of assuming that what's happening in the office is going to magically happen, just while you're in motion out in the neighborhood. It's probably for the therapist having you know, an experience, you know, of what your walking path might be, and knowing kind of where, okay, this is the hot spot where all of the walking moms in the neighborhood get together and chit chat. And that might be a time where we kind of need to veer away for a little bit or, you know, this is where, you know, anything else happens along the way, the one really obnoxious, barking dog,you know.

 

Katie Vernoy  38:38

And I think the point that you just made is a really important one. If you are the person that are setting the environment, so like I picked a park by my office, you want to walk the route, you want to make sure you're aware of the things and it could be different at different times. And sometimes you can't predict all the variables you can't do... you can't account for everything that's going to happen. You know, sometimes there's going to be a baseball game in the middle of the day, and you had no idea. And so you're there's a lot more people than normal. But, but in environments that you don't know, like a client's home, when you go the first time, the client is really setting the pace, you know, and that's part of informed consent that we can talk about, but like, what is it going to look like? Do we have a space? Am I going to get to your home and we're going to take off and go somewhere else? You know, like what does it look like? But if you can do whatever you can to create a sense of predictability, and that's one of the steps we'll talk about later, I think the more you know about the environment, the more you know about the potential risks and uncertainties, the better you're going to be able to navigate and hold that space for the client.

 

Curt Widhalm  39:46

Is there cultural considerations to consider out in what we're calling the unusual space here?

 

Katie Vernoy  39:53

The first thing is identifying the cultural norms within a client's home for example, or how they interact in public. I think there's having those conversations around how you want to show up, and it could be even, and without requiring too much education from the client, but requiring it, you know, asking, is there anything I need to be aware of in coming to your home? You know, are there safety concerns? That's, you know, that's a separate topic. But are there other things that would be helpful for you and your family if I either did or didn't do. One of the articles I read talked about taking off your shoes in a Japanese home or, or other types of things that you may want to consider, even attire, what is going to be appropriate for the activity, but what's also going to be respectful to the family? Like if you show up in, like, a full sweat suit, is that going to be seen as appropriate to the family? Because they know you're going to go out in the backyard and play basketball with the client, or is it going to be seen as disrespectful and unprofessional? And so I think there's looking at how you navigate the relationship with the client, as well as any cultural factors specific to the family or the client, it really comes down to conversation. But I think it's also just finding your own way of showing up that feels like it can kind of go across those things. You know, I think always entering with curiosity and humility, I think can always be very helpful, asking for clarification, if needed. But I think, as I mentioned before, I think within the relationship or even within the space, you want to make sure that you're really paying attention to how you show up, and how you show up in relationship with the client.

 

Curt Widhalm  41:37

So I'm imagining that for these kinds of considerations, if you're seeing multiple clients in a row, and do you just like bring costume changes for in between sessions?

 

Katie Vernoy  41:50

Hopefully not, hopefully not. I know that, that people who do a lot of these things back to back, find their professional attire, that they appreciate whether it's, you know, a really nice comfy pair of jeans, and good looking tennis shoes or whatever. But I think it's something where it may be appropriate to to have some changes of attire. But I think that also lends to, you know, making sure that you are not forgetting, scheduling and all those other things. So I guess we're gonna talk about that in the next episode, but...but I think being able to show up on time, you know, with traffic or showing up, not out of breath, because you ran from the last walk and talk session, like I think all of those things, you know, there's a lot to consider.

 

Curt Widhalm  42:39

So, being appropriate to each of the particular clients and cultural considerations as you're going there. Let's dive into the clinical work now. Like, how are we doing this? You know, it's not just like, Alright, here's the CBT workbook out in watching the band, or it's not finger waving, like EMDR, while we, you know, walking backwards, like a college tour guides, like, what are some of the considerations that we're gonna do here?

 

Katie Vernoy  43:12

Okay, so some of this is kind of the clinical how to, I got a great starting point from Cooley et al, 2020, 'Into the Wild': A meta-synthesis of talking therapy in natural outdoor spaces. I think it provides good information on the uncertainties of the settings. And I think it really a lot of it applies to home settings as well, obviously, some of this is, you know, I've got other stuff from other articles and from my own experience, but that's really the the foundational article that kind of gave me the best practices as they were. So you want to start with the assessment and formulation. We've talked about this a little bit. But I think truly, and Curt and I are talking about putting together a full assessment kind of considerations worksheet for you, so we'll have that with the course, when we put this out there. But I think that the first thing that you really want to look at is, is the client suitable. And so we talked about some of the flexibility and the ability to manage the relationship, but more specifically, are they physically suitable for it? Which we'll talk about accessibility issues in our next episode. Are they clinically suitable, and are there potential benefits for you to actually do this treatment with them? And so really kind of everything we talked about, that is what you want. That's the first kind of point of the assessment. You also want to make sure it aligns with treatment goals. And obviously, there's a very broad array of treatment goals that could be helped or hindered by a non traditional therapy treatment, but like, specifically, if we're looking at a client who has a lot of conflict with family, doing family therapy at the home, getting as many family members as possible could be very aligned with treatment goals. Whereas a client that's wanting to learn individuation, going and meeting them in their home, you might be swimming upstream if the family is very kind of everybody's present, and you're trying to do some of that work. You also want to make sure you want to do a self assessment about your own characteristics. If you're going to be outside, you want to have an affinity for nature, if you're freaking out, every time you see a bog, that's not a good match for you. You want to make sure that you have the flexibility to be able to navigate the different environments and you have to have some confidence about it. If you're really uncertain, either going into a client's home or going outdoors, you're gonna have a hard go of it. Client characteristics for outdoor therapy, you definitely want to have them to have an attraction to natural spaces, unless you're working on some sort of a specific phobia. You don't want them freaked out in the environment. And even then, you don't want them freaked out. Like it could be just like a kind of a ladder there.

 

Curt Widhalm  45:59

Sure. I think this might be an important thing. Let's dive into what is the alignment with treatment goals? What do you mean by that?

 

Katie Vernoy  46:08

We'll talk about kind of the client characteristics that might make this a better setting. And if it's just client characteristics, it would not be necessarily most important to align it with treatment goals. But if it does align with treatment goals, it can be really, really rich and positive. And so when we look at aligning whatever the mechanism is, with treatment goals, I think it needs to be a match and needs to be a clinical match. And there has to be a rationale. Like if you're just going outside, because it sounds like fun and the client doesn't really care one way or the other and it then it negatively impacts the the treatment. Obviously bad. But if you've got a client who is trying to feel more embodied, they're just ahead walking around, then they're just all thoughts, no anything else, I think being able to be more physically active during a session and allow some more of that embodiment would be aligned with the goals, for example. I think for the home setting, you know, some of the alignment could be around helping them set up their own systems, and whether it's managing executive functioning skills, or whether it's interacting with the people around them, or whatever it is, I mean, certainly you've talked about, like ERP and eating disorders, you know, kind of the big ones that make the most sense. But even making sure that what we're doing is in support of the goals and is not going to hinder the goals. Sometimes if that's the only place you can meet like, it's only home visits, there's nothing you can do, and I think a lot of mental health, that's kind of what it is.

 

Curt Widhalm  47:48

Sure, sure.

 

Katie Vernoy  47:49

You may be you may be swimming upstream, like I said earlier, but I think it's, it's something where if you can use the environment, as part of a, you know, and where you're meeting and how you're meeting in support, in direct support of the treatment goals, I think it can be very, very helpful.

 

Curt Widhalm  48:06

Okay, then, are there some clients characteristics that also are part of this conversation that may impact how well they're going to respond in a non traditional environment?

 

Katie Vernoy  48:20

Yes, I think the clients who showed the biggest affinity for outdoor therapy already had an attraction in their natural spaces, or felt a healing, previous healing experience outside, or those types of things, you want to make sure that you're assessing if they've had a trauma outside, or there might be triggers out there. I mean, that doesn't necessarily preclude using an outdoor space, but you want to make sure that you're thoughtful about it. If you have a client who is comfortable with having you into their home, and comfortable being at home, that helps to a certain extent, obviously, the reverse could be clinical fodder, and, and part of a treatment plan. And I think the other thing that I really found with my own clients is if there's a discomfort with conventional therapy, they're very excited about these other options. Because 'I don't want to sit still, for an hour, looking you in the eyes, like that sounds like torture, I'm never going to do that.' And so for me, some of the clients just it was like, they become the big team themselves in doing that. And that was really exciting to see. Similarly, I think as clinicians, we need to if we're going to be outside, we should have an affinity for nature and not be freaked out by every bug that comes by or be very flexible in how we interact with nature. And so we need to know that about ourselves. And so that assessment, I guess, is not one that's necessarily in each individual assessment, but one that we want to make sure that we're confident professionally that we can, can enter the space.

 

Curt Widhalm  49:54

Well, okay, so now you're talking about the client and the clinician, go into one of my favorites things... There's also the relationship here. There's always spaces for shifts in relationships, if it's adding or subtracting somebody from the therapy room, if it's something where being in a different space, you know, a lot of us went through this in the pandemic of 'saw people in person now we're seeing you online,' some people made that shift to doing walking talk at the time. What kinds of things have you seen or come across that talks about how that might shift that therapeutic alliance?

 

Katie Vernoy  50:33

Well, we talked about this a bit before, but I think in the assessment, you're going to want to make sure that the client can navigate into a less formal relationship. And knowing more about you, I mean, I wear a hat, I wear a baseball cap outside, I certainly would not do that on the screen. And I'm not going to do that in my office. And so the lack of formality, the humaneness that you're bringing as a clinician, and just navigating on the boundaries, I think I can't emphasize enough how much that is important for you to assess for, can the client do this? One of the interesting things that happened is one of the clients that I, actually more than one of the clients, that I met outside, I had never met in person before. And so I found myself telling them like I'm tall. You know, this is, you know, it's hard to tell when you're when you're online, I'm tall, you know, here's my phone number in case you can't figure out which one's me, you know. So I think that there's also that kind of, you know, kind of being together physically, that does shift that dynamic. You know, how I walk, I am a tall person, I have a long stride. So I try to mirror that and mirror the pace of my client. And like I said earlier, sometimes I try to slow them down, because they're like going for a speed walk. And it's like, no, no, no, especially when we were wearing masks like No, no slow down, you need to be able to speak. It's something where the relationship can, I think really be very positively impacted. But it just has to be very conscious. I know, I've said that a number of times, but I think it just needs to be really conscious. So finishing the assessment, I'll just kind of run through this really quickly, I think you want to, to kind of consider the presenting issues, I don't know that there's any particular that are contra indicated, I think that's a case by case basis because the environments are so different. You might go to a home and end up being outside, you might be outside and then end up having to like shelter under a thing because of the rain like so like anxiety, folks that need ERP, depression, social phobia, isolation, a crisis, you know, I think a lot of those things, there's not I'm gonna say rule of thumb, I think there's going to be definitely some some need to to really assess your clients specifically, and how they're going to do in this setting and whether or not it might stir up or exacerbate any of the presenting issues that they bring.

 

Curt Widhalm  53:10

Is that something that you would recommend a more evaluative process for a new client before doing this? And I think some of us who've worked with clients for a while we can kind of just look at somebody with one eye and be like, Yeah, you're okay for walking talk therapy. But for somebody that you haven't met before? Is there more of an evaluative process that you might go through during an initial intake phone call?

 

Katie Vernoy  53:38

With some of the new clients that I've brought it up with, I like to do the first session in person seated. And for me, I still have my office. So that's where I choose to do that first session. And at this time, I'm still doing masks inside my office. So it's a formal process. It may also be I would do it telehealth first, to have a conversation. Because I'm taking more notes, I'm doing more assessment, there's just a lot of information for me in the way that I do my initial assessment that I have to get through in order to really do that. So during the phone call, as well as that assessment appointment, I would really talk about what it looks like, pros and cons. What do they think about it? If I felt like it was aligned at all with them. Some clients want to do it because it's like, 'Hey, I am sedentary all day, I would love to have an excuse to walk for an hour, while also taking care of this other need.' It's like multitasking. But some clients are like, 'Oh, I would not want to be in public. There's too much going on.' And I've had clients that even we're doing walk and talk and they're like, 'Yeah, I can't cry in public,' or you know, there's something too deep to talk about. And so in the beginning of treatment, I think you're going to want to assess what are they bringing in and if they're at a high level of crisis, I think outdoor therapy or walk and talk may not be indicated because there's so many other things that you have to control, and unless they are completely soothed by nature, and you know that they're going to be okay, in the setting, there's just too many variables. Crisis may be okay in their home environment, and it may feel less overwhelming for them for you to come to their home, less anxiety about going to treatment, because basically, they have to open the door, which could be stressful, I'm not, I don't want to discount that. But it's less potentially less stressful of getting out of your getting dressed, getting out of your home, going to an office, you know, what, braving traffic, all of that stuff. And so I think with those types of situations, you're gonna want to be very cautious. But what I found with clients that I see mostly I see executives and, you know, leaders and helping professionals and stuff like that most of them, the level of crisis is fairly low. And so when we get through the thing, it's basically talking about here, the different options, that I have that part of my informed consent, I see people on video, I have a walk and talk availability in the park nearby or in my office, and this is what it looks like. And I've got kind of the COVID requirements and all that stuff in that. And so if somebody shows interest in walking outside, I then dig deeper, but a lot of people just don't know what it is, and aren't that interested in it. And then you just don't worry about it.

 

Curt Widhalm  56:14

So when we were talking about, you know, kind of having some plans of being out in the environments, like what are some of the considerations that you might want to look at? We talked a little bit about what's out in the neighborhood, but I'm sure that that's not everything that we need to think about?

 

Katie Vernoy  56:29

No, of course not. So once you've made the assessment, and you have a clear sense of kind of, if this is right for the client, then you then you want to formulate how you're going to use the environment. Because it can be kind of this passive, we're just walking, we're not interacting with nature. And and if that's the formulation, that's a formulation, right? Like you, it's just, hey, we're outside, maybe use it for stabilization, maybe there's metaphor that pops into your head, but it really is just kind of passively there, you're building the relationship and something may come up, but you're not actively using the environment.

 

Curt Widhalm  57:14

Okay.

 

Katie Vernoy  57:16

Now, alternatively, you can use the environment kind of as a third person in treatment and in nature that could be interacting with whatever it is, and so deeply interacting with it, it could be rituals, or different things that happen outside, that's probably on the scope of this conversation, especially because we're running low on time. But I think some folks actually have activities that they do with nature outside in nature that have their more creative activities, and you're actually engaging with the environment. At home, that can look like, you know, setting up a homework station, it can look like having a family meeting at their kitchen table. You know, like there's a lot of things that can happen where you're actively engaging with the environment, versus using it as a place to meet. Does that distinction make sense?

 

Curt Widhalm  58:05

Yeah.

 

Katie Vernoy  58:07

When you're out and about or are not tied to the two chairs in your office, I think that you can do roleplay in a different way, you can do some modeling within those things, whether it's how you walk, how you do the different things. Like there's there's a lot of things that can happen, that with the physical mobility that happens with you entering their space, or them walking with you outdoors, that it just allows for more physical freedom to do a lot of different things,

 

Curt Widhalm  58:36

Getting to maybe some of the last pieces of structure here for clients. We have our normal informed consents. You and I have both worked on our own informed consents. We're crafting some for maybe sharing with our audience here that takes the hits of both of ours, but what kinds of things do you consider adding into an informed consent here? We're gonna get more in detail on this in part two of this episode as well.

 

Katie Vernoy  59:05

I think broadly, I think people need to know what they're signing up for, that it's voluntary. They can stop at any time. I think, you know, we're going to have probably minutes and minutes of conversation on informed consent. But I think it's something where, needless to say you need to have an informed consent specific or a portion of your informed consent specific to these types of settings, where you talk about risks, you talk about confidentiality, you talk about how voluntary it is, and then also potentially around the elements of them kind of being in charge of their own health and physical liability. But I think the big difference that I want to identify here is that once you've got the informed consent initially, it is more of a dynamic setup because of how uncertain the environment is. And so in this article it talked about process contracting, which is basically checking in, referring back and making sure that you're continuing to assess the informed consent and shifting it if needed. And I've mentioned this before, I'll mention it now, because I think this is really important, best practice is where you can introduce predictability. And so you've assessed, you've kind of formulated how you're going to use it, you've created an informed consent, you do the process contracting to continue to assess and keep the informed consent valid. And then introducing predictability is really about where you can make things the same. And so I meet my clients at the same place. And we'll talk about logistics of if you have back to back sessions, I have two different places that I meet my clients for walk and talk, for example. But you know, you try to make it so that there is some level of predictability. So you're not constantly in the state of reacting to the uncertain environment, so that you can get a little bit more of that treatment space. And as in every space risk assessment is very important. It could be dynamic in a home, it could be looking at the relationship, and certainly if you are going to a home that has any kind of violence in it, or, or any kind of conflict, that's part of the risk assessment. When you're outdoors, it could be about like, is this path safe to walk on? It could also be about is this client up for walking today? Or do we need to, to kind of shift gears and do something different? I'll say it again, you know, people can recognize that maybe there's a question on this in the continuing education course... but you start with a strong assessment and formulation, you create a really strong informed consent. And then follow that with process contracting to continue to assess and check back on the informed consent, you introduce predictability, you make sure you're doing appropriate risk assessment. And then the last point is know your scope of practice. And we will talk about this in the next episode. But just because you're an experienced clinician does not mean that this is within your scope. And then also, think about consulting with experts. And this could be people in other fields like home health aides to make sure that if you're meeting with a homebound client, for example, that you understand what's happening with their physical health and how you can make sure that you're not doing anything that's going to be harmful to them. Occupational therapists, horticulturalists. If you're going to do like a strong activity, that you want to use plants, you want to make sure you're not using some sort of a poisonous plant where you both end up with like poison oak or something. But I think it even in how we take care of our own professional development and our scope of practice here really, potentially also requires some creativity.

 

Curt Widhalm  1:03:03

You can find out how to get continuing education for this episode, keep listening. We'll post our links and references in our show notes. You can find those over at mtsgpodcast.com. And join our Facebook community, The Modern Therapists Group and follow us on our social media to find out about everything that we're doing and places where you can share your ideas with us as well. And tune in for the next episode next week. Don't forget to subscribe, and until next time, I'm Curt Widhalm with Katie Vernoy.

 

Katie Vernoy  1:03:38

Just a quick reminder if you'd like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you've successfully completed the steps.

 

Curt Widhalm  1:03:53

Once again that's moderntherapistcommunity.com.

 

Katie Vernoy  1:03:57

Thanks again to our sponsor, Dr. Tequilla Hill.

 

Curt Widhalm  1:04:00

Therapist if you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequila Hill has created and curated a wellness guide specifically with deep compassion for the dynamic personhood of the psychotherapist. Subscribe to Dr. Hill's offerings at bit.ly/staywellguide and you can find many of the inspiring offerings from Dr. Hill 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

 

Katie Vernoy  1:04:38

Once again subscribe to Dr. Tequilla Hill's How to Stay Well While you Work! Therapist Wellness Guide at bit.ly/staywellguide

 

Curt Widhalm  1:04:48

Hey everyone, Curt and Katie here. If you love this longer form content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education, events and a whole lot more.

 

Katie Vernoy  1:05:13

If you don't think you can make a monthly contribution, no worries. We also have a buy me a coffee profile for one time donations. Support us at whatever level that you can today. It really helps us out. You can find us at patreon.com/MTSGpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

 

Announcer  1:05:34

Thank you for listening to The Modern Therapist's Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Mar 28, 2022
Now Modern Therapists Need to Document Every F*cking Thing in Our Progress Notes?!?
35:09

Now Modern Therapists Need to Document Every F*cking Thing in Our Progress Notes?!?

Curt and Katie discuss a recent citation from the California Board of Behavioral Sciences (BBS) to a therapist for cursing while in session. We explore: How do we document ruptures during the therapy session? Is the BBS over-reaching by controlling what therapists document? What are the best practices for note taking? All of this and more in the episode.

In this podcast episode we talk about appropriate documentation practices for modern therapists

As therapists it’s important that we take accurate notes. But what is important to include in the notes, and how much should we really be documenting?

Wait – Is it alright to use curse words in session?

  • Therapists should be first and foremost aware of the client and their potential reaction.
  • Note the therapeutic relationship with the client, their history, and how the client empowers themself when making language selections.
  • If considering using casual language, consider the client’s vernacular.
  • Follow the client’s lead when it comes to their language in session, including cursing.
  • The BBS has no specific statute related to cursing or swearing.

“If things aren’t written down, they did still happen – but now it’s open to interpretation.”
- Curt Widhalm

What should modern therapists document in clinical notes?

  • It is important to document any bold interventions or ruptures in the therapeutic relationship and repair attempts for ruptures.
  • In note taking, it is important to follow the clinical loop: assessment, diagnosis, treatment plan, intervention, use of intervention, and the client’s reaction and progress.
  • Your notes will be a balance of covering your liability and creating notes that help you remember the session.
  • Therapists should consider documenting the use of any language that could be deemed not clinically appropriate, even positive statements like “I’m proud of you,” or “Yes, my dear.”

“I think any rupture in the treatment relationship is worthy to document because it’s potentially clinically rich, but also a point of liability.” – Katie Vernoy

Does the California Board of Behavioral Sciences (BBS) outline what we should say in our notes?

  • In the 300-page PDF outlining the statutes for LPCCs, LMFTs, LCSWs, and Educational Psychologists, notes are only mentioned 10 times.
  • There is no mention in the statutes of what can be said and what can’t be said in notes.
  • Some agencies and institutions will stress writing very little to ensure protection from liability, but as this citation showcases, this might not be best practice.
  • The BBS wants to ensure the protection of clients and you might need to justify your words, just as you would justify the use of an intervention.
  • This is a reminder that the BBS can and do look at therapist’s notes.

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Dr. Tequilla Hill

The practice of psychotherapy is unique, creative, and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

If you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill a mindful entrepreneur, yoga, and somatic meditation teacher has curated How to Stay Well While You Work Therapist Wellness Guide to support providers that are struggling to manage your own self-care.  Subscribe to Dr. Hill’s Stay Well While You Work! Therapist Wellness Guide and you can find many of the inspiring offerings from Dr. Hill’s 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

Support The Modern Therapist’s Survival Guide on Patreon!

If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings, and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more. If you don't think you can make a monthly contribution – no worries – we also have a buy me a coffee profile for one-time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Statutes and Regulations Relating to the Practices of Professional Clinical Counseling, Marriage and Family Therapy, Educational Psychology, and Clinical Social Work
The Case for Cursing

Client’s Experiences and Perceptions of the Therapist’s use of Swear Words and the Resulting Impact on the Therapeutic Alliance in the Context of the Therapeutic Relationship by HollyAnne Giffin

Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel “Swear” Words by Richard Stephens and Olly Robertson

Relevant Episodes of MTSG Podcast:

Do Therapists Curse in Session?

Make Your Paperwork Meaningful: An Interview with Dr. Maelisa McCaffrey Hall of QA Prep

Noteworthy Documentation: An Interview with Dr. Ben Caldwell, PsyD, LMFT

CAMFT Ethics Code Updates

Bad Business Practices

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


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Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm  00:00

This episode of The Modern Therapist's Survival Guide is brought to you by Dr. Tequilla Hill.

 

Katie Vernoy  00:05

The practice of psychotherapy is unique, creative and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

 

Curt Widhalm  00:26

Dr. Tequilla Hill with mindful entrepreneur, yoga and somatic meditation teacher has curated how to stay well while you work therapist wellness guide to support providers that are struggling to manage your own self care. Stay tuned at the end of the episode to learn more.

 

Katie Vernoy  00:41

Hey everyone, before we get started with the episode Curt and I wanted to make sure you were aware that we have opportunities for you to support us for as little as $2 a month.

 

Curt Widhalm  00:50

Whether you want to make that monthly contribution at patreon.com/MTSGpodcast or a one time donation over at buymeacoffee.com/moderntherapist. Every donation helps us out and continues to help us bring great content to you. Listen at the end of the episode for more information.

 

Announcer  01:12

You're listening to The Modern Therapist's Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  01:30

Welcome back modern therapists. This is The Modern Therapist's Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all of the things that therapists should worry about. And this is part two of an episode that we started last week about a citation from the California Board of Behavioral Sciences to a therapist about using a curse word in session. And if you haven't listened to last week's episodes, we talked a little bit about, we talked a lot about using curse words and sessions. And today, we're gonna focus on a different part of the citation. In the citation, it talks about the therapist not documenting about their decision to use a curse word, how it fits within the treatment, what the client's response to it was, and this being a part of why the therapist was being investigated and wanting to do a dive into: what are we actually supposed to put in our notes? We've had a couple of episodes in the past. So one with Dr. Melissa Hall and one with Dr. Ben Caldwell about what you need to put in your notes. We'll link to those in our show notes over at MTSGpodcast.com. We're not talking about SOAP Notes or structure, that kind of stuff. Today we're talking about legitimately, what do you need to put in your notes? And what is this signal by the California BBS really mean for the rest of us here? So, Katie, what needs to go in our notes?

 

Katie Vernoy  03:11

Well, I think just for folks that want a quick primer, because I when they can go over to both of those episodes and get stuff I'll say something and kind of lead into the rest of this. The documentation for services should follow the clinical loop. Dr. Melissa McCaffrey Hall is someone who talked about it really well and meaningful documentation. But you start with an assessment that leads to a diagnosis that then has a treatment plan, that then on a weekly or a session by session basis, you talk about the interventions that you're putting forward to help the client to meet their treatment goals that's on the treatment plan. And that's a clinical loop, you know, diagnosis, treatment plan, session notes - comes back, and hopefully you're addressing the diagnosis. In this situation. Again, we talked about the cursing before, it seems like there is a discussion around were all of the interventions put into the note. And I don't know if we have to include all interventions. I think there's a lot of mirroring and reflection and active listening and all of those things. But I think potentially you can put some of those things in the notes, but I don't think every single micro intervention needs to go in notes. But I think big interventions probably do, especially ones that are truly impactful to our clients, as well as the responses to those interventions and an even like group notes or SOAP Notes or any of the notes. There is an idea, pretty established, that we must put down the interventions that we're using and the client response.

 

Curt Widhalm  04:55

So in the very nature of this you're bringing up intervention is there are planned interventions, and then there are also the ones that just kind of slip out. And I think it's important for us to read from this citation. So that way, our audience here has the same knowledge of what's going on here. So I'm going to quote, I'm going to quote from the citation. And once again, we're not releasing the name of the therapists themselves, due to respecting their privacy on this, but I think that this is a key indicator of looking at how our licensing boards are enforcing stuff Yeah, and, and potentially looking at their their overreach here. So jumping into the middle of this, we talked in last week's episode about the therapists use of a curse words towards a minor in session, and quoting from the citation, regarding the record keeping a portion of your notes which you had handwritten are illegible. Additionally, your notes failed to identify which minor you had confronted during the session. Furthermore, your notes do not document either your decision to use a curse word as part of your description of the minor clients behavior. What's your rationale was for doing so what the minor client's response was to your description of his behavior, or that you would apologized to the minor client regarding the wording you had to use to describe his behavior. End quote.

 

Katie Vernoy  06:25

I think that there are pieces of that that are fair. And I feel like there's still information that we don't know to identify at the word that you used as overreach. I think that the level of policing around our documentation seems surprising to me. But I don't know if I particularly disagree with any of their statements. It sounds like you do, though.

 

Curt Widhalm  06:49

My reaction on this is, if this is in fact used as an intervention within the the treatment session, which by all accounts seems to be what this therapist and the therapist attorney justified that no other ways of reaching this client really made any sort of emphasis. That doing something big and bold in session in order to try and get through a client does seem to be a maybe very on the spot decision as an intervention to kind of disrupt and shake things up a little bit. That maybe not planned as a intervention strategy. You know, I think last week, you and I both admitted that, yeah, we use curse words in sessions from time to time. I don't think that any of my treatment plans will ever include session seven, use curse word with this client to disrupt what is the therapy in order to help them gain a new perspective. But I think it is something where, with intentional interventions, and that that clinical feedback loops that you were talking about, yeah, we do need to include in our notes, intervention use client reaction. And I think that that's the language that the Board of Behavioral Sciences is using here, that is kind of a catch all for this. Where maybe there's a little bit more nuance in here is in some of the off the cuff interventions that we do, or things that are human relations, sort of impacts that we have on other people that we might not consider in the traditional sense of interventions that it gets into kind of a fuzzy space of are we leaning towards the the cya of covering our asses of needing to transcribe the entirety of our sessions just to prove what has happened? That's kind of where my initial reading of this is. Do we have to document everything that is said, and moving into even some of the direct quotations that we use in session with more frequency?

 

Katie Vernoy  09:06

That may be what the BBS is describing? I think, for me, I don't take that in in that way. I think in this situation, it is hard to know if this is something that is coming from a parent that is is upset at the therapist or the therapist decision making. I'm not sure if this is a truly harmful therapist who is saying really inappropriate things in session, or some other thing, right. Like I can't speak to this particular situation. And I certainly don't feel like we need to do transcription of our sessions and quotations of our own stuff. So that's, that's my caveat. If I was in a session, and I said something to a client, they said that hurt my feelings, and we talked about it and I apologized and there was a repair or there wasn't a repair, I would document that I think any rupture in the treatment relationship is worthy to document because it's potentially very clinically rich, but it also is a point of liability. And so to me, it feels like if I recognize that a client is upset by an intervention or specific words that I use, I would document that.

 

Curt Widhalm  10:24

And I think that this is the difficulty in looking at information like this because it gets much more complicated with the more people who are in the room. Having worked on legislative language before and worked on trying to define things before and creating language for statutes that is broad enough that it speaks to what we do in our profession. A lot of times, we just borrow language from where it's already written. And one of the things, especially for couples and family therapy is that there hasn't really been a good definition of how in statute, it looks different than working with individuals. You know, we have 100 plus years of psychologists language to, you know, work with individual people. But sure, the theories around marriage and family therapy, we can borrow some of the language that statutes should suggest that those go in there. But for really being conscious of the steps that we're making towards putting this information into our documentation. What I'm hearing you say is that if you're really calling out one member in this citation saying the same thing, if you're really holding one member accountable, you need to be specific to that up to an including emphatic language. Is that what you're saying here?

 

Katie Vernoy  12:01

Well, I think you're, we're talking and I feel like we're talking into different areas. I think, in this situation, we have someone who clearly was overwhelmed, or at least that's what we've assumed, has illegible notes, and there's not specifics in it. So to me, the flavor I'm getting is that if this person if this therapist would have put in their notes, something along the lines of confronted X member of the family or use disruption by confronting X member and had some bold language and discuss the use of that language, and provided a repair within the session, without saying, I cursed at this kid, the family got upset, and I whatever, but like actually using clinical language to describe what happened, the confrontation, the disruption within the family system, as well as repair and planning for the future. To me, I don't know that we would, that this would have been part of the citation. We're assuming because they said you did not you say you used a curse word and your rationale for using the curse word that we're like, oh, we have to transcribe. I don't know that. I don't know that. I agree with that. And I do share your concern that should this become statute? Yeah. I don't think we need to transcribe our sessions, or put forward really dramatic tales in our progress notes, so that we cover everything. But I think it's, it's a jump in this situation to say, Oh, well, they wanted this. It sounds like they were appalled at what they found. And they put language to how they put it forward. I honestly have no idea. And I don't fault this therapist at all. I can't make a judgment on that. But if we're looking at the notes were illegible and incomplete. Everything was missing. Right?

 

Curt Widhalm  13:55

Well, the eligibility, part of it, I think, is a curious piece. And I think you and I have both heard from clinicians. And I haven't heard this as much in the last 10 years. And yeah, I do want to give you credit for being the one who brings up this point, before we started recording today. So but you and I both heard for most of our careers, about therapists who've taken the approach of well, if it's illegible, then people have to ask me what was meant there. And that's another way of protecting me in my practice. And this is a very clear indication that that is not true.

 

Katie Vernoy  14:35

Not true at all. We need to type stuff into an electronic health record. That's pretty clear at this point.

 

Curt Widhalm  14:43

I think it's really important to be able to have clear notes, do them well. And I think getting into the nuance of just like how descriptive do we need to be in the response to that But I take your point, as far as you know, what may need to be, as far as you know, use this disruption. Is it, you know, needing to put in more and more exact quotes? Is it, you know, just in the more confrontive ones? Or is it also going to be in any sort of situation where a different perspective is going to need that nuance reflected in the notes as well?

 

Katie Vernoy  15:27

What do you mean by that?

 

Curt Widhalm  15:28

So, you know, there's the clients that therapists use curse words to disrupt them. Yeah. There's also the other end of the spectrum where therapists may use more affectionate language to help to emphasize a point to that maybe seen as a boundary crossing of, you know, expressing some affection in a way that has some context sway, you know, hey, I really care for you. And I really want to see you be successful in this, do we need to then document that same nuance in that direction?

 

Katie Vernoy  16:06

From the description that you're providing there, I think the answer is the therapist, it depends. To me, when I express something that I think that therapists typically don't, you know, I tell my clients, I'm proud of them, I tell them, I care that care about them, or I care about what's going on with them, or whatever it is, I do show genuine human connection. I think that with one client, it may be completely documenting it out, not necessarily for the cya purposes, but for reminding myself what I'm doing. And, and and having that as part of the clinical record, because I think it's important. For other clients, if I slip up and say, hey, yeah, you and me both buddy, or Yes, my dear, or have a wonderful weekend, my dear, or something where I slip into a phrase that I might use with friends versus with my clients. And it is a client who may have a response to that that would be not clinically appropriate, or their, their response is clinically appropriate, but it would not be conducive, and it would need to have a conversation about it. I may document, you know, used informal language of care, we'll address it the next session, you know, to close out the session, I will address that at the next session and talk about the conversation of like, Hey, I was pretty casual at the end, I feel connected to you. But I wanted to make sure that we talk about our relationship. Like I think if there's a clinical reason, that or a personality reason why the client may take in something in a way that it was not intended or feel that it may be harmful. Yeah, I'm gonna document what I said and how I addressed it. And so I think it's, it's something where, depending on your relationship with the client, that context and what context may be needed, should a complaint or a concern or a clinical conversation comes down the pipe, and you need to remember kind of what was going on there? I think, yeah, I would document that for myself.

 

Curt Widhalm  18:06

As many of our listeners know, I sit on the California Association of Marriage and Family Therapists ethics committee, and not speaking for them, but a discussion that has come up at one of our meetings with one of the staff attorneys who also is on the ethics committee, talking about the way that opposing counsels would approach therapists and depositions specifically around their notes. And hearing you say, you know, use informal language of affection. I'm thinking of the way that that could be interpreted by somebody who's looking at your notes, who's not involved, and the kinds of questions that would come up. But what do you mean, why, why didn't you write with that exact language is? That, you know, this could be anything. My client remembered this as being something completely different than what you're saying now, that may lends towards needing to go even a step further than what you're talking about here.

 

Katie Vernoy  19:10

Sure. And I think that's part of the 'it depends,' I think, if it's a client that potentially is going to have that as a complaint, yeah, I'd write the exact phrase.

 

Curt Widhalm  19:19

How do you make a decision that about which clients are likely to make complaints versus those that are not?

 

Katie Vernoy  19:25

I think that's a good point. I think there are times when it comes from past history of whether it's kind of being litigious or other things. I think, for me, it's more my feeling in the moment, you know, and so this is more intuitive or instinctive. Do I need to be more descriptive in my notes or not, is a client that I, I think, may want to see their notes may or may have other things that they're doing with these notes, or if they would be potentially more confrontational or litigious, but you're right, I don't I don't think that there's a great way to make that assessment and maybe the the informal words have affection is not a good phrase to use. To me, I think it's something where if there is a concern that comes up in session that you feel like you want to document, you have to decide do you document it with euphemisms, clinical language? Or do you quote yourself? I don't know. I think there's, there's arguments both ways.

 

Curt Widhalm  20:21

Yeah, as you're talking, I'm thinking about the number of times that we may start down a path with clients that clients just kind of give indication that it's not the appropriate way of of going. That, you know, we may bring up an idea of, let's say, for, I don't know, working with anxiety or something where, you know, you might ask a question of, like, you know, have you ever, you know, considered doing this and the clients like, No, I'm not going to do that. Do you document every single one of those like, rejections that clients do? And in your notes?

 

Katie Vernoy  20:59

The 'No, I'm not gonna do this.' I think that's different than I tried it. And I felt like it was harmful. I think that was a bad idea. Why did you tell me to do that? I mean, there's different flavors to it. I think if it's a conversation of like, okay, what kind of coping strategies are you going to use? Or what kind of interventions feel right to you? To me, that's, that can be a higher level documentation. But if somebody says, "Hey, I was thinking about this thing all week, I didn't do it, because I think it's wrong. And this is, this is the thing, the mismatch I'm feeling in this relationship right now." Yeah, I would document that.

 

Curt Widhalm  21:34

Because I think that there is a way that as you point out, my practice being more with kids, that there's probably a lot more casual ways of bringing things up with kids and relating them, there might be even with some of the adult clients that I work with, you're making me think within this conversation of kind of the being able to describe in documents, why I might do things differently from case to case where a lot of these statutes are written for kind of the here's the standard for everybody. Yeah, I think if statutes had their way it would be everybody must do these things all the time here is very clearly what is okay. And very clearly what is not. Before the episode, Katie and I had looked at the California BBS's statutes and regulations relating to the practices of professional clinical counseling, marriage and family therapy, educational psychology, and clinical social work. This is a 300 page PDF that's available on the BBS website, we'll include a link to that in the show notes as well. Now through the magic of computers, we control F, and put in the words and put in the word notes, out over 300 pages in four different disciplines, notes came up 10 times in this document. Wow. And most of them were about the requirements of education, what needs to be in graduate programs, as far as areas to cover, students need to be taught how to take notes. And most of the remaining other ones where supervisors need to check the notes. So this clinical feedback loop piece of this is something that is left to just kind of the undefined standards of the profession. That seems to be what is being grasped at. And Katie had also made the recommendation of can you control F documentation in the same documents, and we ended up with about 70 hits, and most of them were, these are documents that need to be provided to the board for proof of your hours and this kind of stuff. So getting back to this citation. Yes, I can agree, handwritten illegible notes. Not gonna fly.

 

Katie Vernoy  24:05

Not gonna fly.

 

Curt Widhalm  24:07

The guidance in what the state has said as far as what needs to be in the notes. I'm, I'm still kind of wrestling with, did this therapist do something wrong in their documentation? If it comes down to needing to specifically look at what is the threshold of things that need to be documented? As I'm hearing you talk about it in this episode, you're saying it's kind of things outside of the norm, things that if we wouldn't do this with all of our clients, if there's something specific to an individual client, we should probably make note of that. So that way, anybody else who's reading it can understand our process of why this fits with this particular client or situation? Yes. Were you ever taught that?

 

Katie Vernoy  25:05

Was I ever taught that? I think I was. I don't know that I was taught that as a clinician, when we were looking at this and how I was thinking about an even wrote this in my notes in preparation is when I was working as a child care worker, aka, a residence counselor in a group home, anything that happened that was out of the norm, especially if there was an injury, or some sort of horrible thing that happened to a kid, we did a serious incident report, or an SIR. And so for me, that was always the case that I would write stuff up, if it happened. And the the client, that kid was having some sort of reaction to it, or they got hurt, I would write that up, and just the facts and what happened and how you resolved it. And so for me, when I moved up the ranks in being a clinician, there's always that in the back of my mind that if something goes down, that is different, that is potentially harmful, and/or could be perceived as harmful, because it was a mismatch or whatever. Write that stuff down and make sure that you talk about your rationale, what happened and how the client responded and any repairs. So to me, I don't know that that was specific to clinical training, certainly, as I was working as a supervisor, the clinical loop was present. But there's also all these liability issues. And I think especially working with kids and families that are very chaotic, or there's a lot of factors that are making things very challenging for the family, I would encourage my clinicians to document those things because of how chaotic it was. So their supervisors would know so that the clinicians would remember what happened. I think there's all of those pieces that that made it so I'm potentially a little bit more conservative in my note writing, meaning that I write more than other folks may because I feel like there is a need to understand, remember, and cya.

 

Curt Widhalm  27:11

From hearing from a lot of our listeners, past students, people who've consulted with me and other just general conversations. I think they your training might be more specific than what a lot of other people working in other agencies, maybe maybe not community mental health agencies, like I will group what you said in and assume that that is a largely kind of standard rule for a lot of community mental health. But for a lot of nonprofit agencies. I don't hear this kind of emphasis, I hear a lot more of the document as minimally as possible that this audience right here, listen to this. This citation is proof that that is bad direction from shows agencies that way, keep Katie is talking about is really covering your ass, not the agency's ass that this is the proof that boards can and do look at your notes. Yeah, they're going to find faults, if notes are not up to standards. And this goes back to your law and ethics professors of if things aren't written down, they did still happen. But now it's open to interpretation. Yeah. And yeah, your justification, days, months, years later is not necessarily going to be protection, because what is written in the note at the time, is what is going to be first and foremost evaluated.

 

Katie Vernoy  28:50

And I think the the big difference from what you're talking about with other kind of nonprofit agencies and agencies that have Medicaid billing, is I was also taught that my my progress notes the clinical documentation that I put together is a bill. And so there needs to be sufficient intervention to justify the minutes that I'm billing for. So the reverse was actually what I was taught all the way coming up, is your notes need to be longer for longer sessions, and you need to have sufficient documentation to prove that your time was worth what we're billing for it. So the other piece and you brought this up before we begin was this kind of what do we remember? Yes. And I think when I am on top of my game, and I get my notes write down right away, I find that I have some details, some richness, and it does help me to remember from week to week, what's happened when I'm not on my game and I start getting behind on my notes. I struggle with that. And I think that folks who are chronically overwhelmed, and I'm going to include a lot of the folks in community mental health but even practices that are very full Do get behind on their notes. And then how do we do this detail? And you talked about another issue with, potentially when you write the note and what's in it. So let's move to that part because I think that's important too, before we close up.

 

Curt Widhalm  30:14

Well, and I will forever credit Dr. Melissa McCaffrey Hall for this advice, that the number one reason that most people seem to be behind on their notes is that they don't end sessions on time. And this is phenomenal advice that I pass along to everybody, in that the reason that we do a 50 minute session or a 45 minute session is to leave yourself time to document this stuff correctly. Yeah. And I'm going back to talking about how attorneys might approach you in a deposition, they will ask you, when did you write this note? When? Why didn't you write it earlier? What do you remember the next day about anything? Like, can you remember what you had for lunch yesterday? And who served it to you? And what was the interaction process? And this is all showing proof of just how much your memory can and does have errors to it? And if that's the case, then you having errors in your notes from being written a day or a week or months later? Is very, not good practice. It is inviting liability.

 

Katie Vernoy  31:35

Yes, I think and I've been on the right, the note right after session and write the note a little bit later. I'm not gonna get myself too much more liability than saying that. But I do think that writing your notes from a state of fear doesn't feel good, either. So going back to the citation to finish up because I know we're getting short on time. I can see why they said what they said I can imagine a situation where it's appropriate. If it becomes statute that every time we use a word that doesn't seem quote unquote, professional, IE see the session from last week. I worry if that's in statute, because I think there are different ways we speak with different clients, there are different things that we do. And so to me, I don't I don't want this to become a statute where we have to do these things. I do worry that this is some overreach. And I also feel like there are some things that we can do to protect ourselves which is sufficiently document what has happened, do it as close to finishing the session as you can and recognize that part of your documentation is your clinical reminder of what's going on, as well as cya if somebody comes looking at those notes later.

 

Curt Widhalm  32:53

You can check out our show notes at MTSGpodcast.com. Follow our social media and take a moment and drop us a note your thoughts of what we're covering here, stories that you've heard, and anything else that you would like to have us cover and until next time, I'm Curt Widhalm with Katie Vernoy.

 

Katie Vernoy  33:15

Thanks again to our sponsor, Dr. Tequilla Hill.

 

Curt Widhalm  33:18

Therapists, if you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill has created and curated a wellness guide specifically with deep compassion for the dynamic personhood of the psychotherapist. Subscribe to Dr. Hills offerings at bit.ly/StayWellGuide that's bit.ly/StayWellGuide and you can find many of the inspiring offerings from Dr. Hill 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

 

Katie Vernoy  33:56

Once again, subscribed to Dr. Tequilla Hill's how to stay well while you work therapist wellness guide at bit.ly/StayWellGuide.

 

Curt Widhalm  34:06

Hey everyone Curt and Katie here. If you love our content and would like to bring conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more.

 

Katie Vernoy  34:29

If you don't think you can make a monthly contribution no worries we also have a buy me a coffee profile for one time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/MTSGpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

 

Announcer  34:50

Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter and please don't forget to subscribe so you don't miss any of our episodes.

Mar 21, 2022
Do Therapists Curse in Session?
32:50

Do Therapists Curse in Session?

Curt and Katie discuss a recent citation from the California Board of Behavioral Sciences (BBS) to a therapist for cursing while in session. We explore: Can therapists swear in session? Should they? Are there times when cursing is appropriate in session? Are therapists allowed to make errors without the fear of citation from their board? We explore these and more in this episode.  

In this podcast episode we talk about the ethics and responsibilities of cursing in session.

After hearing about the citation for a clinician who had cursed in session, we wanted to explore what is acceptable related to using curse words in session. We know as therapists that what we say matters, and now more than ever our choice of language matters. Who is allowed to curse in the therapy room? We tackle this question in depth:

Is swearing or cursing ever appropriate in session?

  • Both Curt and Katie swear in session when appropriate
  • Swearing in session can create a more authentic therapeutic rapport with some clients
  • Sometimes clients will ask for permission to swear in session
  • Follow the client’s lead when it comes to their language in session, including cursing
  • It is mostly important to reflect the client’s language without judgement
  • Clients might be looking for more humanity in their therapists
  • Therapists are people; curses can slip out when therapists feel depleted and without resource
  • Cursing based on your own humanity can cause therapeutic rupture and clinicians should be mindful of the therapeutic alliance and make repair attempts

“The concept of professionalism has a fairly biased frame. It's something that's very specific to a specific culture… typically, white culture [suggests] I am professional if I don't curse… Even words that are considered curse words – sometimes there's such a morality around that and morals are culturally-bound” – Katie Vernoy

What does the research show us about swearing?

  • Some research suggests that cursing out loud decreases pain
  • “Professional language” is often rooted in whiteness with a goal of excluding people of color
  • When not accurately reflecting a client’s language, you run the risk of editing them
  • Swearing speech is primarily meant to convey connotative or emotional meaning with emphasis

What do professional organizations say now about cursing in session?

  • The BBS recently cited a therapist for swearing in session as unprofessional language
  • Only one professional organization, The National Association of Social Workers, officially bars cursing in session – specifically derogatory language
  • Swearing speech is primarily meant to convey connotative or emotional meaning with emphasis
  • Therapists have a responsibility to make sure they are emotionally equipped to deal with clients

Is there an ideal language for therapists to use? … I caution against blanket rules. – Curt Widhalm

  • Slurs are never acceptable to use during session, especially when there are cultural differences between client and therapist
  • Considerations related to expressing your humanity, using curse words, and the clients you see
  • Ethically, we have guidelines of client beneficence and avoiding maleficence, meaning don’t harm the client
  • Technically cursing is allowed, but only with reason and while remembering that some folks are litigious

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Dr. Tequilla Hill

The practice of psychotherapy is unique, creative, and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

If you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill a mindful entrepreneur, yoga, and somatic meditation teacher has curated How to Stay Well While you Work Therapist Wellness Guide to support providers that are struggling to manage your own self care.  Subscribe to Dr. Hill’s Stay Well While You Work! Therapist Wellness Guide and you can find many of the inspiring offerings from Dr. Hill’s 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

Support The Modern Therapist’s Survival Guide on Patreon!

If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings, and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more. If you don't think you can make a monthly contribution – no worries – we also have a buy me a coffee profile for one time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
The Case for Cursing

Client’s Experiences and Perceptions of the Therapist’s use of Swear Words and the Resulting Impact on the Therapeutic Alliance in the Context of the Therapeutic Relationship by HollyAnne Giffin

Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel “Swear” Words by Richard Stephens and Olly Robertson
Relevant Citations in the  MTSG Podcast:

Stephens, R., & Clatworthy, A. (2006). Does swearing have an analgesic effect? Poster presentation at the British Psychological Society Psychobiology Section Annual Conference, 18
20 September 2006, Windermere

Stephens, R. (2013). Swearing-The language of life and death. The Psychologist, 26(9). Retrieved from https://thepsychologist.bps.org.uk/volume-26/edition-9/swearing-language-life-and-death

Relevant Episodes of MTSG Podcast:

CAMFT Ethics Code Updates

When Clients Have to Manage Their Therapists

The Return of Why Therapists Quit

Impaired Therapists

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


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Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm  00:00

This episode of the Modern Therapist Survival Guide is brought to you by Dr. Tequilla Hill.

 

Katie Vernoy  00:05

The practice of psychotherapy is unique, creative and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

 

Curt Widhalm  00:26

Dr. Tequilla Hill a mindful entrepreneur yoga and somatic meditation teacher has curated how to stay well while you work therapist wellness guide to support providers that are struggling to manage your own self care. Stay tuned at the end of the episode to learn more.

 

Katie Vernoy  00:42

Hey everyone, before we get started with the episode, Curt and I wanted to make sure you were aware that we have opportunities for you to support us for as little as $2 a month.

 

Curt Widhalm  00:51

Whether you want to make that a monthly contribution at Patreon.com/mtsgpodcast  or a one time donation over at buymeacoffee.com/moderntherapist. Every donation helps us out and continues to help us bring great content to you. Listen at the end of the episode for more information. 

 

Announcer  01:14

You're listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  01:28

Welcome back modern therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists about things that we do things that show up in therapy things that are happening in our profession. And today's episode started with looking at a citation that was issued by the California Board of Behavioral Sciences to a therapist, this is public information, we're not going to name names. But this is part one of a two part episode.

 

Katie Vernoy  02:05

Oh at least two parts.

 

Curt Widhalm  02:08

Part, episode one, at least two parts dealing with this particular citation. And if you know us that we can dive deeply into the strangest of things. But this is an important one in looking at the way that licensing boards are evaluating things. And this has some potential ramifications throughout the rest of our profession. If you're not in California, your board may come after you one day too. So listen, listen to these because this does have some ramifications across our profession. Now, very, very broadly, not getting into a ton of details. If you want to peruse, you can probably pull this up, we're not going to link this one for you. But very, very broadly, therapist was doing reunification therapy with a parent and children. And my understanding of reading through the citation is that the therapist used a curse word in session. A little bit of perspective in having done some reunification therapy before. There's a lot of dynamics at play with the parent who's not in the room. But there does not seem to be any disagreement that a curse word was used. The disagreement seems to be how the curse word was used. And this particular case, one of the children in the room felt that the therapist was calling the child the curse word, the parent who was in the room and the therapist will say that the therapist was using the word to describe the child's behavior. The California Board of Behavioral Sciences in their citation said that this is unprofessional conduct. And this among some other things that we will explore in this episode and next week's episode are going to be why we're talking so deeply about this. But Katie, do you curse in session?

 

Katie Vernoy  04:18

We'll share Yeah, Yeah, fuck yeah. Christian session. I don't always, I don't always, and I don't with every client, but I think there's so many different elements to cursing in session. And obviously this one's going to get one of those explicit marks and so maybe we should have put a warning we already put it on the episode but if you don't like cursing turn it the fuck off.

 

Curt Widhalm  04:46

Put a little parental advisory label on the show graphic for this episode. But

 

Katie Vernoy  04:53

I mean, I'm actually cursing more than I would normally for a fact obviously but I think it's something where the elements that we need to look at are, is it unprofessional conduct? Can we be human beings? And is there an reason that it would might be more effective clinically, or times it might be really harmful clinically, like I think there's there's a lot of different elements to this. So.

 

Curt Widhalm  05:17

So I think anecdotally, a lot of us who work in the fields tend to take an approach of well adopt the kind of language that a client is using, and oftentimes following their leads, and particularly in working with teenagers a lot. In my practice, I'll get the question of, Can I curse them here? Usually, after they've said a curse word, right?

 

Katie Vernoy  05:40

Yes, same adults, though, in my case.

 

Curt Widhalm  05:44

And oftentimes I, I will say, this is your space. And if this is something that helps you to be able to express yourself, well, go ahead and do it. And I may, you know, reflect back their language, it may give me a little bit of, you know, more genuine approach and letting down some of my professionalism a little bit in order to help clients feel that I'm connecting with them on their level. And for many of the therapists that I talked about, we tend to take this kind of an approach that, particularly when we're working with communities that have maybe had some issues with the way that therapists come across too professionally, that there's a lot of power in the language of using curse words, that helps to show that alright, as therapists, if we can meet with them on the level and the way that they express themselves, that it helps to build more of a real relationship. And I've seen this back when I was working and agency work working in substance abuse, homeless populations, that it did just kind of help give me a little bit more of a response of clients thinking that I'm authentic. I imagine that you had some similar experiences in DMH yourself?

 

Katie Vernoy  07:00

Sure. I mean, I think there's there's a few things that you said that kind of struck me and I don't know if it's worth, you know, talking about but I think there's using the client's language and you said, kind of meeting them at their level? And I don't know exactly, if that's saying like, one form of language is better than an other and, and for me, I think I don't think that's what you were trying to say. But I think for me, it's more kind of embodying the space and using the language with them without a judgement there, but

 

Curt Widhalm  07:33

And it wasn't intended as placing anything as far as being higher or lower level. I mean, if, if I have a three year old in session that we're going to talk on, you know, our hands as phones in order to convey messages, I'm going to meet with them on their level. So this is just kind of being able to match client characteristics.

 

Katie Vernoy  07:54

Sure. Okay. I think the other element that you're talking about really is authenticity. And for me, I want curse words to be used in session where it feels authentic to do so. And potentially as a connecting mechanism, but I think, just using curse words, because your client does, I don't think it's going to fly. So So I think, a couple of things there. I don't know if they're relevant, but, but to answer your question, I think the more important element of this is, knowing your client well, and really reflecting their language without assumption. I know a mistake that I had made more than once, and I realized it as I was doing it, is that I assumed that the client cursed and I was wrong. And I'd used a curse word I saw their eyebrows kind of go up. And it was something where I felt it was to reflect the gravity of what I've experiencing, like, oh, fuck, you know, or Wow, that was really shitty. You know, like, I've I've used those expressions, because that's how I talk and other arenas. But when I saw the client's eyebrows go up, I was like, Oh, wait, I'm tracking back. And although they're a person who is not a formal person, they seem to be, you know, kind of casual and how they speak. It still wasn't a word that was appropriate for them. And so to me, I feel like I, I have since moved to a place of cursing as little as possible, unless I really know like, meaning zero, unless I know the client very well. And we've had those exchanges and I've definitely heard them curse, which not everybody does, because some people see it as more of a kind of formal environment that we're sitting in. But I especially had to kind of assess this when I was working with the teen boys on probation. I mean, that was a whole different, you know, kind of way to connect with folks around language and perspective. And so I think, a blanket statement of never curse or curse whenever you want. I think obviously, that's not what we're here to say.

 

Curt Widhalm  10:04

When I first read this citation, I did a little bit of a self study on myself of just keeping track of the number of sessions that I had in the following days, right? Use a curse word, and it came to about 60% of my sessions.

 

Katie Vernoy  10:22

You definitely work with teens.

 

Curt Widhalm  10:24

I work with teens, I work with parents, I work with a number of different clients that our relationship has established. And I don't consider myself somebody who curses frequently in my day to day life.

 

Katie Vernoy  10:40

So you curse more in session than in your day to day life,

 

Curt Widhalm  10:43

Probably. I mean, I haven't done this kind of data tracking on my personal life, maybe I should just for comparison sake, but in observing myself, I did the follow up question of who? Why am I person care, and it fell into a couple of different categories. One was to really kind of ask clients to expand on things like, you know, if a client says, like, I'm feeling like shit today, where that's gonna make me feel shitty, like, Oh, why do you think that that's going to make you feel shitty, you know, just kind of echoing their language, family sessions are my favorites of when, especially with very young children, I'm talking, you know, those kids under the age of six, maybe preschoolers that are using curse words, and parents are trying to correct it, of, you know, talking about parents using the language in front of their children and how that's reinforcing to them. Yeah, and finding alternatives. And then there are those times where there's just kind of the emphasizing a point with clients that I've already had an established relationship with where this is being used, being able to just kind of help them maybe recognize a particular moment in session, as far as here's an emphasis on this. But in my, you know, data of like, one week of looking at this, these were all clients that had been the first to swear in sessions.

 

Katie Vernoy  12:16

Mm hmm.

 

Curt Widhalm  12:17

And I think I kind of follow you and and many others in our field that we don't lead with this, and I don't think clients necessarily, overall want us to lead with this. There's a couple of older articles, I'm talking 10 plus years old now, that kind of look at the role of therapists swearing in session, very, very minutely. And seems to be from time to in our fields when there really was a lot more of this elevated professionalism expected of psychologists, therapists, social workers, etc. But I think you know, really, overall, with the old man shaking, his fist, decaying morals of our society, where cursing seems to be a lot more prevalent. I think in the last 10 years, this has been something where either we're more readily admitting it or our clients are actually looking for more of that humanity out of the professionals who serve in these roles.

 

Katie Vernoy  13:16

And when you were talking the the concept of professionalism has a fairly biased frame. It's something that's very specific to a specific culture I'm in typically, white culture is more in the like, I am professional if I don't curse, I think even words that are considered curse words. Sometimes there's such a morality around that and, and morals are culturally bound to that. I feel like if we were to never curse, and if we don't curse personally, I don't, you know, like, you don't have to bust out a curse word if you don't if you never curse, but like for those of us who that's part of our communication. I think it is interesting that our profession and a professional body would say, hey, that is unprofessional behavior, when in fact, it may be the most connecting thing we can do. Like I said, I've I've made mistakes and curse when I shouldn't with clients that don't curse and I recognized it in the moment. But to me, there's using it thoughtfully. And then there's also just being who you are and talking how you talk, and having the clients that match with you. I mean, there are folks who just that's how they talk and should they be required as therapists to completely remove all cursing from their vocabulary.

 

Curt Widhalm  14:48

You bring up the professional organizations, and there's one professional organization who puts it in their ethics codes and This is the National Association of Social Workers, their standard 1.12 or one point 12, derogatory language, social workers should not use derogatory language in their written verbal or electronic communications, to or about clients. Social workers should use accurate and respectful language in all communications to and about clients.

 

Katie Vernoy  15:24

So it's, it's implying that cursing is de facto disrespectful.

 

Curt Widhalm  15:30

I think that in any ethics code, there's room for interpretation here, but this one is specifically talking about the language that gets used and says,

 

Katie Vernoy  15:41

It says derogatory language, I guess. So like that is that's where the interpretation is that you're talking about.

 

Curt Widhalm  15:46

Right. Which then kind of leads to the question of who gets to decide what words mean, you know, this is a intention versus impact sort of conversation, because I can think of a million ways to not use curse words and still speak derogatorily about somebody? Sure, you know, and I can think of ways where clients may even be offended for not utilizing the kind of language that they incorporate into their world. Whether that includes curse words or not.

 

Katie Vernoy  16:24

Yeah, I just think if you were to, to when somebody says I'm feeling really shitty today, like, you could come back and say, Well, what do you think is gonna make you feel that way? But if you were like, so what makes you feel like poop today? Like, I think it would just be funny. But secondly, it's, it's, it's editing them?

 

Curt Widhalm  16:46

Well,

 

Katie Vernoy  16:46

 in the reframe.

 

Curt Widhalm  16:47

I have, I have worked in environments before where clients readily use this kind of language all the time, but have had co workers who would try and kind of calm things down and be like, Can Can we not use that language here? Can we use something more respectful and those kinds of coworkers didn't last long in those environments? Yeah, some of looking at this is also looking at some of the neurological research that has come out in the last 10 or so years about the effectiveness of using curse words, as a way of relieving pain. Oh, interesting. And we'll put some citations, at least in the show notes. Not necessarily going to find all of the source articles he re for people but,

 

Katie Vernoy  17:44

But we're gonna say we're gonna have citations never fear, you'll be able to find it.

 

Curt Widhalm  17:48

We're gonna have some citations here. But the use of curse words has allowed for people being subjected to physical pain to report on a subjective units of distress, less pain being felt when they're allowed to curse. And this was also replicated in a Mythbusters episodes that so I mean, if

 

Katie Vernoy  18:14

It has to be true, it's very true.

 

Curt Widhalm  18:19

The question really becomes, is cursing allowed or not. And this is where we get into these weird, like, can we create blanket rules for our profession? I'm not going to be like leading cursing with my clients.

 

Katie Vernoy  18:36

No,

 

Curt Widhalm  18:37

Especially, you know, children.

 

Katie Vernoy  18:42

Yeah, I think probably the parents would not be pleased if you taught your child, your child clients to curse.

 

Curt Widhalm  18:50

And part of this is going to be based on your theoretical orientation. You know, if part of what your family therapy is is working on creating structure around appropriate language in the household, and kids are going to be cursing or not, or if that's something that parents are trying to move their kids away from, inevitably, you're going to have to at least document that you're working on.

 

Katie Vernoy  19:14

Yeah, yeah, I agree. I think that there, there are clinical reasons, whether it's part of the joining and the relationship, whether it's authenticity, whether it's specific things you're working on. I think there are reasons to thoughtfully engage in cursing and session. You know, because I think otherwise, it is really just about humanity. I mean, to me in reading that citation, I'm not clear so it could have been that the the clinician was speaking about behavior, reflecting back language from the family. And it could have been thoughtful, thoughtful use, but I'm curious having worked in a lot of these types of situations where there's reunification, or DCFS involvement, or probation involvement, where there's families that are under a lot of stress, they're being mandated to treatment, there are a lot of things going on. And those families righteously can be challenging for a clinician to work with. And it can be very, very overwhelming. And so to me, I'm thinking, was this a clinical choice? I'm reflecting the language, I'm being authentic, or was it a, I am at my last my wit's end and holy fuck I am done for the day. And so it was not thoughtful, it was humanity. And the question I posed to you, dear sir, is if we curse in session, because of our humanity, is that okay?

 

Curt Widhalm  20:51

So a couple of the articles that are out there, one of the people who has looked into this a little bit more than some others is Timothy J. 2008. Article from J. And Janowitz, says that, in contrast to most other speech, swearing is primarily meant to convey connotative or emotional meaning. In other words, that, you know, a word like shit does not usually necessarily literally mean a pile of feces, it means that there is some sort of emphasis to it based on the context of the language. Yeah, I think that, on that point of, it's about the emphasis of it. Speaking from a position of reality, what you're asking is, is there an ideal language for therapists to use? Hmm. And, again, I cautioned against blanket rules, because there may be polite society that does find it extremely offensive, you know, one of the very weird things about our field is that you may be, you know, talking into your hand as a mock cellular phone with a child in one session. And then your next session, maybe exploring the BDSM desires of somebody who's exploring their sexuality, then rules, even from one session to the next may be impossible to create a absolute value, let alone a strict rule of what ideal language that you can use. It's a very fancy way of saying it depends.

 

Katie Vernoy  22:36

Well, I'm hearing a whole bunch of it depends. But I think there's that additional element of, if I've, I'm at the end of my resources, I'm exhausted and something is thrown at me in session that I normally could catch, and I don't. And I basically start being a human in the moment, because I have no more resources left is that worthy of a, of a disciplinary action,

 

Curt Widhalm  23:07

we do have a responsibility to put ourselves in the best position to take care of our clients. And, you know, I can imagine and I've had frustrating sessions over my career that have stirred up emotional reactions in sessions and working through in subsequent sessions or subsequent communications with clients or former clients that there is a ownership of some of that humanity, some people are going to be litigious. Some people are going to file complaints, you know, if I'm going to draw a line on this, you know, not everybody is going to want their therapist to curse. Some people are going to think it's the best fucking thing that's ever happened. But I think that there is probably an absolute line. And even this line is kind of gray in and of itself. But I think that there is a line that is probably the intention of that NASW code, which is where the use of slurs come in. And especially if there's cultural differences between the therapist and the client that, you know, if I have a client who's expressing, hey, I got called the N word down on the streets and is actually using the pejorative language. They're even in all of my trying to connect with a client's me as a very white therapist. I'm staying away from reflecting that word to them. But I think that you know, in any of the expressions that we have, that being very careful about not using slurs is probably a line that we all definitely need to be aware of where that is, and follow that one

 

Katie Vernoy  24:58

To me taking what you're saying and adding my own thoughts to it is really having common sense and making sure that we have sufficient resources available to either remain appropriate and not become offensive to our clients, if at all possible. I think the other element of it is kind of this common decency and respect. I think if one of my first jobs out of college was working in a group home with kids who had been removed from their parents homes or their caregivers homes, and I was carrying a child, I was working as a childcare worker, not as a therapist, and I was carrying one of the children and hit a pothole in the road, sprained my ankle and went down with the kid. Even in that moment, when I'm in excruciating pain, and the kid is crying because they fell with me, I did not drop the kid, I felt very proud of myself, I was much younger than I would drop them now. I didn't curse. Maybe I would have felt less pain. If I did. It sounds like from the study. But I did it because I was aware, I have a kid with me. And there's enough of a filter for me that I wasn't going to immediately go to "fuck". So in sessions, having that much left that much kind of super ego or that much kind of observer, mindfulness, whatever works for you. But having that much to say, even if I'm in a bad spot, let me first excuse myself, rather than get to a place where I'm cursing without it making much sense, clinically, I think is our responsibility.

 

Curt Widhalm  26:57

Sure. I think that overall, what we're talking about here is trying to make a case that cursings allowed. And I think that we've at least done a good enough job to say that we shouldn't disallow it. But there's probably got to be some reasons for, hey, here's why you don't. I mean, obviously, this citation that we're referring to, as far as the basis of this episode is necessary that at least in some cases, you shouldn't,

 

Katie Vernoy  27:28

I think that the know your audience is really important. We've said that throughout. But I think it's also understand the impact of your words. The thing that I grapple with, and I don't know if this is something maybe you grapple with as well is that even when we're feeling especially human, and embodied as a therapist, there is still a power differential. And there still is an expectation that we will show up in a certain way. And I think not showing up in that way, shouldn't be taken lightly. There have been times when my humanity has come through, and I've had ruptures that were not repaired, and clients that left treatment, you know, that frequently, but that has happened, I've had clients who, fortunately have been able to say, hey, and it wasn't necessarily about cursing, but more that kind of humanity piece. But I, I expect it would also happen with cursing. But clients who would come to me and say, You were weird in that session with me what happened there, and then being able to talk about what was happening behind the scenes. But I think there may be clients who have trauma histories around certain ways that people speak, there may be things that you would need to know before you really dig into or become, I think, to free and how you express yourself in your own humanity. I think there's, I think there's times when having curse words in your vocabulary could be a hindrance to you in connecting with clients and keeping the environment safe for them.

 

Curt Widhalm  29:07

What you're talking about is our ethical guidelines of client beneficence and avoiding maleficence. That what we do is for the benefit of clients, and we don't do the things that harm clients, and the history of, you know, polite society, using proper language has been proven to often been an exclusionary way of keeping diversity out of professional roles. And this has existed and today, and I think that, you know, there's always the default to remaining in this classical professionalism that is the guidance to avoiding that maleficence. When in doubt, be safe.

 

Katie Vernoy  30:03

Yes.

 

Curt Widhalm  30:05

But when clients curse first fuck yeah, we're gonna do it.

 

Katie Vernoy  30:08

Shit.

 

Curt Widhalm  30:13

We will link to some articles here in the show notes you can find those at mtsgpodcast.com. One piece that we didn't really highlight in the, in the middle of the show that I think is worth pointing out is a master's thesis dissertation from Holly Anne Giffen from 2016. That served as the basis for us finding some of these other articles. We will include a link to that in our show notes to find those at mtsgpodcast.com. And follow us on our social media and join our Facebook group, the modern therapist group and until next time, I'm Curt Wildhalm with Katie Vernoy.

 

Katie Vernoy  30:56

Thanks again to our sponsor, Dr. Tequilla Hill therapist.

 

Curt Widhalm  31:00

If you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill has created and curated a wellness guide specifically with deep compassion for the dynamic personhood of the psychotherapist. Subscribe to Dr. Hills offerings at Bitly forward slash stay well guide that's BIT dot L y forward slash StayWell guides and you can find many of the inspiring offerings from Dr. Hill 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

 

Katie Vernoy  31:37

Once again subscribe to Dr. Tequila Hills how to stay well while you work therapists wellness guide at Bitly forward slash stay well guide

 

Curt Widhalm  31:47

Hey everyone, Kurt and Katie here. If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more.

 

Katie Vernoy  32:10

If you don't think you can make a monthly contribution no worries we also have a buy me a coffee profile for one time donations support us at whatever level you can today it really helps us out. You can find us@patreon.com Ford slash MTS G podcast or buy me a coffee.com Ford slash modern therapist. Thanks everyone.

 

Announcer  32:32

Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at MTS g podcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Mar 14, 2022
Thriving Over Surviving: Growing a Practice without Burn Out
37:41

Thriving Over Surviving: Growing a Practice without Burn Out

Curt and Katie interview Megan Gunnell, LMSW, coach, and Founder and Director of Thriving Well Institute. We explore: What changes are therapists facing as they grow their practice in the telehealth age? How do therapists scale their businesses and what should they be aware of? Can a therapist and their practice thrive, or does something have to give? All of this and more in the episode.

Interview with Megan Gunnell, LMSW and Founder & Director of Thriving Well Institute

Megan Gunnell LMSW, is Founder and Director of Thriving Well Institute which aids therapist in building the private practices of their dreams. Megan offers a series of courses and individual coaching to aid therapists in expanding their private practices through building group therapy programs, building online courses, creating in person retreats, and even how to build a group practice. Megan teaches therapists how to build not only their practices but themselves up. Megan has been a practicing clinician for over 20 years working as an individual therapist in addition to her coaching and advisory work. Megan started her work as a music therapist, a passion which she still carries to this day. 

In this podcast episode we talk about how therapists can build their practices without burning out.

With the increase in telehealth therapy options, therapists are confronted with a unique problem. How does a therapist build their practice with so many therapeutic options out there, while simultaneously avoiding burn out? Curt and Katie connect with Megan Gunnell to discuss how therapists can make sure they, and their practices, thrive.

“So there are some benefits now, because therapists don't have to just compete with, you know, their audience in a small zip code, they can really expand...”
- Megan Gunnell

How can therapists’ network as telehealth therapists?

  • Your potential client base has now become the whole state.
  • Focus on designing your online real estate and increase your SEO.
  • Joining local Facebook groups of therapists can help expand your referral base.
  • Speak to specific client issues on your website that you specialize in.
  • Avoid template and more generalized language in websites and marketing material.
  • Make your website unique but clear in what you work with.

What is scaling and how does it avoid burn out?

  • For many therapists, caseloads have increased dramatically over the past couple years
  • Scaling is more about pivoting than it is creating passive income.
  • Looking to expand your practice into a group practice can help alleviate referral loads.
  • Some therapists can avoid burn out by diversifying their workload and reintegrating natural talents such as creativity.
  • Getting into community, especially with other therapists, is a great way to avoid burn out.
  • There is still a need for single-focus private practices.

What can therapists do to scale their businesses?

  • Be in tune with out motivated you are to scale your business; ask how committed am I?
  • Consistency is key.
  • Have a willingness to make mistakes and take risks.
  • Don’t be afraid of failing; use moments of failure to motivate you.
  • Be open to learning new things like tech, marketing, or automation.
  • Be realistic of your capacity to take on learning sometimes complicated or frustrating systems that might help your business.
  • Don’t be afraid of showing who you are as a person as you build out your practice.
  • It can be scary to expand your practice, and many therapists want assurance, but there is no one way to expand – it’s individual to your unique practice.
  • It can take support to expand your practice; reach out to your community for help.

“There's absolutely nothing wrong with a single focus, one dimensional private practice where you're just doing one on one client work, there's nothing wrong with that, I want to normalize that, and you can make a great living, you know, and not burnout. But for me, I wanted a different rhythm of my weeks.” – Megan Gunnell

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Dr. Tequilla Hill

The practice of psychotherapy is unique, creative, and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

Dr. Tequilla Hill a mindful entrepreneur, yoga, and somatic meditation teacher has curated How to Stay Well While you Work Therapist Wellness Guide to support providers that are struggling to manage your own self care. Stay tuned at the end of the episode to learn more.

Support The Modern Therapist's Survival Guide on Patreon!

If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings, and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more. If you don't think you can make a monthly contribution no worries we also have a buy me a coffee profile for one time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Stay Well While You Work! Therapist Wellness Guide
Thriving Well Institute Website

Thriving Well Summit May 2022

Megan’s Courses on building groups, practices, and retreats

Megan’s Private Practice

Thrive Advantage Group

Thriving Well Institute Facebook Group

Thriving Therapists Instagram

Relevant Episodes of MTSG Podcast:


Why You Shouldn’t Just Do it All Yourself

Creating Opportunities

How to Navigate Through Your Growing Pains as a Therapist

Making Daily Business Decisions

Clinical Versus Business Decisions

Bad Business Practices

How to Overcome Imposter Syndrome to Leave Your Agency Job

What to Know When Providing Therapy to Elite Athletes

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

 

Curt Widhalm  00:00

This episode of the Modern Therapist Survival Guide is brought to you by Dr. Tequilla Hill.

 

Katie Vernoy  00:05

The practice of psychotherapy is unique, creative and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.

 

Curt Widhalm  00:26

Dr. Tequilla Hill a mindful entrepreneur, yoga, and somatic meditation teacher has curated How to Stay Well While you Work Therapist Wellness Guide to support providers that are struggling to manage your own self care. Stay tuned at the end of the episode to learn more.

 

Katie Vernoy  00:41

Hey everyone, before we get started with the episode Curt and I wanted to make sure you were aware that we have opportunities for you to support us for as little as $2 a month.

 

Curt Widhalm  00:50

Whether you want to make that monthly contribution at patreon.com/mtsgpodcast  or a one time donation over at buymeacoffee.com/moderntherapist. Every donation helps us out and continues to help us bring great content to you. Listen at the end of the episode for more information.

 

Announcer  01:12

You're listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  01:28

Welcome back modern therapists. This is the Modern Therapist Survival Guide. I'm currently at home with Katie Vernoy. And this is the podcast for therapists about things that we do the ways that we look at our businesses, and all sorts of other things. Today we are joined by Megan Gunnell, Founder and Director of the Thriving Well Institute, thriving, or thriving wellness?  Thriving Well Institute      Thriving Well Institute, we have coaches and people talking about scaling your business up and all that kind of stuff today. And we've asked Megan to be a little bit more raw with kind of some of these answers to have a little bit maybe different conversation here today. But thank you for joining us.

 

Megan Gunnell  02:10

Thank you so much for having me. I'm really excited to be here.

 

Katie Vernoy  02:13

We are so excited to have you. You are definitely a friend of the show. And so excited to be here with you and have this conversation. The first question that we ask everyone is, who are you? And what are you putting out into the world?

 

Megan Gunnell  02:28

That's a really great way to phrase that as an introductory question, I guess I would identify first as a psychotherapist, I've been a therapist for over 20 years. And then within the last few years, I pivoted into coaching, and now I'm helping a lot of therapists learn how to build practices and scale their business. And along the way in the mix, I also have done a lot of international retreats and develop some courses and do a lot of coaching. So kind of a little bit of a mix of everything.

 

Curt Widhalm  02:59

And I will be speaking at one of your retreats coming up in May of 2022, the Thrive Summits.

 

Megan Gunnell  03:06

Yes,

 

Curt Widhalm  03:06

In St. George Utah, which will include links for where you can get those tickets and come and hang out with us for a few days. I'm looking forward to that.

 

Megan Gunnell  03:16

It's gonna be great. I can't wait to hear what you have to share with our audience.

 

Curt Widhalm  03:19

I'm super excited to figure out what I want to share to steering this towards our audience here. We've had coaches on before we've talked about scaling and stuff before, we're promising that this is a different conversation. So what are some new challenges that therapists are facing these days, as far as getting their practices builds, there's been a little thing called the pandemic that people have been dealing with, what are some things that people are facing now that even a few years ago, the story has changed as far as you're seeing it?

 

Megan Gunnell  03:56

The pandemic certainly has provided us with a bit of a blessing and a curse as therapists so we have all been inundated with a giant, you know, influx of referrals. And so that's been, you know, a little burdensome. I think personally speaking, it's been a little bit hard. That's why actually at the beginning of COVID, I decided after a long time, coming to build a group practice. I didn't really know what I was doing with regards to that. But I knew I had to do it because my waitlist was getting out of control. But the good news is therapists can now serve their clients in a telehealth capacity, which makes it easier than ever to build a new practice. So you don't have to go through all of the hoop jumping of trying to find the perfect brick and mortar space and you know, figuring out everything that goes along with setting up shop, but I think that as far as what's happened now with regards to COVID and the pandemic, therapists are kind of feeling a little bit of both a little bit of a burden, trying to you know, reach all the clients in need and serve them in a way that doesn't lead them to burnout, you know themselves. And also, the ease of telehealth has been kind of a blessing, I would say for a lot of us after we kind of got used to the initial change of that, for me, that was hard to do at first.

 

Katie Vernoy  05:14

I think it's interesting, because with the pandemic, I think there's been a lot more folks that feel like they can start a solo practice where they can get rolling, but a lot of the guidance around how to build a practice or you know, or how to scale as a practice, like, a lot of it's based on a brick and mortar office, how have business coaches made that transition? Because I know for myself, I've had a lot of different types of conversations. But you know, how you network when your audience is your whole state, you know, or how do you, you know, do some of these things when you don't have in person meetings, maybe this is off base, a different conversation, but it seems very challenging to try to transition all of those kind of old wisdoms into a completely virtual environment?

 

Megan Gunnell  06:03

Well, that's a great point. And we've had to get really savvy about how we reach people in need, which really turns back to how are you designing your online real estate? So a lot of coaches, including myself, will take a first look at how are people finding you? And when they find you? What are they seeing? You know, are you using the power of SEO, are you speaking to your ideal client in a way that really does reach your entire state. So there are some benefits now, because therapists don't have to just compete with, you know, their audience in a small zip code, they can really expand and some are expanding across state lines. I don't know a lot about that I have not served clients out of state. But it has been interesting to see how therapists are now broadening their reach by really serving clients nationwide. And there's, of course, a lot of things we can do in the online space. So with regards to statewide Facebook groups, there's a there's, for example, a Michigan mental health professionals group, it's been interesting to see kind of the activity in there since COVID, started because it used to be very specific to certain cities. And now it's it's really statewide news and information about who you're serving and what your expertise is, which has been great. Because if there's, you know, maybe there's an expert who could serve a client that I have a referral need for, and they might be five hours away. And that used to be impossible. And now it's not,

 

Curt Widhalm  07:29

We had a personal friend reach out for a family member with a very specific mental health issue. And it was something where, surprisingly, in my local network of people that I didn't have somebody who's like, that's my go to for this particular issue. And I spent a lot of time going through people's websites, through social media, trying to find even just a couple of people. What I've noticed is that a lot of the trend has been to have kind of this very therapist friendly language on websites, that's just, you know, my ideal client is such and such, and my, you know, practice caters to all of these wonderful, you know, airy fairy sort of enlightenment sort of things, when really what this particular client was looking for is like, hey, I want somebody that works with this diagnosis, and has some experience with this, and isn't going to be spending all the time talking about whatever the social justice news d'jour is. And I think that this is something where as a field, we tend to copy each other a lot. And we tend to find some of this, I'm gonna put my own flavor on this template sort of thing. In the work that you do with with coaching clients, are you really helping some of your therapist is as they're making some of this stuff really be able to speak to particular client issues and that way?

 

Megan Gunnell  08:57

Absolutely. And I agree with you, because I am not a fan of the copy and paste method. I see that a lot from other spaces and people who do support therapists in different ways. And I'm just not a fan of that. Because I think that in order for a therapist, for example, that I'm working with individually, to really be able to, you know, execute kind of that marketing piece successfully, we have to get crystal clear on what their expertise is and what they want to do, and not gloss over it and not make it sound really coachy or really Instagrammy or, you know, like what you're saying kind of too polished or really soft. I try to drill down pretty deep when I'm working one on one with someone to really try to understand what exactly is your area of expertise, what exactly is, you know, your training and what are we trying to say in terms of reaching your ideal clients. So it has to be, I think, very individualized, it has to be a very unique, one on one process. And I think you can tell when you look at companies that, for example, do website building for therapist, some of them are very copy, paste. And after a while that starts to get blurry. And I like clear, I just work in a different way when it comes to that with therapist.

 

Katie Vernoy  10:19

There's a lot of conversation, especially now because we can do therapy all the way across the state. Oftentimes across state lines, if you start getting licensed in other places, we can start to fill up practices pretty easily. And and I think you were talking earlier about like, trying to figure out how to do this without avoiding burnout. Mm hmm. To avoid burnout. I can speak. And so I think it's something where one of the mechanisms that people talk about is scaling. And so, you know, increasing income without doing it yourself or whatever, or adding additional income streams. And so to me, it feels like we're moving from a space of, oh, my gosh, how do I do my practice? How do I stand out in this big field to, okay, I'm overwhelmed too many clients. And I feel like I'm grinding. And so to me, it feels like there's a lot of us that get to this place of scaling, or whether it's building additional income streams that we that feels like the mechanism. What do you think about that trend? I mean, I know that's kind of what you do. And that's what you've done for yourself. But what do you think about that trend, because it feels like that there's almost something not sustainable about just a single, I'm a therapist, I have a therapy practice, period.

 

Megan Gunnell  11:34

I think that over the last couple years, especially with the pandemic, our case loads have changed. So for many of us, we had, you know, case loads, we could manage in terms of number and in terms of severity of cases, in terms of the intensity of the clients we were working with and their cases and what they needed. And then the pandemic hit. And if you're like me, it went from like a manageable load and a manageable level of intensity with client work to what felt like everyone was in trauma and crisis and major grief and loss, major anxiety, you know, major life transitions, like, it just went from zero to 1000. And at the same time, we were handling COVID ourselves as therapist. So I think this idea of scaling has become more pronounced in the last couple years, because of COVID. So when you think of scaling, and it's not for me, it's not passive income entirely. It's about pivoting. So I knew that when I hit that wall of I'm doing 35 clients a week for 10 years, and there was a reason why I was doing that I was the only provider for my household of four, my husband was running a business that was not lucrative. And we were we agreed to do that for a while. And when we got to the end of that, or I got to the end of that I felt really burned out really on the edge, I would say I was not thriving, I would come home and just feel like I couldn't talk to my family, I felt very negatively impacted by the intensity of the load. And I missed all the other things that I love doing. So I miss the creative side of, you know, creating community and creating groups and creating retreats and creating different kinds of offers. So I needed that I needed that more than ever. And then COVID hit. And I thought how am I going to do this because I'm at capacity. Yeah, so I built the group because I thought if I can build a group, I can kind of expand my offerings, serve more clients in need without taking all the new referrals myself and start to slowly scale back my one on one schedule. So I have more freedom to do some of these other things that really interests me.

 

Katie Vernoy  13:49

I think that's really strong because I there's this element of, it's not like, hey, I'm not making enough money, let's do a side hustle. It's, I need the diversity of types of work. And I think that's very true for me as well. When I went out on my own. I had been doing a lot of other things. And for me, solely doing a therapy practice wasn't sufficient to kind of keep me engaged. I don't know that boredom is necessarily a good way to describe it. But there's that kind of burnout of just not being able to fire on everything, you know, like doing all the things and all the different types of things.

 

Curt Widhalm  14:22

Almost like a creative itch. Yes, exactly.

 

Megan Gunnell  14:26

That's it. Yeah. And I felt that too. And I mean, I was a music therapist before I was a psychotherapist. So I had years and years of doing really creative work. You know, I did a lot of music work. I did, you know, drum circles and mandalas and mask making and art making and guided imagery and meditation and we worked with, you know, all different kinds of integrative practitioners. So, my job as a music therapist, while it wasn't really is as deep as my work as a psychotherapist, it was there was a lot of variety there. And so I kind of missed that and I think honestly, especially doing exclusive telehealth, it can be also kind of lonely as to do this one on one work write client after client after client and then you're done. And there's no like watercooler chit chat anymore when you're in an office where there's a few people or, you know, even just seeing people coming and going, even if you have your own solo brick and mortar, but it's, it's just I needed more, I quickly realized as the Thriving Therapist Community really started actually in December 2019. And it grew from zero to 13,000 members in two years. And that told me something about what people really wanted. And I think what they wanted was a community of therapists who really understood them. And they wanted a place to be inspired to learn how to thrive again, that could be personally that could be professionally, you know, that might be about building a practice for the first time and pivoting out of an agency or hospital job. And that might have been learning how to scale how to build a group therapy group, or how to build an online course or how to build a retreat. There were lots of things I was hearing from this community that made me also excited about teaching and training other therapists on how to do this, too. So that's been really a great way to diversify my everyday work life too.

 

Curt Widhalm  16:16

I'm really glad to hear you framing it this way. Because when we were sending questions over to Megan, before the show of here's some things that we might want to talk about, I was in a snarky mood, admittedly, at the time, just and maybe was looking at some of these questions around, like, how do I get multiple streams of income from maybe a little bit more pessimistic place of is our fields really that bad, where people are immediately looking at like, I have to supplement my income with something else, but you've got this really nice way of looking at it, and maybe helping people to encourage like, I'm feeling unfulfilled in this particular area, I need this variety to be able to round out how I can show up in my business and not just have to, like stop working and go do a hobby for free on the side that is really supportive here. So I don't know if there's still a question on this of like, what's wrong with our field where we can only just do like therapy as as our income here, but for hearing you talk, it seems like some of our listeners who have reached out to us in the past as far as like, what if I don't want to scale up or do all of these things, there's still this really wonderful permission for them to be able to do what you're doing, rock on, if that's what's working for you go with it.

 

Megan Gunnell  17:35

Right. There's nothing wrong with that. I think that's the bottom line. There's absolutely nothing wrong with a single focus, one dimensional private practice where you're just doing one on one client work, there's nothing wrong with that, I want to normalize that, and you can make a great living, you know, and not burnout. But for me, I wanted a different rhythm of my weeks. And so I will, I'll paint the picture. I mean, honestly, for the 10 years that my husband and I were getting on this business idea for him. And I was the primary earner, I was doing seven clients a day, five days a week back to back with no lunch, and I would like eat cheese stick and like some nuts, like, you know, really fast between sessions, I was whipping through notes. I was like, it was like a revolving door. It was just, I mean, every single slot was filled every single day, Monday through Friday, you know, I mean, I would pound it out. And it was just like non-stop, I remember just running to like, refresh my tea, run to the bathroom, like do a very fast note, you know, chew a piece of gum, you know, turn around and open the door and go again. And it was really hard to do that. I'll paint a different picture of what my life looks like now that I've learned how to scale. Yesterday, I saw two individual clients, I did two coaching calls. And I spent two and a half hours in a pottery studio with my husband throwing clay on a wheel so and then we came home and made a great dinner. And we talked to our daughter watched a show and it was like a relaxing, engaging, beautiful, and it was a day and it was more lucrative for me than anything I've ever done previously, because I've learned how to create other streams of income. So I have some that are passive and some that require active engagement. But I really love the flow. I mean, my husband's home today and he said after your podcast interview, we could go for a walk. We could run downtown Detroit for a minute, I have to get my glasses repaired and you know, we could grab a coffee. And that was never possible before. So I mean, I would bang out these seven in a row sessions Monday through Friday, year after year and come home and just feel like don't talk to me. I mean, I remember feeling so edgy with my family that I didn't like who I was becoming. So I feel like a lot of therapists don't want to talk about that. They don't want to admit that that might be happening. I knew I was hitting burnout. 35 a week is ridiculous and let alone doing it for one year, but I kept it up almost a decade. And it was insane. I just I'm grateful for the opportunity to, you know, move into economy of scale. And so if I can serve 100 people and an online course, that I work to make once and I make it, you know, I put a lot of investment into it, but I, you know, can get that as passive income, then that affords me an opportunity to have a different kind of lifestyle. And that's, for me, very satisfying.

 

Curt Widhalm  20:31

You talk about your transition from doing that direct client work to what it takes to have this because we all know on this podcast that it's not just like, hey, here's a new avenue of my business, it actually takes some work. And it takes some mistakes, too,

 

Katie Vernoy  20:50

A lot of work, let's just, it takes a lot of work.

 

Curt Widhalm  20:54

It's not a side hustle, it's an additional hustle.

 

Katie Vernoy  20:57

Mm hmm.

 

Megan Gunnell  20:59

It is. Well, for me, it was easy, because I live on Facebook. And so for me to build a Facebook group, and start that community where I started really engaging, and really listening to my audience to find out exactly what their problems and struggles were, and what their wins and victories were and where they needed support or help. I was spending every minute that I had, you know, on Facebook, between sessions after sessions in the evening, early in the morning, trying to understand and learn about this community. And as I did that, I started to think about what I was hearing. And then I built an offer based on what I was hearing from my audience. So when I do coaching for people, and I talk about how to build passive income, or additional streams of income, I always start with this message, you have to listen to the audience in front of you. And prior to having the Thriving Therapist Community where I was serving all these therapists, I was listening to my audience of clients. And so that's where the first retreats were born. That's where my first group therapy groups were born. And they came from hearing over and over, the same kind of echoed cry from my clients that which was what I wouldn't do for a weekend away. Like I'm a stressed out busy working mom, and I'm overwhelmed and what I wouldn't give, you know, to, like, have a have a weekend for me where all my meals were taking care. I mean, they wrote the retreats for me. You know, they're like, if I could get a massage, if I could do yoga, I could have, you know, great food and just go away for the weekend and come back feeling refreshed. I was like, you got it.

 

Katie Vernoy  22:38

There you go.

 

Megan Gunnell  22:39

You know. So that's part of that is you hear that? You know, in your audience.

 

Katie Vernoy  22:44

Yeah, I think that's interesting. Because when you talk about being on Facebook all the time, I was going like, wow, that sounds awful to me. So I was like, well, that's not for me. So that's good to know. But I think you you did talk about there's a lot of different ways to listen to your audience. There's so many therapists that I'm sure you talk to that Curt and I talk to you that have all of these things, whether it's a course that can augment the work they're doing with their therapy clients, if it's retreats, any of these things like they have a clear need. And yet they still don't feel like they can do it. And so that that's the part where, first off, we're saying, Oh, hey, you can do it and still keep your therapy practice, you don't have to stop being a therapist, maybe just put a balance back, or so that you can still serve some clients and have more of a balanced lifestyle. You can also add this extra element of yourself of creativity and diversity of work schedule, and all of those things. And people are terrified. What are what do you think that's about?

 

Megan Gunnell  23:45

I think that it's about not having the confidence, the know how the accountability or the roadmap and I think a lot of therapists really want a guarantee, you know, if they're going to put a lot of time and energy into doing something like this. They're really hoping that it's going to pay off. And I was too when I believe me when I put down a $17,000 deposit for the first Costa Rica retreat I ever hosted. I looked at my colleague and I was like this is either going to be wildly successful, or the most expensive vacation we've ever taken. Oh, yeah, you know, it's a little scary. Yeah, to do super scary. Super, super scary. That's part of it. And I think, honestly, part of it is just time. I think a lot of people are waiting for the right time to do this and sort of like waiting for the right time for anything right? There's never really a right time to have a baby or right time to go back to grad school or right time to buy a house or whatever. You're just doing these things and kind of folding it into your busy you know, crazy busy life. A lot of therapists feel overwhelmed at the idea of scaling and they don't have a clear roadmap. And so without that or without accountability, it becomes very easy. difficult, I think to move these thoughts into action, you know, so a lot of times people will be thinking about doing some of these things for a really long time. But I love to move them from thinking to doing and that that takes a little bit of support.

 

Katie Vernoy  25:14

Yeah, exactly.

 

Curt Widhalm  25:16

Hearing all of the successes that many people in our space occupied a lot of the steps that we've done to get to where we are with our various projects, podcast courses, conferences, summits, this kind of stuff, we're very easy to share all of the successes that we've had, what are some things that you struggled with or had some mistakes along the way that even with a good roadmap just didn't work out? And how did you handle those?

 

Megan Gunnell  25:44

I'll tell you about one that really stands out. And this was very early on, as I was, I was a brand new therapist, and I wanted to build a music meditation evening at and use our group space at the group practice office that I was, you know, working at, and my dad had said to me, Hey, you know, after you run that thing, why don't we go out for dinner that night? And I was like, sounds great. You know, I said, Why don't you just come you know, so I invited my dad to come, I brought my harp, I played the harp, and I was like, really kind of missing the music part of my life. And I knew that I used to provide music meditations all the time for patients in pain, and, you know, labor and delivery and hospice. And I brought the harp to the bedside, and I kind of like was just missing a little bit of that wonderful music offering. And so I was thinking, this will be cool, I'll make a flyer, this is like back in, like 2005, or something. Like, I'll make a flyer, and I'm going to hang it up. And I'm going to tell a few clients, and I'm going to have this, and I'm going to host this thing, I ended up setting it all up, I put chairs in a circle. And I was like, super excited about it. And I thought maybe they would just arrived like I would just have this roomful of people, and they would just be there ready to pay me for this thing. They were just like, attended, there was no registration. There was no like, you know, pay ahead, I had no idea what was gonna happen. And so dad, in a room full of like 30 chairs, and me and my heart, and I just kept looking at him. And he's like, I think people might still be coming. He's like, it's kind of maybe it's parking. He was like, so nice. Nobody came, oh, it was just this emotionally wounding thing for me. But what I learned from that is, you have to put things in front of people in a way that makes sense, you know, and you have to put it in front of them without stress points for registration, you have to have them pay ahead. And you have to know what you're doing. Like, there were just so many lessons that I learned from that. And I'm glad I did it and fell on my face with it. Because I mean, and that's, that's a small example. But it always kind of just reminds me to stay humble. Because like, I think when we're trying to start some of these things, it's just, it's scary and overwhelming. And we're like, Will anybody want it? Will anybody show up? You know?

 

Katie Vernoy  28:01

Well, that leads me to a question? Because I know I've had my own failures, and I won't share them right now. Or they were putting you on the hot seat, not me. I think it's something where that experience might be someone sign. I'm not cut out for this, right? And so how does someone know if they are the type of person that can add something on the side? Or they can scale? Because I think the common thing that said is like, well, all you got to do is scale? And it's like no, not everyone can actually do this, not everyone is set aside, can really do this side hustle or whatever, like it's just not really possible for everyone. Initial failure, I put that in air quotes, clearly was not indicative of your success. And so how does someone know if it's right for them?

 

Megan Gunnell  28:48

This is a great question. There's a few factors that make it right for someone to be able to scale. First of all, I think they should be in tune with how motivated they are. So I like to say like, are you really motivated to do this? Or are you just thinking about it, and then it goes away? Is it kind of like a fire burning in your gut where you just wake up every day thinking about doing something like that, because if it is, then continue to move forward. The other thing I would say is people need to have a willingness, they need to be willing to make mistakes, they have to be willing to learn new things like tech stuff, or marketing stuff, or automation, or funnels or different kinds of systems and payment integrations that sometimes drive you crazy. They have to also have a willingness to stay consistent. And that was part of what drove me to refine my offer and put it out there again, and fill the room the second time I tried it and so that's I think I also have a little bit of like, competitive spirit inside of me. So maybe that's another factor that helps us like, Oh, that one flopped. Well, the next one is going to be like standing room only. You know, I just kind of had this like quest to do it, you know? Yeah, but I think you have to also ask yourself Are you willing to take a risk? Because some of these things involve emotional and financial and mental kind of risks that we take of like, can we really put ourselves out there? And do we really feel like we have something that is worthy of sharing that's beyond that one on one model of care. And if you're creative, and you're innovative, and you're motivated, and you're organized, and you have willingness, then I think you've got everything you need to make it happen.

 

Curt Widhalm  30:29

That part that you're talking about, that really stands out to me, and just kind of reflecting back on some of the projects and stuff that we've done is, it's kind of easy to say, Yes, I am ready to commit to these things, I can maybe financially afford it, maybe not. But it's also having kind of the plan from the beginning to deal with the stress that comes in a new way of being able to, it's easy a year from someplace to be like, Alright, I'm going to chunk down this deposit. And then it's all of the days in between where it's not just kind of that one day where you're turning to your partner. But it's also you know, Katie, and I had tons of meetings leading up to Therapy Reimagined,

 

Katie Vernoy  31:10

So many meetings.

 

Curt Widhalm  31:11

Like, I'm really glad I have a partner on this. That's understanding what I'm going through. But it's also having a plan for that psychological, emotional self care aspect of it as it pertains to this kind of growth.

 

Megan Gunnell  31:26

Absolutely. And it can be a real roller coaster. Every time I was doing I was I used to do open and close cart for my online course until I like emotionally couldn't handle it anymore. And now it's just open. So if somebody wants to buy the, you know how to build a course, or how to build a practice course, they can just go in and buy it. But I used to have these launches. And I hated the feeling of that. Because it was so much build up so much build up, and it was so exciting. And you would throw it out there and like all these people register. And then the second day, you kind of plummet, you know, on day three is even worse, because you're like, does anybody know the card is still open, you know, and then you're coming up to the close. And then tons of people register again. And so you're on a high and like, you just have this horrible, like, high and low. And that was it. That doesn't feel good to me, it didn't feel very grounded, or like it just it wasn't right for me. So I changed the model of delivery. And that's the beauty of owning your own business and making up these things is right, having the creative power to kind of do something different and pivot if it doesn't work for you. So I've enjoyed not doing launches, because it is your right, that emotional and soul care that we have to do as therapists to want to scale and do something bigger and have a bigger impact. There's all that excitement that goes into this. But I mean, to be totally honest, on the other side of it, sometimes it's there's a lot of self doubt. And it can be really scary. And you know, there's times when you're awake at night thinking does anybody want to do this? Was this a really stupid idea, or, you know, that still happens to me too. But again, going back to the recipe of the character traits that I think make it successful for therapists, part of it is that willingness, and part of it is just staying consistent. Because if we can stay consistent to what we're, you know, showing up for and we get it in front of the right people. And we really have listened carefully to what people are asking for and then build something that works. We're either learning about it, or we're executing something successful. And both of those are wins in my mind.

 

Katie Vernoy  33:33

Oh, that's great. We could talk to you forever. We are short on time and you have so much going on. So if you wouldn't mind sharing where can people find you and all the stuff that you're doing?

 

Megan Gunnell  33:45

You can become a member of the Thriving Therapist Facebook community, and you can find me at thrivingwellinstitute.com. We do have the Thrive Summit coming up in May, so I can't wait to meet you in person Curt it's gonna be great. And that's a wonderful opportunity to get part retreat part inspirational learning summit, and it's gonna be just a fabulous four day experience out in the red rocks of Utah so I can't wait to learn and be inspired and get a maybe a mud wrap or something while I'mout there too.

 

Curt Widhalm  34:16

One of the things that I love about the summit is a that I'm speaking there but the be that you very intentionally put like there's no learning going on at this time. This is the there are built in times to the schedule of like, go swim, go exercise, go biking. Go don't Yeah. And I really like that balance. You know, we did not do that with the therapy reimagined conferences and you know, there's always that that director's choice of like, are we trying to fill it all with education or and I really appreciate that you're creating that balance for your attendees there.

 

Megan Gunnell  34:59

I'm excited about that. And I did that with a lot of intentionality because I knew that I could hear from the audience that was in front of me that people were really burned out. And people were really desperate for a break and they want it to feel restored. It isn't like your typical type of conference where you're going back to back into session after session and you leave and you're a little overstimulated or wiped out by the end. I wanted people to leave feeling rested and refreshed and able to implement what they did learn in a very select few presentations. I didn't want it to be like, you know, 50 different presentations in four days. I wanted it to be like nine, you know, so they can leave and really, really execute something successful.

 

Curt Widhalm  35:42

Awesome. We will include links to all of Megan's stuff in our show notes. You can find those over at MTSGpodcast.com. And follow us on our social media. Join our Facebook group if you're not yet a member of the modern therapist group. And until next time, I'm Curt Widhalm with Katie Vernoy and Megan Gunnell.

 

Megan Gunnell  36:00

Thank you so much.

 

Katie Vernoy  36:01

Thanks again to our sponsor, Dr. Tequilla Hill therapist.

 

Curt Widhalm  36:05

If you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill has created and curated a wellness guide specifically with deep compassion for the dynamic personhood of the psychotherapist. Subscribe to Dr. Hills offerings at Bitly forward slash stay well guide that's bit.ly/staywellguide  and you can find many of the inspiring offerings from Dr. Hills 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.

 

Katie Vernoy  36:42

Once again subscribe to Dr. Tequilla Hills How to Stay Well While you Work Therapist Wellness Guide at Bit.ly/staywellguide.

 

 

 

Curt Widhalm  36:52

Hey everyone, Curt and Katie here. If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more.

Katie Vernoy  37:15

If you don't think you can make a monthly contribution no worries we also have a buy me a coffee profile for one time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymea coffee.com/moderntherapist. Thanks everyone.

Megan Gunnell  37:37

Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

 

Mar 07, 2022
What’s New in the DSM-5-TR? An interview with Dr. Michael B. First
44:37

What’s New in the DSM-5-TR?

Curt and Katie interview Dr. Michael B. First, MD, editor and co-chair of the American Psychiatric Associations’ DSM-5 Text revision, coming out March 2022. We explore: What are the differences between a full update and a text revision? What changes have been made (and how were these changes decided)? What new diagnoses can we expect? Can clinicians continue to use the older DSM-5? How can clinicians advocate for changes in future versions of the DSM? All of this and more in the episode.

Interview with Dr. Michael B. First, MD

Michael B. First, M.D, is a Professor of Clinical Psychiatry at Columbia University, a Research Psychiatrist in the Division of Behavioral Health Sciences and Policy Research, Diagnosis and Assessment Unit at the New York State Psychiatric Institute, and maintains a schematherapy and psychopharmacology practice in Manhattan. Dr. First is a nationally and internationally recognized expert on psychiatric diagnosis and assessment issues and has conducted expert forensic psychiatric evaluations in both civil and criminal matters, including the 2006 trail of the 9/11 terrorist Zacarias Moussaoui. Dr. First is the Editor and Co-chair of the American Psychiatric Associations’ DSM-5 text revision, Editorial and Coding Consultant for the DSM-5, and the chief technical and editorial consultant on the World Health Organization’s ICD-11 revision project. Dr. First was the Editor of the DSM-IV-TR, and the Editor of Text and Criteria for DSM-IV and the American Psychiatric Associations’ Handbook on Psychiatric Measures. He has co-authored and co-edited a number of books, including the fourth edition of the two-volume psychiatry textbook, A Research Agenda for DSM-V, the DSM-5 Handbook for Differential Diagnosis, the Structured Clinical Interview for DSM-F (SCID-5) and Learning DSM-5 by Case Example. He has trained thousands of clinicians and researchers in diagnostic assessment and differential diagnosis.

In this podcast episode we talk about latest updates for the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5-TR.

With the upcoming release of the new DSM-5-TR, Curt and Katie reached out to Dr. First, the editor and co-chair of the American Psychiatric Association’s DSM-5-TR, to find out what’s new and how the DSM committee works.

“During the development of [DSM-5-]TR, George Floyd happened, and our entire consciousness about systemic racism became sort of raised. Then the question was, are there things in the DSM that are reflective of this kind of systemic racism? So, we actually created a committee that went through the entire DSM.” – Dr. Michael First

What changes have been made in the new DSM-5-TR?

  • Text revisions occur to avoid letting the text become stale while supporting ongoing updates.
  • New disorders, specifically Prolonged Grief Disorder, have been added.
  • New codes, modeled off symptom codes, created for documenting suicidality and non-suicidal self-injury with another diagnosis.
  • New categories of Unspecified Mood Disorder.
  • New Criteria set for Autism Spectrum Disorder which is more conservative.

How are cultural differences addressed in the DSM-5-TR?

  • Starting with DSM-IV, there has been a special committee created for culture and culture related issues
  • Hypothetically, the criteria sets should apply to everyone, but in the text, there is a section on Culture Related Features which is more specific.
  • The impact of the George Floyd protests inspired the creation of a new committee to look for systemic racism, lack of nuances, and prevalence issues within the DSM.
  • There are conflicting opinions if “transness” should be included in the DSM and if it’s even a mental disorder.
  • As the DSM is a diagnostic tool to code for insurance, the DSM takes the stance that the Gender Dysphoria diagnosis stay included so individuals can have access to medical intervention and treatment.
  • The Steering Committee for new diagnosis is small, but there is diversity.
  • Before a diagnosis is approved, it is posted for 45 days on the DSM website for all, including people with lived experience, to comment and advocate for diversity

What is the Process for Accepting New Diagnose?

  • The steering committee accepts proposals through the DSM portal for new diagnosis
  • Some diagnoses are qualified based on the United States’ continued use of ICD-10, whereas the ICD-11 is more progressive.
  • With Complex Post Traumatic Stress Disorder, some of the criteria from the ICD have been incorporated into the DSM diagnosis of PTSD
  • Proposals are floated around often, but they often don’t have enough empirical research yet.
  • Proposals need to show a pool of patients who don’t fit other diagnoses, a gap in treatment, and a difference from other possible similar diagnoses.
  • New diagnoses will be approved on a continuum, making the electronic DSM-V-TR the most up to date resource.
  • The committee is more conservative in adding a new diagnosis to the DSM because it is hard to remove a diagnosis once it is included.

“I'd say the biggest [change] is Prolonged Grief Disorder… Now for a number of years, the concept of Prolonged Grief Disorder was really a hole in the diagnostic system… patients were out there that… were suffering, so they had some kind of mental disorder… That's not Major Depression, you can have Major Depression, and Prolonged Grief Disorder. But they're not the same at all. Hardly any overlap. So there's a big hole in the system that allows people to come into your office and not have any place for them.” – Dr. Michael First

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

SuperBill

Interested in making it easier for your clients to use their out-of-network-benefits for therapy? SuperBill is a service that can help your clients get reimbursed without having to jump through hoops. Getting started is simple - clients complete a quick, HIPAA-compliant sign-up process, and you send their superbills directly to us so that we can file claims with their insurance companies. No more spending hours on the phone wrangling with insurance companies for reimbursement. Superbill eliminates that hassle, and clients just pay a low monthly fee for the service.

If your practice doesn’t accept insurance, SuperBill can help your clients get reimbursed. SuperBill is free for therapists, and your clients can use the code SUPERBILL22 to get a free month of SuperBill. Also, you can earn $100 for every therapist you refer to SuperBill. After your clients complete the one-time, HIPAA-compliant onboarding process, you can just send their superbills to claims@thesuperbill.com. SuperBill will then file claims for your clients and track them all the way to reimbursement. By helping your clients get reimbursed without the stress of dealing with insurance companies, SuperBill can increase your new client acquisition rate by over 25%. The next time a potential client asks if you accept insurance, let them know that you partner with SuperBill to help your clients effortlessly receive reimbursement. Visit thesuperbill.com to get started.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Purchase the DSM-5-TR  

Learn about the DSM

Learn about the Changes for the DSM-5-TR

Dr. Michael First’s Email

Dr. Michael First’s Website

Dr. Michael First on Wikipedia

Provide Feedback on the DSM

Submit Proposals for Changes to DSM-5

Relevant Episodes of MTSG Podcast:


What the Grief Just Happened?

Antiracist Practices in the Room with Dr. Allen Lipscomb

Trans Resilience and Gender Euphoria

Death, Dying, and Grief with Jill Johnson-Young, LCSW

On the APA Guidelines for Boys and Men

What to Know When Providing Therapy to Elite Athletes

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Consultation services with Curt Widhalm or Katie Vernoy:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

 

Curt and Katie  00:00

This episode of the Modern Therapist Survival Guide is brought to you by SuperBill. interested in making it easier for your clients to use their out of network benefits for therapy. SuperBill is a service that can help your clients get reimbursed without having to jump through hoops. Getting Started as simple. Clients complete a quick HIPAA compliant signup process and you send their SuperBills directly to us so that we can file claims with their insurance companies. No more spending hours on the phone wrangling with insurance companies for reimbursement. SuperBill eliminates that hassle and clients just pay a low monthly fee for the service. Stay tuned for details on SuperBill therapist referral program and a special discount code for your clients to get a free month of service.

 

Announcer  00:42

You're listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm  00:58

Welcome back modern therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all the things that we do. And we have a pretty big milestone coming up in our profession here where the DSM-5 is transforming into the DSM-5-TR. And we are joined today by one of the very instrumental people behind the updates to this Dr. Michael First. He's professor of psychiatry at Columbia University and editor and co-chair of the DSM-5 talking to us about some of the exciting updates that are happening and a little bit of the process behind it. So thank you very much for joining us here today Dr. First.

 

Dr. Michael First  01:44

Really, it's a pleasure to be here.

 

Katie Vernoy  01:46

We're so excited to have you and to have this conversation, we had reached out to our audience for some questions. So we'll try to get to some of those. But our first question that we ask all of our guests is, who are you and what are you putting out into the world?

 

Dr. Michael First  02:00

Okay, so um, I have a position at Columbia University. I also work at the New York state psychiatric institute. I also have a private practice in New York City, and also a forensic practice. That's pretty pretty busy. And I've my main thing to my life has been DSM, I actually got involved all the way back first at the VA that year, DSM-3 came out in 1986, because I did my residency at Columbia, where Robert Spitzer, who is the king, or whatever, he said, he created the DSM, he put it on the map, so I got to work with him. And I've been working with him and also with the person who did DSM for Alan Francis. And so I've been had my finger in some way, shape, or form every DSM. Oh, and I also work on the ICD 11, who has their own classification. And they're just recently updated theirs as well. So I asked to work on that project.

 

Katie Vernoy  02:54

Wow, that's awesome.

 

Curt Widhalm  02:56

So some of us have been practicing a while, my grad school we were on the DSM-4-TR. So I got to see through the transition of DSM-5, but can you maybe provide a little bit of context for what's the goal of a text revision as opposed to a full update and looking at, you know, just kind of jumping into the next number here.

 

Dr. Michael First  03:18

Let me give you a background of how the text, the 4-TR came about, there was those 3-TR, for example, was the first TR. So it's all started way back in 1980, with DSM-3, which was the first version that had diagnostic criteria. When they were working on it, they had this idea that it was just something that psychiatrist would be interested in. When they publish it, it became this huge hit, you know, it's sold millions of copies really transformed the field, people found that very, very useful. And so, seven years later, they did the DSM-3 are now why that wasn't called DSM-4 simply because the DSM are actually linked to the ICD. And ICD 10 was supposed to be coming out in 1992 or so. Here we were in 1987 today, so we're actually this is an in between DSM-3, DSM 4- revision, so that's why it was called the three R, then DSM-4 comes out in 1994. And then after DSM-4 came out, there was a lot of pushback in the field about APA grinding out a new DSM, every seven years, everybody had to learn it. So things really put the brakes on the DSM. So APA made a decision that we're not going to seven years from now, I'll do with the DSM-5 we're gonna wait and see. What the downside of doing that is the text which is 90 something percent of the book is actually text not just the criteria detects is a really good resource for mental health professionals about diagnosis and prevalence doesn't know anything but treatment, but it's kind of like a super textbook in the sense that it's got the top people in the world working on it. They've kept waiting, waiting, waiting DSM-5, which was clearly going to be at least 10 years if not more away. It ended up being closer to 20 years, the text would have gotten very stale. So that was the motivation to do the DSM-4-TR. Or when they did the 4-TR, or they made the decision, so people wouldn't be bent out of shape about yet another DSM only to revise the text, the diagnostic criteria will go into be unchanged, it turned out there for very, very small changes, because a couple of errors has been found in the DSM 4 like, for example, Tourette's, tic disorders had requirement that the, in order to call somebody diagnose somebody with Tourette's, it had to cause clinically significant impairment and distress. That's a standard DSM phrase. So you're trying to differentiate things that aren't problems, from things that are problems, the neurologist got all bent out of shape about that ticks a tick whether or not it causes impairment, it's still a tick. So we, for example, we deleted that, that criteria, but it's very small stuff like that. So that's why the TR really was just a text revision. So DSM-5 didn't come out until 2013. So with DSM-5 came out, it was a complete redo of all the criteria and the text. And then moving forward, what happened was, is the DSM-5-TR, now, now DSM-5-TR is actually different than the 4-TR, because it is this time, the criteria have changed, they've been changing the criteria. And the way that was accomplished was the fact that we now have APA as a process in place to allow changes to be made on an ongoing basis. That was one of the reasons why the DSM-4 criteria were changed was every time they do a revision, it's a huge expensive, you know, hundreds of people involved process and it because you really want to every time there's a change, you want to make sure that changes, it's been well researched, you consider the pros and cons. So it's a big process. So they realized that moving forward, they APA realized that now that we're not stuck using just books, they could actually have changes made in the DSM on an ongoing basis. And that's what happened since DSM-5 came out. In 2013, there's been a number of changes in the criteria set. So the criteria sets in there five to about 70 of them have some changes, most of them are very, very minor, you're correcting tiny errors, but there's some that are significant. So one of the differences, of course, is that when 4-TR are came out, you could say I want to buy that still say that about five here, but you can say I care about the criteria that he diagnoses, I don't really need to see the text. That's not true. This time, the actual definitions have changed. There's a new disorder in the DSM-5-TR.

 

Katie Vernoy  07:39

What are the big important changes that we should know about in DSM-5-TR?

 

Dr. Michael First  07:40

So we've added a disorder it's Prolonged Grief Disorder. So it's much more clinically relevant. The DSM-5-TR, really than the 4-TR was I'd say the biggest is Prolonged Grief Disorder. So you know, when you whenever a new disorders, DSM, that's big news, I've been going through many, many DSM, the press always gets what's the new disorder. So this is a this disorder was has been researched. Now for a number of years, let me the concept of Prolonged Grief Disorder is really a hole in the diagnostic system. So there are individuals who after losing a loved one, normally, you basically adjust at some point, it's always painful maybe to think about the loved one, but you move on with your life. And in that that's a very important part of the grieving process. There are individuals where they're unable to do that they're basically stuck in a grief reaction, month after month. So after a year has elapsed in the person's grieving and preoccupied with grieving, then you could meet the criteria for Prolonged Grief Disorder. So it's can be given until at least a year has elapsed. And these are individuals or a number of individuals who have that problem. And it was really unrecognized, wasn't in the system at all. Now in DSM-5 came out, and there's a pending research appendix in the back. So when DSM-5 was was in preparation, we already knew about this condition, and there was some controversy about how best to define it. So they actually put something in the research appendix called persistent, complex bereavement disorder in the back that is the precursor to what's now called Prolonged Grief Disorder. So it's been around but, So now, after this, we finally got to the point, we felt that the research was clear enough, the case was compelling enough that it would do more harm than good to put it in there. And it went through all the processes within the APA for approval, and it was approved and added to the online version, and now that's going it's in the hardcopy version as well. That's by far the biggest change. Probably the next biggest change has to do with suicide. Now suicide. If you look at the DSM now, suicide is basically a criterion in major depressive episodes, criterion number nine, that's like the biggest suicide of course, as a therapist, what are the most important things that we have to deal with very, very important but the DSM has a little sidelight so to speak. So we felt it was very important for therapists and clinicians and researchers to have a way to indicate the presence of suicidal behavior, independent of depression. Suicidal behavior can occur in a wide variety of mental disorders including no mental disorder at all. So we wanted to have a way to indicate that. So it turns out that there's a mechanism within the ICD 10, which is the coding system. You everybody know that when you write down the diagnostic code, you get paid. That's your that's how the DSM code, that's the code from the International Classification of Diseases, which is a government controlled system, we realize that there are these things called symptom codes in the ICD 10, which are not disorders, but they allow you to list a particular symptom, that is of particular importance. So we actually went and requested from the NCHS, the National Center for Health Statistics to have a new code created for suicidal behavior, current and history of suicidal behavior, and also current non suicidal self injury and history of non suicidal self injury. So there's four separate codes that are now in the book that will allow you, it's optional, obviously, to list those along with the diagnosis. So if you have somebody with Major Depressive Disorder, who's suicidal, you would list both major depressive disorder as a diagnosis. And we also list this special code. In addition, that's so that's a really nice addition. The rest are not quite... so one of them is there's a category that's been added actually restored, called unspecified mood disorder. And what's that? Why is that a big deal? It turns out that, you know, when you first see somebody who has a mixture of mood symptoms, you have to right, you're one of the things about getting paid is you need every time you see the patient or his client, you need to write down a diagnosis.

 

Katie Vernoy  08:32

Yep!

 

Dr. Michael First  08:32

What the person look like during that meeting. So let's say you have your first meeting with a client, and they have this, you know, mix of irritability and agitation and a little sad, what would you call that? And you say, Well, you know, I'm going to have to look into maybe I'll check their history more speak to some other previous treaters, we got to write something down. So what the DSM does in general, when you see someone and you don't know what the diagnosis is yet, either because it doesn't fit into any of the diagnoses, or because you simply don't have enough information. That's where these unspecified codes come from. So they typically do you see somebody who is psychotic, and either you don't have enough time to figure out what diagnosis it is, or there simply doesn't fit in the type of psychosis doesn't fit into any diagnosis, you would write down Psychotic Disorder, unspecified. So for mood, there is Bipolar Disorder, unspecified, and Depressive Disorder unspecified. The question is that person who is agitated and irritable, what is it? What would you call that? And there's some implication, if you wrote down Bipolar Disorder, unspecified, then in their record their medical record, the rest of their life will be something that says Bipolar disorder, when in fact, this may simply morph into a case of Major Depressive Disorder, because irritability and agitation is commonly seen in depression. So the real what we had to do, we introduced a new unspecified category that allows you to be neutral about whether it's bipolar or depression. So that's why it's called Unspecified Mood Disorder, which you can use that you're saying no, I don't know what it is. And I'm not I know it's a mood problem, because the symptom is a mood symptom. But I'm not going to commit myself to say whether it's either depressive or bipolar. So it's a new parking place, so to speak, to put your client before you figure out what's going on in a way that's going to be less stigmatized. And that's great. And if it's a couple of corrections to problems in the criteria, that's one of the ones is Autism Spectrum Disorder. So Autism Spectrum, so if you were called in, when we went from DSM-4 to five, that was a new category that was created that used to be autism, autistic disorder, and Asperger's disorder, there are several different and pdds are different types of autism disorders. For DSM-5, they decided to consider the entire thing a spectrum of conditions. So it's now Autism Spectrum Disorder. And it comes with three levels of severity. So Autism Spectrum Disorder is defined, there are two clusters of symptoms. There's the social interaction, social engagement, awkward social reading, social cue, cues, piece of autism, and then there's this preoccupation with unusual interests or repeating words. So there's two separate dimensions of autism, the autism spectrum, so the criteria set was reformulated. And we had to come up with a new algorithm. Now, the challenge here is Autism Spectrum Disorder is really had a huge amount of interest for the past 10, 15 years because of what appears to be this explosion in cases of Autism Spectrum Disorder. And part of that has been argued that people are recognizing it more, and that's why there's more cases, but part of it is over recognizing anyway, that's the kind of little weird and awkward Oh, they're on the spectrum, that's become a common phrase in the English language. Now, if you watch movies and TV start hearing, Oh, that guy's on the spectrum. So it's become incorporated into language. But it also shows that it's been overused and over diagnosed. So when you.. the diagnostic criteria sets, the prevalence often depends upon how you construct the criteria set. So when you have a criteria set, for example, the test five out of 10, if you were to make the requirement three out of 10, the prevalence would go up a lot. If you were to go up to eight out of 10, you would shrink the prevalence. So those kinds of criteria that give you a number out of a larger number has a big effect on prevalence. So when they reformulated the autism criteria set, they wanted to make sure that the the new criteria set was conservative. So that so the way it works is there are three items for the social impairment piece of it, and four of the interest restricted interests problem, the restricted interest is two out of four, the social one was supposed to be three out of three. But if you look at the criteria itself, it just says, including the following wasn't clear if you had to have all the following or any of the following, or whatever it was intended to be all the following because they were very worried about not inflating the rates of Autism Spectrum Disorder. So the new version now has very clearly all of the following. So that I think is good. I don't know how many people were making that error, but certainly was there to be made. And you opened up to different interpretation. I think those are some of the bigger ones. There's lots of small number of small tinkering around. But I think those are probably the most one of the greatest political interest.

 

Curt Widhalm  16:47

We received a lot of listener feedback and some specific questions as far as some diagnostics that may not be appearing and specifically, some things like Complex PTSD, Developmental Trauma Disorder, Orthorexia, can you explain to our audience a little bit here, as far as what your process is for inclusion, or further research into maybe an inclusion of these in the future? These are things that are being discussed with the APA, and kind of how the decision is made, as far as what do we include? What we kind of continue to  just monitor and see what's out there.

 

Dr. Michael First  17:21

So that's another a change in process when the DSM-5 was done over, however, eight years, they had all these committees, and they would would look what's out there in the literature, and people would write in suggestions. So there's a whole process during the DSM-5 to make lots of major major changes, those committees don't exist anymore. Instead, there's a steering committee. And what the steering committee does is we entertain proposals for new new disorder. So the Prolonged Grief Disorder, even though it was in the appendix, somebody had to come and propose that it be added to DSM-5. But when you put together the proposal, that is, on the DSM portal, there's a whole complicated... we they give an indication of what kind of empirical information is required you and submit your evidence of validity, reliability will make your cost benefit analysis is the harm versus the advantages is balanced in the right direction. So yeah, there's some hurt hurdles to go through to get one of these things in there. And the website lays out what those hurdles are. So now, the system is more reacting to what people suggest rather than coming up with diagnoses on our own. So he says, a little bit of a change. So that's now the process. All the changes you've just mentioned so far were suggested, and then ultimately approved, but let's cover some of the ones you met. So right now, there's really no unless somebody were to write in and say I want Complex PTSD in there. We're not going to be considered unless somebody actually outside the system proposes it and makes it formal proposals. Now, complex PTSD is interesting, because the ICD 11 I mentioned in the beginning that I worked on the ICD 11. On past Complex PTSD, they both PTSD and complex PTSD, in ICD 11. So they made the decision to include that condition. Now, the DSM, turns out that the DSM version of PTSD if you compare it to the ICD, PTSD and complex PTSD, they're elements in the complex PTSD, much of that has been incorporated to the criteria set for PTSD. So it's kind of a little blurry with what's and what's not emphasized, is it typically when Complex PTSD was first proposed, it was a type of PTSD that happened in response to chronic early traumatic experiences often ongoing. That was the original concept, but it turns out, this is from the ICD 11. If you look at the ICD 11 definition, even though they say that's often the kind of trauma that causes Complex PTSD, that's not required. That defines Complex PTSD, at least in the ICD. It's like PTSD, plus some chronic changes in the person to soon have a chronic sense of disconnection, chronic inability to social impairments, they basically been changed, the trauma is so extensive, it's almost like change them as a person. So you have more typical symptoms of PTSD like re experiencing, and avoiding things plus these more fundamental differences in the person. Now, some of those complex PTSD symptoms are now in the PTSD criteria set. So that's what I meant by saying that we sort of took some of the complex and added it to the regular one. So that so here's an example where there are a number of examples where the ICD 11 and the DSM-5 differ. And that's one of them, you know, DSM-5 decided to have a single PTSD category that was a little bit more broad, where ICD 11 decided that they wanted to have two. Some of the other proposals, some I've heard some other proposals, but a lot of these proposals that have been floating around, haven't really reached the stage of enough empirical research, really, to be able to be seriously considered for the DSM, they're potentially good ideas, but none of them have been offered as actual proposals, with proposed evidence to be able to be evaluated, but any of those somebody, and if you're any people listening, want to make such a proposal, you go to the way which you could do that. There's a website, which is easy, www.DSM5.org, if you go to that website, that's the DSM website. On the front page, you'll see there's a it tells you how you can make a proposal and what you need to do to fill out the application.

 

Katie Vernoy  21:44

It seems like what you're describing is a process to really allow a feedback loop to the steering committee. And you also described the the DSM as being because it's electronic, being a little bit more dynamic in being able to pick these things up.You know, what is the likelihood that one of these diagnoses assuming they've got the empirical research attached with my ended up in the next DSM like like is that?

 

Dr. Michael First  22:10

Well, to say that there is no next DSM for the time being, it could go in if somebody were to write a proposal today, for Complex PTSD and arguing that the current PTSD isn't covering a very important group of patients that there's a these are the kinds of things you would kind of argument you could make for something like that would include things like the fact that I that diagnosis does exist is hurting people because people are not recognizing it. More so the reason it's hurting them, the treatment for complex PTSD would be different than regular PTSD. That's another part of the compelling case. Another part of the argument is that you need to show that it's somehow distinct from regular PTSD and distinct from other conditions, like adjustment disorder, or, or, you know, this new Prolonged Grief Disorder. So those are the kinds of things you would need to do to make a convincing case, and then you would submit it. And if it goes through the whole process, and was approved, it would now go into the DSM. The hardcopy version, of course, you know, it's not if you buy it, it's not in your version you bought, but the electronic version, it will go into there. So we're in a funny transition now where you have the hardcopy version and the electronic version living side by side. And therefore, if you buy the hardcopy version, you're not, you know, it's it's easy to see the ongoing changes, but APA considers what's approved and in the electronic version to be the official DSM. And the hardcopy, like, the one that's going on sale now is a snapshot of where the electronic version looks like, you know, it looks like now. So everything that's in electronic version is now in hardcopy version. But as things happen, if somebody were to get complex PTSD in there, and it gets in there before the next hardcopy version comes out, then you'll have the situation where it's only on the electronic version, and not in the hardcopy version, but it's it's on the electronic version, you could use it, you know, it doesn't have to be in the hardcopy version to be legitimate diagnosis to make when one of your clients

 

Katie Vernoy  24:03

That's decided then, I'm not buying a new copy, then I'm just gonna get the electronic version.

 

Curt Widhalm  24:11

So when you're looking at the research that's submitted, what kind of thresholds are you looking at here? It sounds like part of this is not only the criteria that's maybe showing up in people's offices, but also some of the ways that things are being treated as some of the factors that you look at in how things are included, how things are rolled out, you're kind of kept under some of the existing diagnostics that are there, but what are you really looking for in the research that people are proposing?

 

Dr. Michael First  24:43

Well, this does not that no one thing I mean, I personally, I'm a clinical utility persons so to me, the most compelling thing is making a case that is going to help people and not hurt them. I mean that person, but that's not sufficient. I mean, you can make a proposal that that's the case but if because there's two things. One is this, say this is a good category to put in there. And then it's how to define it. That's a big problem and lots of concepts are out there. But what would be the criteria set, for example, for Complex PTSD that actually is a distinct group, and wouldn't by accident, include people who don't have complex PTSD? So it's a technical thing is the case for complex PTSD is, like, let's look at what happened with Prolonged Grief Disorder. There's a perfect, so that's already happened. How did that get in there? Well, patients were out there that people were noticing that didn't fit in any of the DSM categories. And they clearly were suffering. So they had some kind of mental disorder. They didn't have as I people say, Oh, well, they have Major Depression. That's not Major Depression, you can have Major Depression, and Prolonged Grief Disorder. But they're not the same at all. Hardly any overlap. So there's a big home system that allows people to come into your office and not have any place for them. So that's the first piece of it, then another compelling thing about comp, Prolonged Grief Disorder is is that psychotherapy that has specifically been developed, it's a variation when a CBT for treating Prolonged Grief Disorder that's been successful. So that's another compelling reason not only are you calling it something, but you have something to offer your clients by saying, Well, this is the recommended treatment. So that's the kind of argument you know, the DSM, it's very the spin, especially since DSM-4 detector, in fact it was a paper that came out before DSM-4 came out called holding the line on diagnostic proliferation, it was very easy, used to be very easy, it sounds like a good idea, we go into the DSM, a couple of problems is that once a category gets into the DSM, it's very, very, very hard to get it out. There's been very few diagnoses which have been deleted, because always some constituency says you will ruin my practice if you get rid of this diagnosis. So that's why knowing that it's easy to get in easier to get in than to get pulled out, you really want to make sure that things that are in the DSM won't need to be pulled out because you've too hastily added. I think there's been kind of a much more conservative view about putting categories in the DSM nowadays than there were back in 20, 30 years ago.

 

Katie Vernoy  27:13

We also got some some questions and we've had some conversations actually recently about diagnostic criteria that potentially needs to be adapted to fit a more diverse population or an understanding of the diversity in our population. I'm just curious, how culture, other demographic differences, all that all the things, how those things have been addressed in the the text revision, but also kind of the the concept around how you're making sure that the criteria, the descriptions all of the pieces really align with a very diverse population that we that we live in?

 

Dr. Michael First  27:50

That's a great question. In fact, there's been major efforts, since DSM-4, there was a special committee starting with DSM-4 for culture, culture related issues, how disorders present differently in different cultures. Now, the criteria sets are hypothetically supposed to be vanilla, that apply across all cultures, the way you deal with cultural variations in the text is one section called Culture Related Features. If you look at the content of that text, it's very specific than in this population and may look like this. So it's trying to show how that variability is taken into account. But it's an opportunity to let me tell you about a very important thing that we did with the TR that was basically, it's very interesting was they taking your during the development, During the development of TR, George Floyd happen, and our entire consciousness about systemic racism became sort of raised. Then the question was, are there things in the DSM that are reflective of this kind of systemic racism? So we actually created a committee that went through the entire DSM, looking for, um, not necessarily races as the most extreme case, but things that were not quite nuanced enough, like very often, you know, like, the big one of the big problems, of course, it's like what is race anyway? But that is because you're, you're an African American, are you really different than other people? If you are different, like very often in the DSM, the prevalence section will say this, if we break it down by ethnic group will say of depression in blacks is this and in Latinos Is this the question is why is it different? Is it because of biological reasons among these groups is out twice as if it is a different life experiences? It's lots of huge amount of data that the the disadvantage social settings for some of these groups, is the reason why they're different, not something essential about being Black or Latino. So that was one of the things when they went through the whole book, they're looking to avoid giving a message that something about the race itself is what's causing it to happen. So the way they dealt with it, is that they have a statement that says it's this in blacks and it's not and an extra sentence that says, this difference is likely due to differential exposure to racism or things like that. So it was a very, very thoughtful way of trying to make it clear and de emphasize it also get rid of stigmatizing statements, that to the whole, the whole book went through that thing, and that was really triggered by the awareness that was that was not originally part of the original plan of the TR it was the fact that that happened during the process. A new committee was been doing the process. I'm glad that we had enough time was early enough in the process, that we're able to get it in the DSM-5, I was a little dubious. But we they worked really, really hard that committee to be able to go through the all areas of the text revision to make sure it it worked for across culture, and also not not taking the certain minorities, stigmatized,

 

Katie Vernoy  30:54

Were any of the diagnoses assessed in that way and determining whether those diagnoses were appropriate across all the different demographic considerations. So one that comes to mind specifically, we recently had a discussion on Trans mental health and Gender Dysphoria is one that that kind of is a requirement to be able to kind of move forward with some of the things for transition. And it was interesting, the conversation was like, Well, I'm not dysphoric it's it's socially, you know, kind of everyone around me is dysphoric about my gender, I'm not and I have to kind of go through this process of saying that I'm dysphoric in order to get the letter that I need for the hormones or whatever, were there, or are there plans to look at kind of the impact of diagnoses or how diagnoses are put together and the impact on folks that are in in typically marginalized populations?

 

Dr. Michael First  31:44

Well, culturally, I think Trans is a special case, I could get to that whole issue of should trans even be in the DSM. I mean, lots of people in the Trans community don't consider it a mental disorder. So let's get general, we do consider that like Conduct Disorder is a good example, about a lot of the items and Conduct Disorder in minority populations living in high crime area, it's normal, it's like adaptive to do some of the items in the Conduct Disorder criteria sets. And we don't want to give people who are trying to adapt to their typical environment a diagnosis simply because in a different population, it advantage suburban population, it would be evidence of pathology, so you get into text for Conduct Disorder has things in there and the criteria sets get adjusted to drop items that might be overly influenced by culture and not apply to other cultures. And now Trans is a different story. So...

 

Katie Vernoy  32:38

Okay

 

Dr. Michael First  32:38

Let me get into that. So the name is also changed DSM-5, it's now called Gender Dysphoria. It used to be Gender Identity Disorder, that's what it was, is up to DSM-5, so they actually changed it from Gender Identity Disorder to Gender Dysphoria to make it less stigmatizing it was felt that saying, there was something wrong with your identity, there's a disorder and your identity was much more stigmatizing than saying that you're upset or it's creating a dysphoria. The fact that the term used in the ICD for this condition is Gender Incongruence, which is very well descriptive term, it's the sense that your assigned gender and your experience gender are incongruent. So the recent the problem, is it. So the individual they say, Well, I'm not dysphoric. I agree, you could say that they shouldn't get any mental disorder. But there's a big problem. How do you get qualified for treatment? Unfortunately, we live in a country, there's lots of things that are very harmful, like, you know, marital strife, child abuse, you can't get paid if you put a code for marital relationship problem on your billing form and submit it, nobody's gonna cover it because the insurance companies and the government have made a decision, unwise in my perspective, that's not my call, to not inlcude, not cover things that are not really ensuring the way they look at us insurance is for medical conditions. That's the basic concept, we're not going to, for example, if you want to get plastic surgery to make yourself look better, and make you feel better, their government says we're not going to cover that because that's sort of a cosmetic thing, even though it makes you feel better. You're not treating a disorder, to have a nose job, for example. There's a whole bunch of things that the government doesn't want to cover, unfortunately, basically, in the ICD, everything is outside of the disorder section, you won't get covered for. Now Gender Dysphoria is in the mental disorder of section, actually, therefore, you could qualify for treatment. If they were to remove it from the DSM entirely, then you would never be able to, insurance companies would not, not to say the insurance companies are happy about covering it, but they would really have a weapon to say well, if it's on the DSM, we have no obligation to cover so what what happened in the ICD 11 which I saw just came out they had the same problem, but they had a different solution. The ICD 11 is all of medicine not just mental disorders. So they had the option of moving Gender Incongruence out of the mental disorder section and moving it somewhere else so that it could still get paid for. And where did they move it, they created a new chapter called Conditions of Sexual Health or something like that. And therefore they were able to put it there. And now it's a condition that could get paid for. The United States, which is still using ICD 11. United States still using ICD 10. So there's no place in ICD 10 to move it. So that's why we're kind of frozen in the situation of it continuing to be in the DSM in that spot, for very utilitarian reasons. I mean, I'll give you another example, somebody who actually heard this case, person had sexual reassignment surgery, and broke took it off as a tax deduction under the health thing. They were challenged by the IRS, they said, Oh, no sex reassignment surgery is a cosmetic procedure, you can't take a deduction for that's their attitude.

 

Katie Vernoy  35:59

Wow

 

Dr. Michael First  36:01

It's  very tricky, because again, they don't want to cover things. So it's a balance, yes, it's stigmatizing. But on balance, is it better to deal with the stigma, by virtue of the placement in the DSM, or not have the services covered anymore, we're kind of stuck, there's some talk about moving maybe to a different spot in the DSM to try to help with that. But the code, still, the code, and the code is still mental disorder code. So until the ICD code actually changes, it's going to, it's gonna be a mental disorder, we don't have any control over that. That's the government.

 

Katie Vernoy  36:35

Sounds really complex.

 

Curt Widhalm  36:37

So if I can kind of synthesize down some of the important points that I'm hearing here is, in this process, you've taken some of the criticisms from the field of the DSM and made it more inclusive. As far as feedback opportunities for professionals. It's not, you know, committees hidden away in dark rooms, you know, twirling their mustaches, or running their fingers and just, you know, being the arbiters of mental health diagnostics. But one of the major things that I want to emphasize that you've brought up here a couple of times, is that there's a lot of parts of the DSM that are not just the diagnostic lists, that people should read from time to time. And I think that outside of maybe some of the psychopathology classes that grad students have to go through, we sometimes forget that and that a lot of the information that we do break up in our conversations that the text parts, this is the major emphasis of the text revision here is go and read these parts. And it probably answers a lot of the questions and criticisms that we have from the field. And now, more so than ever, it's had an opportunity for a lot more people to at least make suggestions and that feedback has been looked at.

 

Dr. Michael First  37:51

I can't agree with you more they criteria pretty bare bones. So yeah, on their own, they lots of could discuss argue about what what generally means that's what the text is there for. The text allows you to explain what they are, how do you assess it? As I said, the text is like 99% of the words in the DSM and the criteria, maybe 1% or less. So the text is extremely important. That's why we did the text revision. The difference to the from the last one is we did just leave it to the text, we also have the criteria. But you're absolutely right. Many of these things we dealt with, like this whole thing about systemic racism, if you look at the criteria set, there's nothing in the criteria in the TR, that would indicate that we did anything having to do with our sense sensitivity to race. That's all in the text.

 

Katie Vernoy  38:35

So to that point, I wanted to check in on a couple of things, because it seems like there's an opportunity for anyone anywhere who's able to do some research make the case they can submit to the committee. But I'm curious about who's at the table who's who's on the steering committee? And are you including folks that is there a diverse population of folks, there are other people with lived experience that are giving feedback, like how are you making sure that there's enough folks at the table to make sure that you continue this process of assessing how you're not managing just not even just culture, but also the lived experience of being autistic or, or other areas of neurodiversity? That there are folks who have psychotic symptoms that are weighing in on some of these things? And what the presentations, those things? I mean, it just it seems like there's, there's such a huge opportunity to have a lot of perspectives. How are you navigating that internally with a steering committee?

 

Dr. Michael First  39:33

Well, the steering committee is very small, then it goes to a committee are experts, there are women on the steering committee, and there are people who are African American, but it's still Well, obviously, just because there's one African American and a couple of women, it doesn't mean all perspectives are covered. We realize you're not simply a bunch of white guys making the decisions here. Got it tomorrow to the to where but you're making it where do we get those other perspectives? Well, the way we try to deal with that is before when something gets like, lets this go to Prolonged Grief Disorder is a good example. That category was controversial because there are a number of people who felt that you're calling people who are having normal grief, you're calling them having a disorder. And there's a lot of pushback against that category. So what we did is when before somebody gets into the final DSM and approved, it gets posted on the DSM-5 website for 45 days, it's open for comment and we get lots of comments. And that's really the opportunity for people with lived experience to say, you know, you, you clearly didn't take into account this aspect that I live with this, if you didn't get it to committee would read all of that. If they make a good case, then they could change it. Absolutely. So that's the way I mean, being on this tiny group of people who make the decisions. Unfortunately, the limit to how diverse we can make this, there's not that many people, but there are many layers. I mean, even within the American Psychiatric Association, it's got to be approved by this thing called the APA Assembly, which is sort of like Congress, so to speak, with lots of diversity built into that. And then so the so many different levels of approval, that's where some of the diversity comes in. It could it could be make it more, maybe, but that's what we're able to do.

 

Katie Vernoy  41:15

Well it seems like there's also an opportunity to reach out to diagnostic communities when when a new diagnosis is being presented to make sure that you're getting some of that feedback, it seems like there's there's mechanisms in place, my hope is that there's also efforts to connect with folks with lived experience or those elements so that people can really be ready to take on that 45 day period.

 

Dr. Michael First  41:37

Right? That's actually quite how do we, We do our best to publicize it. Yeah, but you're right, it'd be great. In fact, we've done that before, I think that this particular case, with Prolonged Grief, I think there are organizations, you know, patient groups, we could go to them and say, you know, like, we made a change in the psychotic section, or clearly, individuals have lots of experience. NAMI and, those kinds of groups. So there have not been any changes, you know, recently that would affect that. But that would be obviously something we would want to do is to go perfect sure that they're aware that the change is there and give them an opportunity to give their feedback.

 

Curt Widhalm  42:14

Where can people find out more about you and your work?

 

Dr. Michael First  42:17

I have a website at Columbia, at Columbia, every faculty member gets a website, I happen to have a Wikipedia page. So you could look at that. My email, I don't keep my email addresses secret. That's one thing. I mean, it was very interested in me working with this, if I have to contact an expert to get their email address could be incredibly difficult. You take them in and you type an email. It's nowhere you have to. I don't know why people are so afraid to have their email address public. But I mine has been public. It's been public the entire time I've been in the field. And I'm happy for people to let me know what they think.

 

Curt Widhalm  42:54

And we'll drop Dr. First's email in our show notes. You can check that out over at mtsgpodcast.com. And we'll include links to a couple of other episodes where we've had some relevant guests in the past talking about things like Prolonged Grief Disorder and some of the other things that we've done and follow us on our social media. Until next time, I'm Curt Widhalm with Katie Vernoy, and Dr. Michael First.

 

Katie Vernoy  43:21

Thanks again to our sponsor SuperBill.

 

Curt Widhalm  43:23

If your practice doesn't accept insurance super bill can help your clients get reimbursed. SuperBill is free for therapists and your clients can use the code SuperBill22. That's Super Bill two two to get a free month of SuperBill. Also you can earn $100 For every therapist you refer to super bill. After your clients complete the one time HIPAA compliant onboarding process, you can just send their super bills to claims@the superbill.com. SuperBill will then file claims for your clients and track them all the way to reimbursement by helping your clients get reimbursed without the stress of dealing with insurance companies SuperBill can increase your new client acquisition rate by over 25%.

 

Katie Vernoy  44:06

The next time a potential client asks if you accept insurance, let them know that you partner with SuperBill to help your clients effortlessly receive reimbursement. Visit thesuperbill.com to get started.

 

Announcer  44:18

Thank you for listening to the Modern Therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Feb 28, 2022
How Therapists Promote Diet Culture: An interview with Rachel Coleman
37:47

How Therapists Promote Diet Culture: An interview with Rachel Coleman

Curt and Katie speak with Rachel Coleman, LMFT, CEDS about what therapists should consider in working with clients who have eating disorders, the impact of society on body image, and how clinicians can increase their competency in an area many feel they are lacking.  Why do so many clinicians feel under trained in treating eating disorders? How do societal views impact our client’s body image and what is the impact of diet culture? Does a lack of graduate education in eating disorders ethically impact our ability to treat eat disorders in a non-specialized practice? What’s missing from our understanding of eating disorders? All of this and more in the episode.

Interview with Rachel Coleman, LMFT, CEDS

Rachel Coleman, LMFT, CEDS is a Licensed Marriage and Family Therapist and Certified Eating Disorder Specialist. Rachel received her Masters in Clinical Psychology from Pepperdine University, and shortly after began working at an Eating Disorder treatment center in Long Beach, CA. After five years of working as a Recovery Coach, Primary Therapist, and Program Director in treatment, Rachel shifted her work into private practice where she aids her clients in embodying daily the principals of eating disorder recovery. Rachel is also a certified Dialectical Behavior Therapist and has completed extensive training in the Intuitive Eating dietetic approach. She is a former board member of the International Association of Eating Disorder Professionals, through which she is certified as a Certified Eating Disorder Specialist. Currently, Rachel practices out of her private practice in Orange County, CA.

In this podcast episode we talk about working with clients who have eating disorders.

In honor of Eating Disorder Awareness week, we spoke with Rachel Coleman about the nuances in treating eating disorders and how clinicians can most effectively treat these clients within private practices.

“We live in a society obsessed with diets and bodies. And so I think it's very easy for subconscious beliefs about food and bodies to infiltrate sessions, because it's subconsciously in us and so it can come out in our language.” – Rachel Coleman

What do clinicians do when therapeutic interventions might trigger eating disorder behavior?

  • Many interventions call for physical activity that might trigger eating disorder behavior or feelings in clients.
  • If a client wants to participate in a physical activity intervention, consider their motivation.
  • Ensure that a client has multiple tools in their anxiety toolbox.
  • Be mindful if the modalities and treatment recommendations are based in fat phobia or weight stigma.

How can clinicians assess their clients for an eating disorder?

  • Eating disorders can present meeting full DSM-V criteria or, in many cases, seem at the “subclinical” or mildly clinical level.
  • Evaluate how your client feels about societal messaging and the impact it might have on them.
  • In assessing clients, look to determine the impact of behaviors and patterns on daily functioning. If client’s are sacrificing other values to focus on weight or body, it should be discussed.

How can clinicians increase their education in treating eating disorders?

  • Clinicians need to do their own work surrounding their bodies and internalized messaging.
  • Therapists should focus on learning about the complexities of eating disorders and the social justice movements that surround weight stigma and fat phobia.
  • Familiarize yourself with the ideas of body trust, body neutrality, and health at every size.
  • Many treatment centers offer free webinars to educate clinicians in eating disorder treatment.

“Let's face it, all of our clients have a body. And all clients are therefore going to have to figure out a relationship with their body regardless of eating disorder
diagnosis or not.” – Rachel Coleman

What are the ethical and legal considerations in treating eating disorders in a non-specialized private practice?

  • Always get consultation.
  • Some clients might present with “subclinical” or mildly clinical levels of an eating disorder.
  • There is a difference between asking questions and treating the answers.
  • Clinicians should encourage clients to see a medical doctor when necessary.
  • Working with dieticians and medical doctors to create a holistic team, best serves the client.
  • Clinicians should be aware when to refer to a higher level of care.
  • Therapists should limit self-disclosures

How does Diet Culture impact our clients?

  • Diet culture is a mindset and system of theories we all exist in, that credits a person’s shape and size as the primary indicators of health and moral superiority.
  • When bodies don’t meet these “standards” of beauty as societally defined, they are often oppressed.
  • Messaging about dieting and our bodies is inescapable in our society, so it’s easy for subconscious beliefs about food and bodies to infiltrate sessions.
  • Therapists’ self-disclosures should be limited and focus on affirming client’s experience.

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

SuperBill

Interested in making it easier for your clients to use their out-of-network-benefits for therapy? SuperBill is a service that can help your clients get reimbursed without having to jump through hoops. Getting started is simple - clients complete a quick, HIPAA-compliant sign-up process, and you send their superbills directly to us so that we can file claims with their insurance companies. No more spending hours on the phone wrangling with insurance companies for reimbursement. Superbill eliminates that hassle, and clients just pay a low monthly fee for the service.

If your practice doesn’t accept insurance, SuperBill can help your clients get reimbursed. SuperBill is free for therapists, and your clients can use the code SUPERBILL22 to get a free month of SuperBill. Also, you can earn $100 for every therapist you refer to SuperBill. After your clients complete the one-time, HIPAA-compliant onboarding process, you can just send their superbills to claims@thesuperbill.com. SuperBill will then file claims for your clients and track them all the way to reimbursement. By helping your clients get reimbursed without the stress of dealing with insurance companies, SuperBill can increase your new client acquisition rate by over 25%. The next time a potential client asks if you accept insurance, let them know that you partner with SuperBill to help your clients effortlessly receive reimbursement. Visit thesuperbill.com to get started.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Rachel Coleman Private Practice

Rachel Coleman MFT Instagram

Rachel Coleman’s Podcast: Mom Genes the Podcast

National Eating Disorder Association

International Association of Eating Disorder Professionals

 

Relevant Episodes of MTSG Podcast:

Navigating the Food and Eating Minefield

An Incomplete List of Everything Wrong with Therapist Education

How to Stay in Your Lane to Promote Diversity and Inclusion

Health At Every Size

Who’s in the Room? Siri, Alexa, and Confidentiality

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Consultation services with Curt Widhalm or Katie Vernoy:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

 

Curt Widhalm  00:00

This episode of the Modern Therapist's Survival Guide is brought to you by SuperBill.

Katie Vernoy  00:05

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Curt Widhalm  00:34

Stay tuned for details on SuperBill's therapist referral program and a special discount code for your clients to get a free month of service.

Announcer  00:42

You're listening to the modern therapist survival guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm  00:57

Welcome back modern therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about the things that we do in our office. Sometimes the work that we do with our clients and always exploring the ways that we can do better for our profession and helping with clients. And this week is Eating Disorder Awareness Week. And it's been a while since we have talked about eating disorders here on the podcast, and wanting to explore a little bit about some of the ways that we can potentially know where our limits are in working with these populations. We do have a couple of earlier episodes that we'll link to in our show notes. But today we are joined by Rachel Coleman LMFT, CEDS, I went to grad school with Rachel so somebody that I have known for quite a while but bring it on the experts to talk about things that we don't have expertise on ourselves. So thank you very much for joining us, Rachel.

Rachel Coleman  02:03

Thank you for having me. This is a fun 1520 year reunion here. I don't know how long is it? Think it's getting up there?

Katie Vernoy  02:12

Yeah. Oh, wow. So excited to have you here. And for this conversation. The first question that we ask everyone is who are you? And what are you putting out into the world? Sure.

Rachel Coleman  02:23

Like Curt said, my name is Rachel Coleman. I'm a licensed marriage and family therapist, and that CEDS is a Certified Eating Disorder Specialist. I have a private practice down here in Orange County, California. I treat eating disorders and all the underlying issues that present along with eating disorders. What am I putting out there in the world? I mean, I suppose I've dabbled in social media. But really, my passion is just in one on one, individual therapy, I really believe in that secret therapy space where clients can identify and break their personal and family legacies around bodies and food and diets. I really believe that helping that what we would call in our line of work the identified patient heal really has a ripple effect. It helps the older generations do their own deconstruction and healing. And then it also I'm hoping changes the future of the next generation. So I really do believe in that that beautiful therapy relationship and the ripple effect that occurs when a client is able to do that awesome work.

Curt Widhalm  03:32

And one of the first questions that we usually ask is for a learning place, this is not to necessarily shame anybody but the experience that you have. And I've maybe even in grad school, I think you were working in eating disorders. If I remember our practicum classes correctly, that you put around for a while, what do you see that therapists get wrong in working with eating disorders?

Rachel Coleman  03:59

I mean, I think that therapists and everyone live in a very diety culture. We live in a society obsessed with diets and bodies. And so I think it's very easy for subconscious beliefs about food and bodies to infiltrate sessions, because it's subconsciously in us and so it can come out in our language. And diet culture is a term that's thrown around a lot. So I can give your listeners a little bit of a definition. My definition of it is, it's a mindset and it's also a system of theories that we live in, that really credits a person's shape and size as the primary indicators of health and also a moral superiority. So basically, with a diet culture, thiness is valued above other body types. Foods are usually described with moral terms like good or bad, healthy or unhealthy. And unfortunately, bodies that don't meet this projected ideal of beauty they have often been oppressed. So when we are just growing up and still living in a culture that holds this belief system, it can easily be something that we don't even realize that we're drinking the Kool Aid of, and it can come out in our conversations or in our perspectives. So often I hear unfortunately, clients share with me things that therapists have said that were really kind of harmful or hurtful, even if it feels like it's nothing big. So for example, I've heard people share that therapists have discussed working out or going to the gym and sessions, or like I said, therapists are on social media these days. So sometimes they will post their workouts or their runs. Even if a client is talking about exercise or going to the gym, even a little like typical quip in our society of like, Oh, I'm so terrible about going to the gym, brings in that moral superiority in a very subconscious way. Or even kind of walking across the room to like, open the door, get a book being like, well, at least I got my steps. And, and I think anything that kind of once again, perpetuates this belief system of working out is good or not working out is bad, or anything like that automatically becomes a place where maybe a client doesn't feel safe, because that's the exact work that they're trying to do. This also comes out with food, you know, if therapists are talking about their chronic dieting, or saying phrases like, oh, I struggle with my weight, I get it. Or feeling like foods, if they don't believe that foods are neutral, and they are coming out in sessions with conversations about oh, trying to eat healthier, or foods are good or bad. Basically, sharing personal experiences about fad diets, or even lifestyle changes. And using air quotes. Anything that kind of just continues to perpetuate these beliefs about food and bodies can really create a space where a client doesn't necessarily feel safe to interrupt any patterns or behaviors that they have been suffering from. So overall therapists not having done the work themselves, to deconstruct their beliefs can come out in those conversations.

Katie Vernoy  07:23

What you're saying is, makes a lot of sense. And I'm finding the bias that I have from society coming up. And so I want to if if it's okay with you, I want to play with this a little bit, because there's a question that I've had for a while. And it's hard to know how to manage it. I was in grad school longer ago than the two of you were. And a lot of the especially around depression, a lot of the treatments were activity, making sure that you're, you know, drinking enough water or eating appropriately, you know, kind of having enough food, but also having healthy foods. I mean, and I have my air quotes going to, I think it's, it's hard for me to know what is promoting health, being active is considered healthy. That was my understanding. I think eating foods that are nutritious and nourishing, I think is considered healthy. And so I can, I'm understanding that element of let's not make this about moral judgments if we do things that are in alignment with what society calls healthy or good, but I'm, I'm struggling to identify how we support folks without that playing in and what what is okay to talk about, like, that's, that's hard for me to find that line.

Rachel Coleman  08:42

Mm hmm. I agree. And I, I do DBT. And in DBT, there's a lot of similar types of modalities that we recommend. So I understand that. Absolutely. There is a fine line and some of those things are very, very helpful for combating depression. So yeah, yes, I think the the, the fine line that I always am navigating in conversations with clients when we're trying to figure out self care, because that's kind of what you're talking about. Sure, is the motivation behind it. So I think often, if the motivation behind it is, well, I'm gonna go do those things because I am trying to change my body, or because I'm trying to pursue the weight loss, or because I, you know, one's gonna hear quotes feel fat, then what you're looking at is how do you deconstruct the motivating factor behind the behavior, rather than okay? There's nothing wrong with going for a walk or a jog or going to the gym, especially if the motivating factor is it's that endorphin release that helps ease the anxiety and there's nothing necessarily about the body that's coming into play. Or once again, if that is the only coping skill in the box for anxiety management, well, how do we brought in the skills within the box. Maybe here and there, there's an exercise element to anxiety management, then there's also 10 other things, so that it can be this just more well rounded whole person thing. And I think this is where if a therapist has done their own work, and then able to have some of these really deeper conversations with clients, they're able to realize whether or not what they're upholding in their modalities or in the recommendations, is based in any internalized fat phobia, in any weight stigma, and kind of is, what's the ethical fine line that we're helping people walk? Does that answer the question a little bit?

Katie Vernoy  10:38

It does. I have some more questions. But let's dig deeper in, I see Curt ready to jump in here,

Curt Widhalm  10:43

You mentioned a couple of times about therapists doing their own work. And in this regard, and for many of us, the education that we received on eating disorders in graduate school was minimal, if anything, what some suggestions as far as doing your own work on this, that our audience might be able to walk away with?

Rachel Coleman  11:04

Sure, I mean, obviously, doing your own personal work on what are your beliefs about food bodies and weights, and doing that either in your own personal reading or journaling or therapy? And as far as you're right, there is very little education. I think we got a one hour lecture. That's all I remember personally. So it's it's definitely insufficient. And I think that absolutely doing more webinars, podcasts, taking any courses you can anything about the complexities of eating disorders, and also anything that focuses on the social justice movements surrounding weight stigma, that teaches cultural awareness and sensitivity towards viewing bodies and sizes, encourages this concept of Body Trust and body neutrality. Those are kind of modalities that we try to work from, how do you trust your body? And how do you honor your body, anything that's aligned with Health at Every Size, which I know you guys have spoken on in the past, most even sought treatment centers regularly offer free webinars, virtually, there's local IADEP, that chapters you can get certifications in intuitive eating. So you can do a lot of extra work on your own. I also recommend, obviously, if you're interested in this field to start working at and even sort of treatment center work at the highest level of care that you can try to get in with because when you are in the trenches, in these inpatient residential settings, you're going to get just an immersion of so much education. And that's kind of where I started my work.

Katie Vernoy  12:41

It seems like there's a lot more knowledge that a therapist would need to really be able to effectively treat an eating disorder. And I also know that there are a lot of folks that have disordered eating are fully immersed in diet culture, and have some of the kind of subclinical or mildly clinical levels of this that I think all therapists need to know. And it to me, I've had some clients who came in for something completely else, and then we're on weird diets. And, and, and also hated their bodies and had really negative self talk really harsh, critical negative self talk. And so I've sought consultation and done other things to try to support that, and referred where appropriate, but I think the the pieces that were critical for me to know at first, were kind of this assessment of figuring out, is this someone that's maybe drinking too much of the diet culture Kool Aid? Or is this someone that has an eating disorder and needs that more specific eating disorder treatment, you have some suggestions for clinicians, who are maybe needing to assess their caseload because you know, when we're recording this, it's the new year, you know, there's a lot of people on diets and fats, and this and that. And so I think there's, there's a need to really understand and assess appropriately to as a start,

Rachel Coleman  14:06

I think you bring up a great point, it sounds like you're doing awesome, work yourself, of just continuing to hold that space, because that's let's face it, all of our clients have a body. And all clients are therefore going to have to figure out a relationship with their body regardless of use for diagnosis or not. So I agree, and that's why I also think that grad schools should absolutely talk to you about this way more, because your every this is something that's going to come up with every single client regardless of their presenting problem. So yes, because all of our clients live in this world, and we live in this world, they're constantly sending the messages to change their body, the impact of that messaging will vary. And so you're right, you're going to have to kind of evaluate where the client is on the impact of this messaging, and then the how much they're applying this diet, culture messaging, when wherever we can just open up this therapeutic space to be a comfortable place for a client to process their connection with their body, their relationships. With the scale, the trust they have with their hunger and fullness cues, with their body size and shape, whatever past or present body insecurities that they have, and how it's impacting their ability to function. Now, ways that they've used food to cope with those feelings, any internalized beliefs they have about their body from past bullying from childhood from parents, you know, what, what was it like at the family dinner table for them growing up was their family dinner table, and just all of the different layers of what how a client feels about food and their body, every client has to eat five, six times a day, you know, they have to learn how to dress their body, how to take care of it, how to get good sleep. So I think having a safe space with that neutral, that neutral energy is a really great space. So anyway, that kind of is touching on that piece. As far as the assessments concerned, I think you're really looking at the impact of any behaviors or patterns on daily functioning. Anytime a client is choosing to focus on weight or body and sacrificing other things that are aligned with their value system, then it starts becoming something where, okay, obviously, this is becoming your priority. And I don't think your priorities are in alignment right now with everything else that is really important to you and makes up your identity. And so we have to kind of make sure that then at that point, whatever these behaviors and patterns are, become some of our primary goals and focuses to treat. And if again, if that feels like it's something that starts feeling it's out of your scope, because the client feels out of control, they're not able to pull back anything, they're not able to easily make those tweaks and go oh, yeah, you're right, wow. So curious, I'm going to try something different when it feels like it is fear base that they're doing these behaviors and patterns, they can't make those changes easily. It's impacting their ability to be in social relationships, go to work, choose other things that are important to them. And then you're probably looking at something that's a little bit more deeply embedded

Curt Widhalm  17:03

In my experience, and I've gone to a lot of these workshops at various conferences and treatment centers over the years and have really noticed just kind of my sensitivity as a clinician to a lot of the things that you're talking about. But it seems like if there's three categories of people, the people who have the bare minimum of eating disorder, education, and then to the gold standard of eating disorder treatments, the CEDS, there's kind of this dangerous place in the middle of thinking that you're further ahead in the work, that I don't know if I'm in that dangerous spot or not. But at least being aware of where that edge is.

Katie Vernoy  17:45

Yeah, you and me both buddy.

Curt Widhalm  17:48

It seems like this is a time that that's really ripe to be making some of those mistakes that you're talking about. And a big part of what we talk about on the podcast here is about being a little bit more transparent with your life. And you brought up social media earlier and some of the ways that clients might have access to therapists life in some of these ways before, do you think that this contributes to maybe some of that fear of treating eating disorders and a lot of the population is that having to look at ourselves in the way that we're putting ourselves out there? It's just easier to pretend that it doesn't exist.

Rachel Coleman  18:25

Maybe Yeah, you're right. There is a dangerous space. And yet, I'm absolutely not someone who's like don't even go there and leave it to the experts like, again, because all clients have a body, everyone is going to have to have some element of conversation about this. I think there are a couple of reasons why many therapists feel apprehensive about treating this and they're not sure what to do and part of it yet is I think that a lot of people secretly know that maybe they don't have peace with their own bodies, or they do have some of that secret fatphobia or they have their own struggle with free behaviors. And they're, they're concerned about their ability to stay neutral not have any transference or countertransference that are impacted their therapeutic relationship. So you're right. I think it's one of those things where it's like, in order to feel like you're navigating this, you do have to have a sense of peace and neutrality in your own personal life. That is really, really important. I also hear a lot therapists say, like, I could never do that, like I just like food too much or I just I just don't get it and it's like, Okay, again, no, I think whatever, whatever that fear is underneath that is probably something that needs to be healed yourself because you are human who also grew up in this space. I think the legal ethical pieces are the most probably concerning with treating eating disorders. I think that is where it's dangerous probably to use your word and then also where people can really shy away because there is that medical liability that can present along with an eating disorder. And there's, it's so embedded in us to be like, check for safety, check for safety. And like, the first course we have in grad school is that law and ethics course which like, I think most people are like, nevermind, we're not going to do this entire grad school program, this is almost like quit right that in there. You know, I think it becomes something where it's very, it's very scary to think, Okay, I am now treating someone who there potentially is a safety concern and medical liability on the line here. So while yes, that space, right there is I think we're client. I mean, I'm sorry, I think that space right there is where therapists tend to completely shy away. And trust me, I consult nonstop with licensing boards and treatment teams, and there's a lot more wiggle room than you think. We I also am almost always with a treatment team. There's almost always a dietician on board and a medical doctor on board. And then most often that we are also referring to those higher level of care. So the impatient and anything to get them the stabilization needed so that we can continue treating outpatient. And then I also think that people under think them, and that is where the dangerous space comes in. Again, people kind of just think, well, you know that behavior is normalized in our society. So I'm not concerned about it. And they forget to ask questions about, you know, heart rates, or sleep or how much water clients are or are not drinking, or the clients are saying that they are eating out. But therapists aren't asking, Well, how much are you eating? And what else are you taking? And they're not asking the little detailed questions that if you start kind of having an awareness of how even shorter is present, then you're able to realize, oh, this might actually be more severe, then my brain kind of caught on initially.

 

Katie Vernoy  21:42

I know for myself, when I've had clients that have started to have behaviors that were of concern, and I pulled out into a team I was, I was honestly surprised by some of the information that hadn't been shared. Part of it is I'm not a medical doctor. I'm not a dietitian. So I'm not necessarily asking really, really specific questions. And my this is leading to my question. But like some of the medical questions, I don't think to ask I'm not a medical doctor, but it sounds like you're saying maybe we should. And so I guess the question is, how do we ask some of these questions and stay in scope of practice?

Rachel Coleman  22:21

I think asking questions is different than like treating the answer. Okay, you know, okay, so I think I often ask, how does your How does your heart feel when you sit or stand up? Oh, it's funky. Okay, let's go, let's make sure you definitely go to your doctor, I want you to go to the doctor and have that conversation, and then I'm going to have you sign the release, I'm going to consult with the doctor because I think we need to make sure that that's okay. Or if it's a female, ask, when's the last time you've gotten your menstrual cycle? Okay, it's been three, four months. All right, you know, I want you to go to your doctor, an OB GYN and get that checked out. Because that's, it can be a sign of malnutrition. And so I want you to make sure that that is ruled out or ruled in so we know how to proceed. And you know, how many laxes and diuretics are you taking again, this is just intake information for me, I'm not, I'm not just reading it, but I'm knowing what I'm what sitting on my couch. And I'm knowing what I need to recommend to do next.

Katie Vernoy  23:14

And maybe that's the that's the part that's challenging, knowing what to do next. I mean, it's easy just to say like, anything that's wonky, goes to your doctor, and and so that that feels like, that feels very doable.

Rachel Coleman  23:25

And then get that release, get that release, because again, we're I can't read labs, right. So if a client gets gets the labs and is like, I got my lab work here, it is like that. That's way out of my scope. So make sure that information is so because I need to ask the doctor what these numbers mean. And I need to know what the doctor so a huge piece of outpatient care with disorders is a lot of times on the phone consulting with other members of the team.

Curt Widhalm  23:53

And I changed the conversation a little bit here to the client end of things and why you see that people with eating disorders don't necessarily seek out treatment.

 

Rachel Coleman  24:04

Yeah, I think there's a huge shame cycle. That is, you know, in rotation here, a sense of going I am scared to talk about how out of control I feel about certain behaviors. And then I also feel a little protective of those behaviors, because they probably came into fruition to protect me from something protect me from weight stigma from trauma, they eased my anxiety. And so it feels like you're asking someone to give up their greatest resource and also their greatest source of misery. And there's, I think, a lot of shame that clients identify that they are in this cycle and they are kind of stuck in this space. And it's it's, it's makes them hesitant, I think, to to seek out that treatment because they're going to have to lay it all on the table and kind of figure out what they need to tweak.

Curt Widhalm  24:56

How do we as a profession kind of contribute to some of the those fears?

Rachel Coleman  25:03

That's a great question. I'm sure there's a sense of trying clients feel like we're, we're so hyper focused on the behavior, that we're maybe pushing them to give something up that they're not ready to give up. And so it feels like they have, they're held accountable, which again, is that fine line of like, of course, we want them to feel like there's some sort of safety and accountability in sessions. But we also don't want to give them ultimatums or feel more ashamed. If they did struggle, that behavior in between sessions, so that then they're going to be avoidant of coming in processing what's going on. So then holding that safe space to say, this is really hard. This is a really, really challenging, complicated cycle to break. And I'm going to keep my fears of liabilities and legal and ethical stuff at the door. So I can hold a safe, neutral space in the room for you to kind of process through where you're at and how we can continue to support you.

Katie Vernoy  26:03

To me, it seems like the risk elements are the things that therapists probably could get tripped up on pretty quickly, you know, especially if they've got a long standing client who's showing up with some of these behaviors, they're getting out of control. And I know, probably a number of therapists that are listening, you know, that was a pandemic thing. Clients that had been fine had an eating disorder long, long ago, all of a sudden, it popped back up during the pandemic, and now they've got this long standing relationship, and referring out feels a little bit daunting, and not advised. Right. And so I think it's, for me, I think the thing that would be helpful is talking through some of that risk, like, When is it okay to kind of allow the client to be in their process? And when is it like no, no, this is a danger. Like, I need to take some big steps.

Rachel Coleman  26:52

I mean, I'm not a legal ethical expert here. Call your licensing board. I...

Katie Vernoy  27:00

But, but when would you call your licensing board, I guess is what I'm asking.

Rachel Coleman  27:04

I think what it comes down to a sense of like, is this client medically able to take care of themselves and safe in between sessions, that is 100%, a call to licensing board, I've been calling you right, the licensing board more and more and more since the pandemic started to like more than ever, because aces are more cute than ever. And one of the biggest challenges to treating as far as right now is that the inpatient residential high levels cares have two, three, maybe more month waitlists. So you have someone who needs to be in a hospital and they can't get in for weeks. Well, you're not going to terminate care, obviously. But also, now you're treating a client who's potentially not appropriate for outpatient. We've been I've been having a lot of very candid conversations with clients treatment plan contracts, which is going based on how you're presenting, this is the course and plan of treatment that is recommended. These are the steps I want you to take. This is the timeline we're both agreeing on. And if the treatment plan isn't able to proceed as we're discussing, then it's not going to be a good fit for us to continue to work together. So I have lots of very candid conversations, I have contracts for safety. I have lots of case consultations, I have mandatory requests for clients to be seeing an dietitian how many times a week or a doctor how many times so that there is a sense that there are multiple eyes on the person. So we do a lot of conversations about that, just to kind of try to make sure that clients are getting the containment and the support and they need while also staying safe. And also working with the system that we're kind of living in right now in the pandemic, which is not unfortunately a rapid, imperfect one.

Katie Vernoy  28:51

Well, on the other end of things, if someone's fasting, or someone is restricting or purging or those kinds of things, I mean, those things are not going to change overnight. And I think people get fearful because if someone throws up twice a day, is that a medical risk? If they throw up once a week? Is that a medical risk if they're fasting every other day? Or if they're restricting down to a certain amount? Or? It seems hard to know, like, at what point do I need to ring these bells? At what point do I need to either try to seek inpatient or whatever it feels like there's this nebulous area where some of it is like, intermittent fasting as a diet that's going on right now. Right, you know, restriction and deep restriction has you know, I saw in a, this was many, many years ago, but restricting calories down below a certain point for long periods of time was shown to have health benefits or something like it was like it was it's it's stuff that doesn't make sense. There's also the whole medical model that's giving us information that doesn't align with this anti diet culture. And so I think for me, it's It feels hard to sort out. When is this? I'm holding space and we're talking about it. And when is it hey, I need to get this person to a doctor or say like, No, you have to change this, or else I'm terminating you.

Rachel Coleman  30:14

This is where the board would say, you've got a lot more wiggle room than you think. This is where the board would say like, Well, yeah, I mean, you're not necessarily doing anything illegal by seeing someone who's purging X amount of times. But as quickly, how can we do no harm? How can we support the client to getting better, and are they able to change and contain and shift this harmful behavior in our current therapeutic plan, I think the examples you just listed, absolutely warrant a higher level of care. That is something I would probably easily identify based on how you're presenting based on your frequency of symptoms, I, you definitely need a high level of care. Now let's talk about what the plan could be to get you there. And if it takes a few weeks, I'm here. And if it takes a little while to convince you, then let's talk about Stages of Change. Let's talk about pre contemplation. Let's talk about all the other things that we can talk about and spend time exploring, while still holding a boundary of listen, I think that you need more support than I can offer you in order to get this, these things changed. And these things are scary. And medically, it's not okay for your body. And so I can't just sit here and be like, we're gonna process how you feel about this. For weeks and weeks on end, we have to kind of hold that fine line. You know, it's funny, you say that about like, when should you refer to the doctor? I mean, for me, that's just kind of my standard, like, if you're going to be seeing me outpatient and you have a diagnosable disorder, you will be in a team, I am not going to be the only provider. Makes sense.

Curt Widhalm  31:51

One of the big trends in our fields is the role of lived experience that a lot of clients are seeking out and kind of looking at the the ways that some of the therapist behaviors that you're talking about earlier, can trigger clients, do you have any recommendations for people with lived experience as far as how to walk this line and being able to talk about their own perspectives of having received ED treatments in working with clients who are presenting with ED related behaviors.

Rachel Coleman  32:21

So what whether clients should share they're in recovery,

Curt Widhalm  32:24

Whether a therapist, yeah should be talking about their own experiences in recovery.

Rachel Coleman  32:31

I mean, I do think that a lot of clients do feel better if a therapist is able to identify and reveal that they are recovered themselves, and they've been there. I don't know if details are needed, I think it can be one of those things where it's, you're really what you're really trying to validate is the client's pain. You know, I can see your pain, I have some experience with my own pain, I will never feel yours, though yours is unique, yours is your own. But I know that this is a long process. And I know that things are hard. And I have empathy. And I validate your experience. I don't know if therapists need to go into details about their own stuff. Because the nature of an even shorter is to be highly competitive, and to be comparing a lot and comparing, when you're in an even shorter only makes you feel worse, it never makes you feel better. I think you definitely want to make sure you're not triggering clients eating disorder brains to start doing extra, you know, comparison and calculation. But maybe a general sense of I validate and see your pain. And I also know that recovery is possible. Because a lot of times when a client's struggling, they don't think that there's hope. It doesn't feel like there's a light at the end of the tunnel. And so if there's things that the therapist can say that will make clients feel hopeful and know that recovery is possible. And I think those things are really therapeutically benefit official, but probably best to keep personal disclosures out of the therapy room.

Curt Widhalm  33:57

One last question is looking at the way that ED is taught. What would you add to curriculums to help people better be able to be prepared in working with this kind of a client population?

Rachel Coleman  34:13

That's a great question. I think I think what's missing is the complexities of how eating disorders present. I think we get there like little box DSM criteria. But we don't really get the fact that every single eating disorder is as unique as the person. So no eating disorder is the same sitting in a room and being able to ask a lot of these questions that we're kind of talking about, I think it'd be really beneficial for therapists to be educated on the various non stereotypical ways that you disorders present and all the great questions that people can ask. I do talk at grad schools a lot and when I do I bring my intake forms, and I pass out my intake forms for students to look at because one of the things I want to teach them is what questions to ask and what things to look for. And just kind of it basically gives them a better understanding of what you sores even look like on your couch, the various ones, the examples, and all just all the very detailed variety of how these these diagnoses can present so that they're able to recognize it, because otherwise you just get the DSM criteria and the Hollywood movies, which are portraying anorexia in one way. And it's just it's not, it's not sufficient enough.

Curt Widhalm  35:31

Where can people find out more about you and your practice?

Rachel Coleman  35:35

Sure. So my website is www.rachelcolemanceds.com. And that's probably the best bet. Like I said, I suppose I dabbled social media. So you can kind of take some months off, and sometimes I'm like, Oh, I have some thoughts. But my Instagram is at Rachel Coleman MFT. And I have a Facebook page with my name as well.

Curt Widhalm  36:00

And we will include links to that in our show notes. You can find those at MTSGpodcast.com. And you can follow us on our social media come and join our Facebook groups, the modern therapist group and share with us your experiences of eating disorder, education, or lack thereof, and things that you would do to help better our fields when it comes to serving our clients. And until next time, I'm Curt Widhalm with Katie Vernoy and Rachel Coleman.

Katie Vernoy  36:31

Thanks again to our sponsor SuperBill.

Curt Widhalm  36:33

If your practice doesn't accept insurance SuperBill can help your clients get reimbursed. SuperBill is free for therapists and your clients can use the code superbill22. That's SuperBill two-two to get a free month of SuperBill. Also, you can earn $100 For every therapist you refer to super bill. After your clients complete the one time HIPAA compliant onboarding process, you can just send their super bills to claims at the super bill comm SuperBill will then file claims for your clients and track them all the way to reimbursement to help your clients get reimbursed without the stress of dealing with insurance companies SuperBill can increase your new client acquisition rate by over 25%.

Katie Vernoy  37:17

The next time a potential client asks if you accept insurance, let them know that you partner with SuperBill to help your clients effortlessly receive reimbursement. Visit thesuperbill.com to get started.

Announcer  37:29

Thank you for listening to The Modern Therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Feb 21, 2022
What to Know When Providing Therapy for Elite Athletes
01:15:34

What to Know When Providing Therapy for Elite Athletes

Curt and Katie chat about the specific competence required to work with elite athletes. We explore how elite athletes present (including diagnosis) as well as what treatment looks like for elite athletes. We also talk about the training cycles and periodization, developmental stages, and identity formation for competitive athletes. We also look at what healthy training environments include and how athletes can take care of their own well-being.  

In this podcast episode we look at what therapists need to know about working with elite athletes

For our second continuing education worthy podcast, we wanted to support therapists in understanding what they need to know (or know that they don’t know) about working with elite athletes.

The differences between being a fan and being competent to work with elite athletes

  • The types of competence needed to support athletes who are at an elite level
  • Sports psychology and other areas of specialty to support athletes
  • The stringent criteria to be called a sports psychologist

What diagnoses do athletes present with when they enter therapy?

  • Not necessarily anxiety, but it can be anxiety related or unrelated to sport
  • Diagnoses can be related to the sport due to body, substance, or changes in circumstances
  • Diagnoses can also be related to other elements of their life and transitions

What does treatment look like for elite athletes?

  • High school and college athletes are most likely the clients we’ll see
  • The integral nature of their team and who is best to be included in the treatment team
  • Logistics and scheduling due to games and practices, obtaining required consents
  • Training schedules, food information is relevant to therapeutic work
  • The different goals for elite athletes than for other folks who enjoy sports
  • Looking at in the moment frustrations versus a desire to leave the sport
  • Sports assessments to identify athletic coping skills
  • Helping athletes to make decisions for themselves and identify when it’s burnout and when it’s a mismatch

Understanding training cycles and the impact on athlete clients

  • Specific language that athletes may use
  • Periodization, micro, meso, and macro cycles in training
  • The importance of planned growth and rest as well as peaking at the right time
  • The focus of timing for everything
  • How injuries or changes in schedule (like with covid) can impact this timing and what that means for athletes

Developmental factors for young athletes

  • The focus of training for younger children as well as the investment phase for youth
  • Developing one’s identity as an athlete
  • What can positively impact and negatively impact the future commitment to sport
  • Other developmental factors related to being a teen interacting with these developmental elements

What a balanced life looks like for elite athletes

  • Who athletes spend time with, share their life with
  • The hobbies that complement the sport
  • Understanding how maintenance impacts the rest of the schedule

The factors that improve an athlete’s well-being

  • Myths related to the tangential benefits of being an elite athlete (i.e., I’ll get college paid for)
  • The importance of having a therapist who isn’t just a “fan”
  • The differences between team and individual sports
  • The competency needed related to understanding the sport to understand all of the dynamics
  • What good social systems around athletes have in common
  • The understanding of how each person in the athlete’s circle interacts with the goals
  • The culture created within the team and with the people around the athlete
  • Simone Biles and Naomi Osaka – a look at how they have been taking care of themselves

The transition out of being an elite athlete

  • Injury and unplanned retirement
  • Planning for an intentional retirement
  • Moving out of the athlete identity into something new

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

SuperBill

Interested in making it easier for your clients to use their out-of-network-benefits for therapy? SuperBill is a service that can help your clients get reimbursed without having to jump through hoops. Getting started is simple - clients complete a quick, HIPAA-compliant sign-up process, and you send their superbills directly to us so that we can file claims with their insurance companies. No more spending hours on the phone wrangling with insurance companies for reimbursement. Superbill eliminates that hassle, and clients just pay a low monthly fee for the service.

If your practice doesn’t accept insurance, SuperBill can help your clients get reimbursed. SuperBill is free for therapists, and your clients can use the code SUPERBILL22 to get a free month of SuperBill. Also, you can earn $100 for every therapist you refer to SuperBill. After your clients complete the one-time, HIPAA-compliant onboarding process, you can just send their superbills to claims@thesuperbill.com. SuperBill will then file claims for your clients and track them all the way to reimbursement. By helping your clients get reimbursed without the stress of dealing with insurance companies, SuperBill can increase your new client acquisition rate by over 25%. The next time a potential client asks if you accept insurance, let them know that you partner with SuperBill to help your clients effortlessly receive reimbursement. Visit thesuperbill.com to get started.

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

 Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this course here: What to Know When Providing Therapy for Elite Athletes

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

APA Division 47: https://www.apadivisions.org/division-47

Offensive lineman weight maintenance: https://www.theringer.com/nfl/2020/5/5/21246544/offensive-linemen-diet-weight-loss-gain-eating

Some sports psychology assessments: https://premiersportpsychology.com/assessments/

Kaplan, E. (2020, July 6). How NFL offensive linemen escape the 5,000-calorie lunch and transform in retirement. Retrieved on January 30, 2022 from https://www.espn.com/nfl/story/_/id/29399747/how-nfl-offensive-linemen-escape-5000-calorie-lunch-transform-retirement

 

For the full references list, please see the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

Outside Obsessions

Finding Your Blind Spots (Deliberate Practice Part 1)

Be a Better Therapist (Deliberate Practice Part 2)

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is a member of the California Association of Marriage and Family Therapists ethics committee, an Adjunct Professor at Pepperdine University, lecturer in Counseling Laws and Ethics at California State University Northridge, a former Law & Ethics Subject Matter Expert for the California Board of Behavioral Sciences, and former CFO of CAMFT. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, with a Master’s degree in Clinical Psychology from California State University, Fullerton and a Bachelor’s Degree in Psychology and Theater from Occidental College in Los Angeles, California. Katie has always loved leadership and began stepping into management positions soon after gaining her license in 2005. Katie’s experience spans many leadership and management roles in the mental health field: program coordinator, director, clinical supervisor, hiring manager, recruiter, and former President of the California Association of Marriage and Family Therapists. Now in business for herself, Katie provides therapy, consultation, or business strategy to support leaders, visionaries, and helping professionals in pursuing their mission to help others. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

www.mtsgpodcast.com

www.therapyreimagined.com

www.moderntherapistcommunity.com

Patreon Profile

Buy Me A Coffee Profile

https://www.facebook.com/therapyreimagined/

https://twitter.com/therapymovement

https://www.instagram.com/therapyreimagined/

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

 

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm  00:00

This episode of the Modern Therapist's Survival Guide is brought to you by SuperBill.

 

Katie Vernoy  00:05

Interested in making it easier for your clients to use their out of network benefits for therapy. Super bill is a service that can help your clients get reimbursed without having to jump through hoops. Getting Started as simple. Clients complete a quick HIPAA compliant signup process and you send their super bills directly to us so that we can file claims with their insurance companies. No more spending hours on the phone wrangling with insurance companies for reimbursement. Super bill eliminates that hassle and clients just pay a low monthly fee for the service.

 

Curt Widhalm  00:34

Stay tuned for details on SuperBill's therapist referral program and a special discount code for your clients to get a free month of service.

 

Announcer  00:42

You're listening to the modern therapist survival guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.

 

Curt Widhalm