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

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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.

Curt Widhalm, LMFT and Katie Vernoy, LMFT


    • Jan 17, 2022 LATEST EPISODE
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    • 34m AVG DURATION
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    Who's in the Room? Siri, Alexa, and Confidentiality

    Play Episode Listen Later Jan 17, 2022 29:19

    Who's in the Room? Siri, Alexa, and Confidentiality Curt and Katie chat about how therapists can maintain confidentiality in a world of AI assistants and smart devices. What duty do clinicians have to inform clients? How can we balance confidentiality with the reality of how commonly these devices are involved in therapy? Can telehealth therapy be completely confidential and data secure? We discuss our shift in clinical responsibility, best practices, and how we can minimize exposure of clinical data to ensure the confidentiality our clients expect and deserve. In this podcast episode we talk about something therapists might not consider: smart devices and AI assistants We received a couple of requests to talk about the impact of smart devices on confidentiality and their compliance with HIPAA within a therapeutic environment. We tackle this question in depth: What are best practices for protecting client confidentiality with smart devices? Turning off the phone, or placing the phone on “airplane mode” Warning clients about their own smart devices and confidentiality risks The ethical responsibilities to inform about limits of confidentiality and take precautions It's all about giving clients choice and information What should therapists consider when smart devices and AI assistants are in the room? “It's not to say we have to be luddites, it's that we have to disclose the potential limits of confidentiality that clients have come to expect.”  – Curt Widhalm Whistle-blower reports on how often these devices are actually listening Turning off your phone is a lot cheaper than identity theft Consider your contacts, geolocation, and Wi-Fi connection Some of this, as we progress into a more technological world, might be unavoidable How do Alexa and Siri impact HIPAA compliance for therapists? The importance of end-to-end encryption for all HIPAA activities (and your smart device may not be compliant) The cost of HIPAA violations if identity theft can be traced back Understand the risks you are taking, do what you can, and remember no one is perfect What can modern therapists do with their smart devices? “Whether it's convenience or practicality that has you putting your client's contacts into your phone, we have to think beyond that because it really can harm our ability to keep that data safe.” – Katie Vernoy GPS location services can be left on for a safety reason, emergency services use GPS location Adjusting settings for voice activation, data sharing, when apps are running, locations, etc. Turning off and airplane mode are also options Always let the client know the limits of confidentiality Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Buying Time LLC Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They've got you covered. Don't know where to start? Check out the systems inventory checklist which helps business owners figure out what they don't want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/ Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/ 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! Psychotherapy in Ontario: How Confidential is my Therapy? By Beth Mares, Registered Psychotherapist The Privacy Problem with Digital Assistants by Kaveh Waddell Hey Siri and Alexa: Let's Talk Privacy Practices by Elizabeth Weise, USA Today Patient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: An Observational Study of Siri, Alexa, and Google Assistant, 2018 Hey Siri: Did you Break Confidentiality, or did I? By Nicole M. Arcuri Sanders, Counseling Today Alexa, Siri, Google Assistant Not HIPAA Compliant, Psychiatry Advisor Hey Alexa, are you HIPAA compliant? 2018 Person-Centered Tech   Relevant Episodes of MTSG Podcast: Which Theoretical Orientation Should You Choose? Is Your Practice Ready for Paid Digital Marketing? An Interview with John Sanders Waiving Goodbye to Telehealth Progress: An interview with Dr. Ben Caldwell, LMFT Malpractice is No Joke   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: www.mtsgpodcast.com www.therapyreimagined.com 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 sponsored by buying time Katie Vernoy  00:04 Buying Time has a full team of virtual assistants with a wide variety of skill sets to support your business. From basic admin support customer service and email management to marketing and bookkeeping, they've got you covered. Don't know where to start, check out the system's inventory checklist, which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at buying time. llc.com forward slash systems stash checklist. Curt Widhalm  00:31 Listen at the end of the episode for more information. Announcer  00:34 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  00:50 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 things therapy, the things that we consider the things that we don't. And stay is one of those days where we're going to be talking about some of the things that we might not consider. And this really comes with some of those smart devices in our homes, our offices, potentially even in our clients homes, and what it means for confidentiality, especially in terms of compliance with things like HIPAA, and who's always listening. And you know, Google a few years ago changed kind of their motto from do no evil to whatever it is. Now I just know that they're, they're no longer committing to not doing evil. But I want to start with kind of this idea of when we especially start with telehealth clients, but this is also going to be true when it comes to our in person sessions with things like smartphones and just kind of being cool in the modern era and having things like Amazon echoes or Google Docs, or any of these kinds of things in our offices of are those things always listening, and what does this mean for client data?   Katie Vernoy  02:07 That's a big intro. Yeah, I, I've worried about this for a while. And that's why I don't have a any kind of AI in my office, although after reading some of these articles I actually do because I have my phone in my office because I receive messages. And I do all kinds of stuff. So it's a little bit scary to think about what might be listening.   Curt Widhalm  02:33 So I mean, this is where I think any of us who have a Windows laptop, there's Cortana, if you have one of these Amazon devices, there's Alexa, if somebody you know, has Siri, these things are listening. And well, some of the tech stuff, you know, might say that they're only listening for key words that would activate them articles that we're looking at here is what we're going to dive into today. As far as does this mean that our sessions with clients are actually as confidential as we're talking about? And what does this mean for our own best practices as we go forward, having smart devices in our offices in our homes, and potentially even in our client's homes. And the way that this conversation initially came up was I was at a dinner party with some other therapists and talking about great dinner party talk that happens wherever I'm at with other therapists, which is,   Katie Vernoy  03:34 Yeah, only although therapists with me, I tend to   Curt Widhalm  03:37 Get people asking a lot ethics questions. And one of the questions that was up for discussion was our duties when it comes to talking with clients about confidentiality, particularly when it comes to telehealth. And I was describing that we have a responsibility to talk with our clients about the limits of confidentiality, that may include privacy in their own homes, if there's potentially somebody who's walking down the hallway, outside their bedroom or office door, wherever they're doing sessions from, and one of the other therapists at this party said, Well, what about any of the smart devices? Do you ever warn them about Google or Alexa or Siri actually listening? And that's what sparked this. So if you ever want a podcast episode, I am available for dinner parties for you to float ideas by.   Katie Vernoy  04:28 Okay, okay, there we go. And so this   Curt Widhalm  04:31 Has led to some research on our part here as far as what is our responsibility? And what do we need to do with our clients as it pertains to some of this AI discussion, even when we don't think that it's happening?   Katie Vernoy  04:47 Well, to me, when you propose this idea for the podcast, the first thing that came to mind was really around convenience versus confidentiality. Because when we're looking at a lot of these things, When we don't turn off voice activation, when we don't make sure that we're not connected to everything through our phones, and all of the contacts and everything within our phones, data is at risk. I mean, even if it says little as a GPA, GPS colocation, it could be a contact could be content that you're actually discussing. I mean, there's, there's a lot of different ways that folks use their phones kind of just live their lives and the convenience of having Google read through your emails, or, you know, whatever it is to be able to scan for things that need to go on your calendar, or to scan for things. You know, like, I love that I can, you know, in the before times when I was traveling, I loved that Google knew where I was flying to what flight I was on, and I would be able to get that information and notifications like you should be leaving for the airport right now. So I think it's something where the convenience of having the AI tracking us and listening to us and reading our emails, and all of that has sometimes trumped our need for privacy.   Curt Widhalm  06:09 The first article that I came across in this is an article from counseling today. This is publication of the American Counseling Association. This article was by Nicole R. Curry Sanders called Hey, Siri, did you break confidentiality? Or did I in this article, Dr. Curry Sanders actually cites an article from The Guardian newspaper, talking about an apple contractor who's a whistleblower. And this contractor is quoted as saying that they regularly hear confidential medical information, drug deals, recordings of couples having sex as a part of this contractors job providing quality control. So these devices are, at least historically have listened. Now, this flies in the face of what some of the tech articles that I'm seeing out there who say that these devices are only listening for those keywords that activate them, but that they're actually constantly on. And according to this contractors cited in this Guardian article, they are recording and sharing this information. So it's very theoretically easily believed that it's also listening in on your therapy sessions. If that's the case, with Apple having this information, everybody who's got an iPhone, that's either bringing it into your session, these devices are potentially listening to everything that's being discussed in your sessions, which is scary, because I imagine that most therapists are not talking about this as a potential breaking of the limits of confidentiality and the promise of confidentiality that makes therapy so sacred.   Katie Vernoy  07:55 And I think that as a society, we have kind of cosign on this lack of privacy, I mean, Siri, or Alexa or Google or whatever, potentially are, they're constantly listening to all of us. And that's part of life. And so are we, are we responsible above this risk that all of us are willing to take by having phones in our pockets,   Curt Widhalm  08:20 And I don't think many of us are, and we'll include the links to what we're talking about here in our show notes. You can find those over at MTS g podcast.com. The next thing that I'm looking at here is a blog post on psychiatry, advisor.com called Alexa Siri, Google Assistant are not HIPAA compliant, and it warns against. Obviously, we all at this point should know that you shouldn't be doing your notes onto one of these devices using some of these voice prompts. But if this article also warns about don't add clients to your schedule using one of these either because it's not an end to end encrypted sort of device, which is one of the requirements of HIPAA, and that HIPAA violations can cost people hundreds or 1000s of dollars. If identity theft can be traced back to them think of how convenient it is to just turn off your phone. So that way, and how much potential money this may end up saving you by just doing the simplest of things.   Katie Vernoy  09:28 Yes, yes, I again, but I still want to you know, we're I know we're   Curt Widhalm  09:34 Any good one ethics discussion should leave people anxious.   Katie Vernoy  09:39 But my question still stands. If I do my part because I am a HIPAA provider. I put my phone on Do Not Disturb or whatever I airplane mode. I put my phone on airplane mode. I don't have any other devices with listening capability in my room, and I only use my electronic health record for scheduling and communication and HIPAA compliant email, blah, blah, blah, like I do all the things, and my client still has a smartphone in their pocket, like do I actually need to warn them about that smartphone in their pocket, because they already theoretically are agreeing to this constant surveillance. By having that smartphone in their pocket,   Curt Widhalm  10:22 I think that we have a duty. And this is reflected in our ethics codes. And we have a duty to tell our clients even things that they may not consider as it pertains to therapy about, okay, where limits of confidentiality may lie? Well, there may be the constant surveillance of these devices in everyday life, but to further prompt them, at least, and especially in our first telehealth session with them that, hey, just in case you haven't considered this, your smart devices in the room may also be listening to your therapy session. And well, you know, it's not the same thing as a sibling or somebody else, brother, parents child's, you know, walking down the hallway, there is the potential that some of this information may be transmitted to people that you don't want to and if that's a consideration, if you want to unplug those devices in the general listening area right now, now would be the time to do so.   Katie Vernoy  11:24 Okay. I mean, that seems fair, I think there's going to be people talking about this, now that we've put this podcast episode out. So I think we also don't want to freak people out. I mean, I think about also there, yes, the data is being transmitted, but it's kind of like how much data are people actually looking at. I mean, it's, it's such an inundation of all of this surveillance data, that the likelihood of someone honing in on a therapy session feels small as part of quality control. And I'm not saying we shouldn't do anything about it, I'm just saying, I'm gonna. Curt Widhalm  11:59 Wave your argument away and saying that the likelihood of somebody breaking into your office and working at client files is also very small. But that does not absolve you of your responsibility to take the precautions to let our clients know about the limits of confidentiality,   Katie Vernoy  12:17 I think it's I think, in talking about it with clients, the way you just said, it sounded a little paranoid, you   Curt Widhalm  12:22 Are being listened to. Katie Vernoy  12:25 You're being listened to. It's I think there's potentially a clinical clinically relevant way to talk about it. I mean, I think, as you know, smart devices that have voice activation potentially can get activated by words that we use, you may want to turn those on, or turn them off their devices in your room, turn them off, turn off voice activation, whatever. But like, there are devices listening in your room, you may want to unplug them. You sounded a little paranoid. It's true. But But I think we want to I don't know, it just it feels a little bit. I don't know paranoid to me, I don't I don't know what   Curt Widhalm  13:03 Your paranoia is my legal precaution of that. And it doesn't have to be presented in that paranoid sort of way. It's just, you know, hey, it's known at this point, like little disclosure, here, we have a little you know, Alexa thing sitting in our living room, sometimes our TV activates it. And then we get little ads on the Alexa based on whatever show that's activated Alexa. So all of a sudden, we're getting, you know, Airbnb recommendations of, you know, wherever the TV show we just watched was located, it's not that much of a stretch of the imagination to think these things are listening, it's happened a couple of times with my phone, just in this episode, it doesn't have to be done in a paranoia sort of way. It's just kind of a, hey, if your privacy means that much to you, and you're gonna be talking about these sensitive things, you might want to consider shutting off those voice activated things in your room.   Katie Vernoy  13:55 Well, I mean, the other thing that we talked about before starting to record is also the the geolocation and potentially contacts on your phone. And so to me, I feel like, at some point there, if we are going to be in a technological society, there may be things that we just cannot avoid. And maybe I'm wrong. I mean, maybe do I do I just never turn on my phone when another person's in my office, like, I feel like being able to not have, you know, if someone's actually physically coming to my office, and our phones have crossed GPS, and all of our apps say like, Oh, they're in the same room, they must like the same things and then start feeding us all of the ads, on the things that either we've talked about, because voice activation is on, or the things that each other have searched for. I mean, it starts to get a little bit nutty, to like, basically be Luddites at the moments during which we're doing therapy.   Curt Widhalm  14:53 It's not to say that we have to be Luddites, it's that we have to disclose the potential So limits of confidentiality that clients may be coming to expect sharing on a Wi Fi network, if you're a well intentioned therapist who has a parent who wants to be, you know, on the Wi Fi network in your office while their kids doing therapy. That's one way that some of these algorithms work to match up people who should be connected on some of the social media sites, if you've got a client's phone number saved in your phone, and you've given third party apps, the permission to scan through your phonebook. These are other ways that you're potentially transmitting data to people that you have maybe lied to people about in your Notice of Privacy Practices that you give to your clients, if the information that you say that what you're doing with it, and how it's going to be shared. And you're sharing this information in inadvertent ways, I'm not aware of any court cases where a therapist has been taken to court on this, but I could see where a therapist could be held liable by having some of this data shared in ways that they never heard that their Notice of Privacy Practices, you know, they take their boilerplate language from somebody down the street, who took it from somebody down the street, who took it from somebody down the street, who took it from actually a paid layer that they actually were responsible with. So since we tend to copy and paste and borrow and pay homage to other people's paperwork, by just borrowing and stealing, and calling it our own, we may not actually be aware of everything in some of these Notice of Privacy Practices that we give out, if what you're doing is transmitting some of this client data, you at least should document that you've had some of these discussions with your clients, as a way of limiting your liability when it comes to having any of these kinds of devices around you. And if the conversation and your own anxieties hasn't pointed it out. So far, we all have these devices, this should be a regular part of the conversation. And should be something where especially talking about a lot of protected health information, especially if you're already a HIPAA covered entity, you have to be aware of this   Katie Vernoy  17:11 Going back to kind of the original thought that I had around this is that whether it's convenience, or practicality that has you put the contacts in your phone, for example, I think that we have to think beyond that. Because it really can harm our ability to keep those that data say I mean, I think about inadvertently, I have done a really good job at keeping my data away from Facebook, I don't take any of the things I don't log into anything with Facebook, I've tried to keep Facebook fairly separate, as well as I use a really old email. And it's not connected to my practice in any way. I'm not sure that anybody else wants to do that. But they're like, I don't share contacts with any of my social media. So my phone is never mind for those things I actively go through and, and deny those permissions. But to me, it could be very simple, even a slip of your of a button press so to speak, where you've shared all your contact to LinkedIn, Twitter, social media, any other social media platform that you allow all of the permissions on your phone, because it's easier because like, oh, well, I'll find my friends, I don't have to go search for them individually. I mean, there's so many ways that are very seductive, that we could do this in an inadvertent data sharing,   Curt Widhalm  18:33 You know, this is no commentary on you. But you identified yourself not as like a super tech savvy person. And yet, I would say that what you just described is more tech savvy than what most people would think about. And that's why we have some of the responsibilities that we do in talking with clients about how their health information may go beyond just our therapy sessions here. Some of these articles that we've seen talk about, you know, don't do things like write your notes, you know, pay Google write in this patient chart, X, Y, and Z. Like, those things would seem obvious, especially to a lot of our modern therapist community who would be like, yeah, that totally makes sense. But just actually having the presence of any of these devices around us, is, you know, a matter of lifestyle for some people and it's knowing to go in and how to shut off some of these things or be able to talk with some of our clients about this because something that's happened during the COVID pandemic and with a lot of telehealth is, we've also become de facto, it people when it comes to explaining to some of our clients just even how to make some of the telehealth stuff work. And so if you know our EHR platforms, and as simple as they get made before for user experiences, if people are still having trouble with those knowing to go in and where to look on a phone for here's where data gets shared back and forth with each other, well, that might be a little bit outside. The scope of what we want to talk about with clients, it's sometimes more simple as far as if you have these devices. And you don't want the conversation of what we're what we're talking about being shared with any of the apps on your phone. Best practice might be just to turn them off during our sessions. But if you leave them on, just know that we can't guarantee complete confidentiality, that's it.   Katie Vernoy  20:20 That seems fair. Um, one of the things that you said earlier, though, struck me because I think that you and I are like, obviously, we wouldn't, you know, kind of transcribe our notes or, you know, kind of do voice over notes on our phone. But that's kind of an accessibility issue for some folks who can't type or handwrite their notes. And I would be very curious on how to protect in that regard. You know, if I've got a voice recorder, that helps me to do my notes, is it within a HIPAA compliant platform that goes directly into my notes? I mean, this might be things that people need to research is how do all of my apps interact? And how do I make sure that I'm not there's not more than what I'm working on open and listening? Because I think that's hard. And I don't know that I wouldn't say I'm tech savvy, I think I actually am. But I think it's something where understanding how privacy and data works, and how things interact with each other how there's data handoffs, I think those types of things feel like they are beyond the scope of being a therapist, but I like what you're saying is like, then just turn these devices off. I guess the only problem is, I have clients that use their phone for their telehealth session. So I don't know if you know, I use simple practice. So I don't know simple practice, then make sure that other apps on the phone are not listening. I don't know if there's even a way to do that. And or if there is a way for people to, you know, like, do you go through and you just kind of disable each of the apps that you don't want to listen, I mean, it feels like there's, there's a challenge here to really having a practical solution, unless we can be certain that the platform that we're using for our video calls on the phone are actually is actually secure. And my assumption is that's the case, I just don't know what else is listening, if and if that's possible.   Curt Widhalm  22:11 And in preparation of this episode, I did not do a deep dive into how, you know, our EHR platforms when they are used on our devices, more popular EHR companies, simple practice, you mentioned those video sessions, if there is a HIPAA compliance, if they have signed a BA agreement with you, those are end to end encrypted communications. Now, what I did not do a deep dive on is does that also prevent other apps and things from also listening, if it is being used on this solitary device that your session is on TBD? You know, follow us on our social media, or whatever. And we'll sort through that through that. It does come back to this point. And especially as we can see some of these tech companies moving more and more into the healthcare space that they're going to make closer and closer approximate efforts to become HIPAA compliant. And this is always kind of a cautionary sort of thing, where I'm a part of a lot of Facebook groups, with therapists, a lot of online communities, and I see a number of people wanting to do things as inexpensively as possible. But without those ba agreements, as business associate agreements, you're not guaranteed to have the same a HIPAA protections if that data does get leaked out or shared in other ways. And so these are your responsibilities as therapists when it comes to confidentiality and this AI conversation.   Katie Vernoy  23:44 And there's a lot of different ways to try to do that. I was one of you were talking, I was thinking about a conversation I had with Roy Huggins from persons under attack, who unfortunately recently just died. And it's a very tragic loss for our profession. And just the way that he would talk about HIPAA compliance. And I'm sure Person Center tech will continue that work was that you have to understand the risks that you're taking, and do what you can and then be comfortable with a risk you're still taking because he's not be perfect. And so I think it's I think it's, it's hard because it can be very scary, because we can't necessarily get to a place where we've we've taken every single precaution. I mean, we could go to a black site, have everyone come in separate ways, no GPS phones are left at their houses, and then be in a room together and then leave. There might be other liability if nobody knows where you are, and you're alone in a room with a client. But I think as a society, I don't think we can protect ourselves from every single thing. But these are things that we can protect ourselves against. pretty simply, I mean, you just turn it off. Um, I think, and that's something that I don't know that a lot of people were thinking about this. Now,   Curt Widhalm  24:57 One of the questions on one of these articles got asked, I think is worth discussing here is for people who are working at sites that require you to have a cell phone on you for safety reasons, whether it be in the floor of a hospital male use system, if you're working for an agency where you go and visit clients houses or whatever, it's what did you see, in kind of the responses to those articles there,   Katie Vernoy  25:26 The main thing is to turn off voice activation, so that there's not a voice activation element. So it's not recording the content, making your phone, a regular cell phone and trying to get rid of some of the other, you know, kind of the smart elements of it, I think can be very helpful. The thing that you can't avoid, if you're trying to go for safety is really, you got to keep GPS on if you need to make an emergency call, they need to be able to ping your cell phone. And so I think there's there are some, some safety issues or not, there are some privacy issues that you can't avoid if you need to have a cell phone. And it's for safety reasons. But I think it's something where the voice assistant technologies, those things are maybe not that easy to find, but but you can, you know, there's some instructions in this, and I'll put this in the show notes so that you can find it. But you know, turning off those voice activation, making sure that you've made yourself as tight as possible. As far as any kind of data that's going out turning off, you know, all of the apps, making sure there's nothing running in the background, even going through your apps and having the permission set to only while the app is on, I think is helpful, because then if Facebook is tracking your location, and Instagram is tracking your location, and Google and whatever, if those are tracking your location all the time, then there's a lot of data being shared. But if you turn those, if you only have those on when you have those apps open, and you consciously close them before you go in my hope is that they're not also running in the background. I've also had something where I put my phone on really low battery use before where it only allows for phone. So it basically shuts down anything running in the background so that you don't have things going that you don't know about. But you know, if you're wanting safety going all the way to turning it off or airplane mode is going to maybe an advisable for safety.   Curt Widhalm  27:24 And in these conversations and what I would suggest is let your clients know what the limits of confidentiality are. And and this doesn't have to be a huge in depth pieces of conversations. Some of your clients may have more interest in what you're talking about, or paranoia depending on why you're seeing those clients. But we would love to hear your experiences with this kind of stuff or thoughts or considerations that you have. You can share those with us on our social media. You can find links to those in our show notes. And once again, those are over at MTS g podcast.com. You can join our Facebook group, the modern therapist group and spill your data to us and Mark Zuckerberg. And until next time, I'm Kurt Wilhelm with Katie Vernoy and Siri.   Katie Vernoy  28:17 Thanks again to our sponsor buying time   Curt Widhalm  28:20 Buying Time's VAs support businesses by managing email communications, CRM or automation systems, website admin and hosting email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly with a full team of VAs gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available.               Katie Vernoy  28:48 Book a consultation to see where and how you can get started getting the support you need. That's buyingtimellc.com/book-consultation once again, buying time llc.com forward slash book dash consultation.   Announcer  29:04 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.

    How to Understand and Treat Psychosis

    Play Episode Listen Later Jan 10, 2022 38:15

    How to Understand and Treat Psychosis: An interview with Maggie Mullen, LCSW Curt and Katie interview Maggie Mullen, LCSW, a national trainer on culturally responsive, evidence-based care for psychotic spectrum disorders. We talk with Maggie about her anti-racist and disability justice framework of psychosis, understanding psychosis on a spectrum, what to do when psychosis enters the treatment picture, assessment of psychosis, and treatment using Dialectical Behavior Therapy (DBT). We also talk about how society defines “normal” and pathology, exploring cultural differences in these definitions. Interview with Maggie Mullen, LCSW Maggie Mullen, LCSW (they/them) is a clinical social worker, national trainer, community activist, and author of The Dialectical Behavior Therapy Skills Workbook for Psychosis. Maggie specializes in culturally responsive, evidence-based care for psychotic spectrum disorders, trauma and PTSD, the LBGTQ+ community, and formerly incarcerated people. As a training director at Kaiser Permanente, they take great pride in mentoring, training, and supervising the next generation of social workers. You can find them online at www.maggiemullen.com In this podcast episode we talk about looking at psychosis differently We started the conversation on psychosis when we were looking at conspiracy theories. We know that folks who believe in conspiracy theories and those who have a diagnosis of psychosis are different, but knew that we needed a deeper dive into how to understand and treat psychosis. We dig deeply into this conversation in this week's podcast episode: Maggie Mullen's anti-racist and disability justice framework of psychosis “People with psychosis [are] being overly institutionalized… over medicated or highly focused on medication as the sole treatment. And particularly for our… black, indigenous, and folks of color experiencing psychosis, and people who are being shot and killed by police… when they're out responding to their symptoms in a public way, or being incarcerated and not receiving treatment.” Maggie came from a community organizing background Inequity and lack of resources for people who experience chronic psychosis The focus on medication rather than other forms of treatment for psychosis BIPOC individuals being shot by police when psychosis shows up in a public space “Psychotic spectrum” versus the segregation of psychosis as “other” “We are often the least prepared to deal with our most acute clients” The continued segregation of psychotic disorders Cultural considerations when determining what is psychosis or other types of experiences The lack of inclusion of psychosis in the research Psychosis is not “other” but is actually a spectrum of behaviors and are very common The symptoms of psychosis are not constant, they fluctuate for every individual The importance of following the model and voices of the disability justice movement Including education on the treatment for psychosis, rather than allowing therapists to opt out Folks with psychosis are often not included in the research, which needs to change What to do when psychosis comes into the treatment picture for our clients “The reality is there are wonderful outcomes, I think, for people with psychosis, when we look at it from a different perspective. Which is to say – what if some of the work might be on changing your symptoms themselves? But what if part of the work is actually on accepting your experiences so that you can just experience less stress with them?” We need more training on psychosis to feel confident Normalizing the experience of psychosis Helping to make peace with psychotic symptoms (i.e., making friends with the voices) to decrease distress Looking at treatments beyond medication How to identify psychosis and assess for impact and impairment The myth that all elements of psychosis are distressing and bad Why Maggie Mullen is using Dialectical Behavior Therapy (DBT) to treat psychosis “People with psychosis deal with emotion dysregulation, actually more so than the average person…that's where we know DBT is really effective” We frequently underestimate the ability to help folks with psychosis Using DBT skills for emotion regulation concerns that frequently come up in psychosis Psychosis and PTSD oftentimes occur together and aren't always diagnosed Trauma can influence the onset of psychosis AND psychosis can be traumatic Maggie's pilot program with DBT for psychosis The concrete and straight forward nature of DBT skills make them very accessible Understanding psychosis differently, including the cultural differences of what is “normal” How to identify what is “real” and what is psychosis How do you define what is normal for someone? What do we decide what we pathologize? Breaking up the binary of normal or not normal – reframing as “experience” The importance of understanding what is negatively impacting the client and how to keep clients safe Take the lead of your client and trust that they know themselves best The tension between taking the lead of the client and mandates and requirements as a therapist The Dialectical Behavior Therapy Skills Workbook for Psychosis by Maggie Mullen, LCSW Maggie wrote a book to democratize DBT skills Using DBT, but making the skills more concrete and accessible Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Buying Time LLC Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They've got you covered. Don't know where to start? Check out the systems inventory checklist which helps business owners figure out what they don't want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/ Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/   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! Maggie's website Maggie on Instagram The DBT Skills Workbook for Psychosis by Maggie Mullen, LCSW   Relevant Episodes of MTSG Podcast: Conspiracy Theories in Your Office Fixing Mental Healthcare in America: Serious Mental Illness and Homeless Fixing Mental Healthcare in America: Psychiatric Crises in the Emergency Room Fixing Mental Healthcare in America: Peer Support Specialists   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: www.mtsgpodcast.com www.therapyreimagined.com 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 sponsored by Buying Time   Katie Vernoy  00:04 Buying Time has a full team of virtual assistants with a wide variety of skill sets to support your business. From basic admin support customer service and email management to marketing and bookkeeping, they've got you covered. Don't know where to start, check out the system's inventory checklist, which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at buying time. llc.com forward slash systems stash checklist.   Curt Widhalm  00:31 Listen at the end of the episode for more information.   Announcer  00:34 You're listening to the modern therapist survival guide where therapists live, breed 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  00:49 Welcome back modern therapist. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all sorts of stuff and just my continued ability or inability to introduce episodes well here but   Katie Vernoy  01:06 yes, yes.   Curt Widhalm  01:07 Recently, we had an episode on conspiracy theories. We very, very briefly talked about the difference between people who are following conspiracy theories and psychosis. We did an almost barely adequate job of talking about it and decided that we needed to follow up with somebody could who could help us talk about psychosis a little bit more deeply. And so we have a guest today, Maggie Mullen LCSW w. And they are a fantastic resource when it comes to working with psychosis and very glad to have them with us here today. So thank you very much, Maggie, for joining us.   Maggie Mullen  01:49 Thanks so much for having me, Curt. And Katie.   Katie Vernoy  01:51 So glad to have you here. Like I told you before we got started, we needed somebody to talk about psychosis saw that you had sent in a little pitch to us. And we're like, oh my gosh, this is perfect. We're so excited. And I can't wait to kind of get to meet you here on the podcast. But let's, let's have everyone meet you and say what we always say to all our guests, who are you? And what are you putting out to the world.   Maggie Mullen  02:12 As Curt mentioned, Maggie Mullen, LCSW I use they them pronouns. And I am an author and trainer. And what I am working right now to put out into the world is an anti racist and disability justice approach to working with people experiencing psychosis that really focuses on centering their experiences and needs. And one of the ways that I'm really going about that right now is by offering DBT informed treatment to people who are struggling with psychotic spectrum disorders like schizophrenia, schizoaffective, disorder, bipolar disorder, etc.   Curt Widhalm  02:43 You get into this work, that a lot of therapists have their own stories that just what's your story as far as getting into working with psychosis, and really having this level of passion for it?   Maggie Mullen  02:59 So I come from a community organizing background, right, a lot of the work that I was doing before grad school was really centered around how do we bring communities together to fight for change. And I chose a path of social work, because I really wanted to have the opportunity to do both that macro kind of bigger level practice, but also help individuals because I was somebody who was able to connect with people pretty well and really enjoyed that part of the work. And as I was in grad school, learning more about mental health and kind of being in that part of the field, the thing I kept seeing over and over again, was the inequity and really lack of resources for people who are experiencing psychosis in a chronic way. And the way that, you know, that kind of shows up and at least at US, US society is, you know, seen people with psychosis being overly institutionalized, you know, really over medicated or highly focused on medication as the sole treatment. And particularly for our, you know, black indigenous and folks of color experiencing psychosis, and people who are being shot and killed by police, right when they're out of responding to their symptoms in a public way, or being incarcerated and not receiving treatment. And for me, that just felt like a call to action to say, I want to get involved in this area that really needs to be expanded. And I think one additional piece is if you look at almost any piece of literature in our field, right? So if you're like nerd like me, you want to go and do research about something. If you look into almost any psychotherapy treatment, you'll see that there's a rule out for participants who experienced psychosis. And that's really widespread across almost all therapies. And I find this odd because the same type of like what we used to call delusional beliefs we now call distressing beliefs or distorted beliefs, those same types of things happen in other diagnoses, right? We see this in eating disorders, right? People who have such distorted beliefs about their bodies to the point that they're willing to, you know, encounter significant health issues in order to engage in certain behaviors, right or even with depression, right, where we have distorted beliefs about your self worth to the point that you're willing to hurt yourself. but we don't exclude people so aggressively from treatment as we do with psychosis. And for me, that's really kind of a question that I kept coming on grad school, like, why this group? Why are we segregating them in this kind of way that's leading to, you know, high rates of suicide, high rates of incarceration, all those things that I mentioned before, that are just poor quality of life issues for these folks.   Curt Widhalm  05:20 So to ask maybe an obvious question here. Why, why what have you found out and asking this big question, what is our system have against psychosis? Is it fear from treatment professionals in the past? I'm sure that you've come up with some at least explanatory answers here.   Maggie Mullen  05:41 Yeah, there's not one right answer, I think is part of this, right. Like, if we went back really far in history, one of the things that we would see is that across cultures, right, there are really different approaches to psychosis, right? We see in a lot of indigenous cultures, the idea that people with psychosis are actually, you know, accessing other states of reality, and that scene is a strength, right? And something that's really valued, right, like people who are medicine are healers. And we don't see that particularly in white society in the US, right, where we're really have kind of more colon colonized mindset. But I think a lot of this comes from fear, right? Just the idea that I don't understand maybe what's happening to this person, they're behaving in a way that's, you know, erratic in my eyes, when it can't really get into their, you know, headspace and understand what they're experiencing. And I think that's part of how our field is responded, because if we look back at Dr. Aaron Beck, right, the creator of CBT, who just passed recently, he was doing trials of CBT, with people with psychosis back in 1950s. And for some reason, and I don't know all the reasons why his research kind of stopped around that point, right, kind of hit a dead end. And then we just kind of started offering these things to people with more like depression, anxiety, etc. I think part of this is just again, that fear that you mentioned, Curt, more than anything, unfortunately,   Katie Vernoy  05:45 when we look at this, there are folks who try to exclude psychosis from their practices, especially private practices. But we can't always exclude it. Right? Like there are times when it comes into our office, we've an established relationship with the client, and we can't always exclude and I'm not saying that we should always exclude it. I think that's part of the problem. But when we don't when we actually start working with psychosis, because it is so... I don't even know what the right word is...kind of fringe, maybe to our profession. I mean, I even think about I know you do DBT for psychosis, I've talked with DBT centers that say if they have psychosis, they shouldn't be doing DBT. I mean, like, there's, there seems like there's not really guidance, when whether you invite or exclude psychosis, when it shows up in your office, it seems like there's there's an opportunity for us to really do it wrong. And so I mean, typically, we asked what a therapist get wrong. So I guess I'm asking that question. But I, I'm trying to sort out kind of even how to get to the correct question, because it seems like part of what we get wrong as we exclude these folks from our practice. But if they show up, I imagine there's stuff that we're really getting wrong in the room and in the treatment planning.   Maggie Mullen  08:18 Yeah, I think part of this is that combination of we need clinicians to have more training across the board and treating psychosis. And again, I think with these newer wave therapies, like CBT, for psychosis, act for psychosis, more DBT skills kind of approach that are really emerging as very strong in the literature and really effective for people. And that are offered, but just not I think, in a very widespread way, again, at least in the US. And so I think part of it is we need clinicians with more training, so they feel more competent. And I think part of where we get things wrong, is that we think of psychosis as like these people over there, right? We kind of again, like you said, kind of put them in like a box segregated in some way. And the way that we really approach psychosis now in a kind of more modern or progressive sense, is that there's really a spectrum of psychosis. Right. On one end of the spectrum, we see people with less distressing less bothersome experiences of psychosis. And that for like, for me, for example, that looks like I'm on call for my work every once in a while, and I My phone has to be on 24/7 because I might be calling the emergency room to do an evaluation. And what will happen to me occasionally is I will think I hear my phone rang, and I will look down and I'll see no miss call, right? And I'll like say to my partner like hey, did you see Did you hear my phone ring? And they're like, No, that's an experience of an auditory hallucination, right. I've just had experience of psychosis. And on the other side of the spectrum, we have more of these distressing chronic life impairing experiences like psychosis that are more common for people who get diagnosed with schizoaffective sorta are psychotic spectrum disorder of some kind. And people who experienced those diagnoses fluctuate on the scale in the same way, right? That they are doing better at certain points, or their symptoms are not as distressing, etc. And part of the reason we frame it in this way now is to normalize the experience of psychosis that at some point, almost all of us will have some experience of psychosis. And I think when we look at it from that perspective, it feels less scary to approach psychosis. And I think also it can instill some hope that I think a lot of therapists don't have when they work with psychosis, right? We feel like, it feels hopeless, nothing's going to change, things are not going to get better. But we get training, I think and experience in that way. And the reality is there are wonderful outcomes, I think, for people with psychosis, when we look at it from a different perspective, which is to say, what if some of the work might be on changing your symptoms themselves? But what if part of the work is actually on acccepting your experiences so that you can just experience less stress with them? Right, so how do I make friends with my voices? So they don't bother me in the same way? Or how do I have to, like, do education with somebody's loved ones and families or societies to accommodate the fact that this person may need to, you know, do certain things to manage their psychotic symptoms, right. And that's just a normal part of their experience, rather than a pathologized experience. So I think these are ways as therapists that we have been getting things wrong historically. But we also know that there's plenty of ways that we can shift that with training with education, to make ourselves feel more confident doing this work   Curt Widhalm  11:37 The longer that we do this podcast more than I recognize that maybe my graduate training was not the greatest. And I'm trying to recall back to the way that we were educated on it. And it just seems to have been like one class in like the the psychopathology class that was just kind of, here's defining what it is. And if you ever end up working on it, then you'll get trained at your site. And it really kind of allowed for opting out of even having to learn about it. And my experience across time has been that it still shows up in my office that clients still present with this kind of stuff. Where do you see, you know, if my experience is really bad, where do you see graduate education needing to go as far as removing some of this fear or other ring of psychotic spectrum as a thing that needs to be feared?   Maggie Mullen  12:43 I think it starts with following the model and the experiences of the Disability Justice Movement, right, I think the thing that we can do first and foremost, is bring in the voices of people who experience psychosis themselves, right, have this lived experience, into our education or classroom settings. Because it's one way that we, I think, with any kind of stigma, right, that's out there is that through more dialogue and experience with people who are living with this, you know, whether we call it condition or experience or whatever, the more comfortable we get with it, the more normal it becomes to us. And so I think it's starting there and in the education and kind of classroom settings to reduce that kind of othering. And then, in addition to that piece, I think, again, it's the part of actively including, and teaching the treatments for folks with psychosis, and not acting like we can opt out of it. I think one thing I find, with therapists, not across the board, but oftentimes, is that we are often the least prepared to deal with our most acute clients, right? So we are often trained really well to work with people with, you know, garden variety, depression and anxiety adjustment issues, etc. The word Well, exactly right. And we don't get a lot of trained, I think that is very quality for people who are chronically struggling and dealing with things that are acute and very difficult for them very distressing. And I think that's part of where our education and our schools needs to change is to shift away from, you know, exclusive treatment of worried well, and really integrate the bigger spectrum of mental health and well being overall,   Curt Widhalm  14:20 to maybe even further add to this is not necessarily treating psychosis as something that just needs to be medicated away, which has been historically just kind of where well, you ship them to a psychiatrist, and that'll take care of the voices.   Maggie Mullen  14:38 Absolutely. Yeah, I hear that even for my colleagues, right, who work in my clinic have the idea that like psychosis is actually easy to work with because it's on the psychiatrist right to do that work. It's not really on us. We're just chasing them around getting them on medication. But as you've probably experienced in doing any of this work yourselves, many people with psychosis struggle with medications as an intervention, right? That can be life changing. For a lot of people, and for other folks, the side effects that come with them, you know, are so impairing that they're like, I don't want to do this right or, or I'm scared to do this or whatever it is because they can really change your life, your health outcomes, and even just the longevity of your life. So when we rely exclusively on that stuff, it really denies people the ability to build a life worth living, but isn't just, you know, kind of circled around medications as the only treatment   Katie Vernoy  15:26 Well, even in and how you're talking about psychosis, it just really puts a different flavor of it for me with this whole idea of a spectrum of psychosis. And to me, I mean, if we're really looking at auditory hallucinations, like hearing the phone ring, but it hasn't really wrong, or, or even, you know, kind of some of these really distorted thoughts that come up and these delusional beliefs that we have about ourselves that happen in, you know, even kind of garden variety, depression and anxiety, it seems like assessing psychosis would actually be much more complicated. If we're really looking at the full spectrum of the experience. What is your advice as far as identifying, you know, kind of what, what requires or what would be helped by this knowledge around psychosis?   Maggie Mullen  16:16 Can you answer a different way, Katie?   Katie Vernoy  16:19 Yeah, I guess I'm just asking, basically, how do you assess psychosis when it's not kind of this florid psychosis? How do you how do you actually assess psychosis with this idea of a spectrum of psychosis and psychotic experience?   Maggie Mullen  16:38 I think it's really dependent on the level of distress and impairment and causes in somebody's life. Right? Like with all things, when I think about if you're doing really good assessment for any mental health issue, and psychosis is no exception. It's like, how is this interfering with your goals? And the things you want to be doing with your values, your ability to do what you love? How is this in terms of the emotional side of it, right? Like, how much distress how much upset is this causing you, etc. And getting a really clear picture from clients around those pieces, I think can tell us whether we what level of intervention we need to kind of do. Because again, I think one thing that providers often do is we also kind of do the other extreme, which is to assume that if you have any experience of psychosis, it is distressing, and it's bad, right? Like we need to get rid of it. And I think a lot of people who have lived experience of psychosis will tell you, I actually find that there's some very comforting parts of my psychosis, right? Like, maybe I hear the voice of my mom talking to me who passed away or some other loved one, right, or, you know, something that can feel like it's just reassuring to them. And so when we need to when we're doing these assessments, we want to also be integrated in what's the problem and what's actually quite adaptive and works for your life instead,   Curt Widhalm  17:51 So why DBT for psychosis   Maggie Mullen  17:54 So in thinking back to the part about like, where researchers and mental health people got it wrong. So for a long time, providers assumed that people with psychosis didn't experience emotions in the same way as people who were maybe more neurotypical because they weren't expressing their emotions through their effect or their body language, right. And a lot of that has to do with negative symptoms, which are part of that spectrum of psychosis. And what we now know is that people with psychosis deal with emotion dysregulation, actually more so than the average person, right? So they're dealing with overwhelming emotions, that are sometimes triggered by their symptoms, right. So if you have a critical voice telling you, you're a bad person, that's going to cause emotion dysregulation, we're going to get emotional, sure, and kind of the cycle that can happen where then you might experience more psychosis, right? More symptoms, because of an increase in emotions, so kind of becomes a cycle. And what we know to be true is that people then cope with that emotion dysregulation the same way that somebody with, you know, BPD, who's in treatment for DBT, like do which is self harming suicide attempts, substance use, etc. And so that's where we know DBT is really effective, right, based on both the literature, the research, but people's lived experience around it. And so the idea with how we use DBT skills, and I say DBT skills, because we're taking an informed treatment approach, we're not necessarily doing a full DBT treatment program, although that is appropriate for some people with psychosis. We're thinking, let's break that cycle of again, emotions and symptoms kind of escalating each other by using something like distress tolerance skill, or an emotion regulation skill or mindfulness to help break things up and help reduce your distress.   Katie Vernoy  19:44 It seems to be completely logical that that would be the case like and my experience of working with some clients that had different different diagnoses on the spectrum of psychosis, and I also in my experience, if in any way was was aware of oftentimes trauma histories as well as is that? Is that relevant to this conversation?   Maggie Mullen  20:09 Absolutely. Yeah. Thanks for bringing it up. So one thing that I think is, or I don't think I know is very common amongst people with psychotic spectrum disorders is PTSD. So not just experiences of trauma, but experiences of trauma that are continuing to impact our life in a really significant way. And right now, we think about a third of people with schizophrenia have PTSD, which is a very high number. We actually think it's probably higher, though, because clinicians tend to not assess for PTSD very commonly. And clients don't tend to also report those symptoms very actively when they're not asked. So when we think about, again, what clinicians might be missing, it's important that we assess for that and, and part of how we think about trauma with psychosis is that it's really common for people with a psychotic spectrum disorder to have, you know, childhood trauma, so some kind of trauma from growing up. That might be one of the contributing stress factors in the development of psychosis over time. And we also know the experiences associated with experiencing psychosis are traumatic, right. So for example, we talked about the idea of like being incarcerated or being taken by the police in handcuffs to go to the hospital, right, that's a traumatizing experience for a lot of people, particularly for people of color. We also have, you know, being mistreated in hospitals kind of being warehoused there for long periods of time. And then certainly just the experience of psychosis itself, right, when you're just oriented and you're, you know, kind of separated from reality that can be really scary for people, right, we might do things that are out of character for ourselves. So trauma is a common experience, I think, for people with psychosis. And secondarily, there's really great treatment for people experiencing PTSD who also have a psychotic spectrum disorder. But it's really uncommon for providers to offer it because of fear, I think, again, to what we were talking about earlier. And we know, I think more so part of what we see the literature and research changing is that we are including more people with psychosis and studies now than we used to before. So for example, we see a lot of the new prolonged exposure, which is, you know, one of the gold standards for treatment of PTSD, that if somebody has relatively well controlled psychosis, so they might experience some active psychosis, but it may just not cause strong levels of distress. They're a great candidate for PTSD treatment. And same thing for cognitive processing therapy or CPT as well.   Curt Widhalm  22:31 Over the couple 100 episodes or so that we've done, we've had plenty of guests who come in and speak very well about their their target populations. But I don't think that we've had people like you who've actually piloted programs that back up that this is just beyond kind of the here's something that I've experienced a lot in my office and done well with, can you talk about what you saw as an opportunity with the program that you piloted?   Maggie Mullen  23:00 Sure, so I was trained as a DBT clinician, that's like my bread and butter as a therapist and working in a fully intensively trained DBT program. And I like live and breathe DBT, like, I am one of those DBT nerds that you hear about in grad school. And I think I felt like I was working, you know, as a DBT therapist, but also working a lot with people with psychosis in a in a kind of a treatment program. And there was this weird separation where we saw like, these two worlds being again, just very disparate, and not a lot offered between them necessarily, even though again, for people with borderline personality disorder who are really well treated by DBT. A lot of them actually experienced psychosis as part of their symptoms. And so what I did, essentially, with the encouragement of my colleagues was to say, why don't we just try to offer some of these skills to our clients and see how they do with them, see if they're practical enough, if they're concrete enough, which is, you know, important for people who might be experiencing chronic psychosis to be able to use them. And I really did this in conjunction with cognitive behavioral therapy for psychosis, right. CBT for psychosis has a really strong evidence base. And so I felt like, let's address this cognitive piece that CBT is really good at, but also integrated behavioral piece of DBT. And our clients loved it. Like it was actually kind of overwhelming the response that we received, as well as the outcome studies that we were doing around clients talking about how they were using those skills, and what that what that was shifting in their life, essentially, to feel like, not only do I know how to shift my thinking, but I can do something differently about it. And the thing about DBT skills that maybe no one will tell you is they're very straightforward, right? There are a lot of things people are already doing. Right? So self soothing, right? Many of us self soothe in many different ways, right? we distract ourselves, right? We use all of these skills, I think in many adaptive ways. And part of the work I think of integrating DBT skills is saying, Okay, do that intentionally now, right like don't just Do it as a background thing, but like think about what do I actually need right now that I'm feeling distressed? Because of the voices I'm hearing? You know, do we need to practice? You know, tip, right, which is a common skill in DBT when somebody is really distressed? Or do we want to practice opposite action here, because you're feeling some unjustified emotions, for example, and really just getting people to practice those in a more active way.   Katie Vernoy  25:20 I guess I keep going back to this notion that psychosis is not something that is separate, although I think there are programs where folks end up that are separate, like a day treatment program, those types of things, but oftentimes, even in those programs, it's folks that have had pretty intense emotions, intense suicidality, you know, there's, there's a reason that they're there, it's doesn't always mean that every single person in these day treatment programs have psychosis. But regardless, I think that the, the thing that I keep coming back to is this idea around looking at psychosis differently. And when we do that, it opens up all these other treatment options, because we look at as folks who have this element, and not "them", when you were talking about the way that other cultures look at psychosis, and the ways that folks who are having some of these experiences are, are seen as whether it's a medicine person, or someone that has insight in a different way. Or there's, there's different things where, you know, people are in touch with different parts of reality. I think about religion in the United States, and the similarities with that, and how people will hear God, they'll they'll, you know, they'll see signs, there's, there's a lot of things where there are pieces of things that are kind of acceptable, and culturally appropriate. And there are things that are seen as other and I'm just curious, because you talk about kind of your your background and the way that you're perceiving psychosis, and it seems like it would be very hard. And maybe this is what I was trying to get to earlier with the assessment question, but it seems like it's very hard to identify, in some cases, what is real? And what is psychosis? And so the question I have is, again, kind of like, how do we sort through that? How do we sort through? Is this a cultural experience? I mean, I think earlier, you said it was more around, you know, kind of distress. But sometimes having these things that are culturally appropriate are very distressing, you know, you get messages from God, or you get messages from other sources that are very distressing to you. And so how to how do you grapple with that when you're really trying to honor the experience of the person and sorting through whether it's psychosis or whether it's something else?   Maggie Mullen  27:48 I think one of the questions that you're kind of getting at is the question of like, how do you define what's normal for somebody?   Katie Vernoy  27:55 Yes.   Maggie Mullen  27:56 Yeah. And I, this is a question. I think that is when we like really backtrack as mental health professionals to the idea of like, what do we pathologize? And what do we consider normal? It's really hard to do our jobs to some extent, because the DSM is, right, kind of almost based on the idea that there are certain things that are not normal. But   Katie Vernoy  28:17 yeah,   Maggie Mullen  28:17 normal is really relative, right, based on culture based on history based on so many different parts of our experience. So it's, it's a little bit hard to answer that question, because it's a real philosophical one, in a way.   Katie Vernoy  28:28 Yeah.   Maggie Mullen  28:28 I think that is what informs our approaches, different providers is like, where do we come from? And our background of how we approach this type of stuff, again, of the idea of like, is there anything that's normal. And so I think when I see like this disability justice pushing around this piece, that's the part that really aims to sort of break up that binary of normal or not normal and say, like, this is all just experience. And again, the part that becomes how we assess things as clinicians is when somebody tells us this is a problem for me, or this isn't normal for me, right? Or this is scaring me, for example. And that's when we treat things with that kind of lens. It's complex. I think, in many ways, though, because for example, if I have somebody who is experiencing mania, they're not going to tell me something as a problem, oftentimes, right, you know, kind of, again, is a kind of generalization. When people experience mania, oftentimes, they feel amazing, right? They feel very on top of the world, not all the time, but for many folks. And they don't want an intervention at that point. And the thing that I'm always weighing right is the idea of, can you be safe at this point, right? Like art, what kinds of risks are you taking, for example? And what are ways that like, I need to intervene to help you just live your best life but take more of a harm reduction approach here, right like to keep you on track so that you're doing okay, the least amount of harm happens. But it's I think it's very tricky because so much of this stuff is relative and I honestly don't know if I have a great answer to Your question because of how murky things get around this piece. And so I think maybe my best advice around it is to say, take the lead of your client and know that they know themselves best and will inform you if something's an issue.   Katie Vernoy  30:12 Yeah, yeah, I think the the thought process that I've heard a number of different times and in my travels and learning about psychosis, is being able to inhabit the world where your client is, and then kind of slowly assess what is real and not real with the client from the clients perspective. And, and to me, I feel like that can be very, very challenging, because I think there's so much bias that comes into how we perceive the world that it's can be hard to truly take the lead of the client, do you have advice on how to how to do that when when it's not like, Oh, you have a different opinion for me, but it's like, Oh, your, your reality is different than mine.   Maggie Mullen  30:54 It's tough. It's really, it can be very challenging, because again, we have two different systems of training, right. So like, I have my beliefs around strengths based approach, following the lead of the client, like they are the expert on their own life that we get. And then there are things like being a mandated reporter, right, and like, needing to assess for risk and safety and things that my agency requires. And those are often at odds with each other, I think with a psychosis with the idea that I approach that really, by trying to be as transparent as possible with my clients coming into treatment around what their experience might be like, and maybe the way that I'm documenting things in my notes, right, and like trying to more educate them and say, Okay, so your doctor is going to talk about your delusions, your ideas of reference, etc. Here's what that means. Now, what's the language that you and I are going to use to describe that type of stuff that is affirming to you, and that is recognizing your experience as unique? And I try to take a bit of that perspective around all of this, because I think we can't necessarily fight the existing system. We have without I think, like working around it in that kind of way. So I don't know if that answers your question. Exactly, Katie,   Katie Vernoy  32:07 Yeah, no, that totally answers my question. Thank you.   Curt Widhalm  32:09 And I think your last couple of answers have really demonstrated why the DBT approach to psychosis fits so naturally, yeah. And I think is where your book probably just came very naturally in this whole process.   Maggie Mullen  32:27 It did it well. And I'll tell you, I didn't start out to write a book. Because I don't know, I didn't ever think of myself as somebody who's a writer, or even frankly, like training. But I got recruited to write a book because I was doing something it was a bit more innovative in this approach to working with psychosis. And the funny part is, one of the things that came up really frequently, just as kind of an aside is getting messages about people with psychosis don't read, right? There isn't a market for this. And it first of all, that's, that's very discriminatory. Yeah, for lack of a better term wrong. It's awful. And I think part of the reason people assume that A is because of stigma, and you know, wrong beliefs about people with psychosis, but also because there are literally aren't any other books written for people that are self help books for somebody with psychosis. And, you know, we have a wonderful books on the market for loved ones, or families or mental health providers working with psychosis, but almost nothing that is geared for the experience of somebody with a psychotic spectrum disorder to say, you take control of your own experience, right, you get to be educated and learn and be offered skills. And I think in particular, with psychosis, the other thing that we know is that most people with psychosis don't get mental health treatment, right, they don't either have access to it, they don't want it or they don't have providers who are, you know, competent in providing, as we talked about before. And so this book, obviously, is not a substitute for therapy. But it's a way to really, I think, democratize these skills to say, I want to get these out to you in a form of offering that's less than $20. And so I always encourage people to seek treatment as part of that book. But this is just one way to kind of get that message out there. So that's part of kind of the journey that led me to writing the book is just wanting to make sure people had access to these skills one way or the other, essentially,   Katie Vernoy  34:16 are there differences and how DBT skills are used when you are learned when you have psychosis as part of the the makeup.   Maggie Mullen  34:25 So the actual skills themselves are really identical to Marsha Linehan's work, right. And I really respect her work. And for me, I did not want to stray away from what the model is because the model is really effective. We're seeing more research now around full DBT treatment programs serving people with psychosis, but that's still kind of emerging literature. And Marsha Linehan, and her book actually even talks a bit about that. But to go back to your question, I think, part of what we do need to do when we're kind of, you know, adapting or kind of shifting. The way we teach DBT skills for these clients is to do a few things. One is to make them really concrete. so that there's just really straightforward information, there's not a lot of psychological jargon, right? Things that are just very straightforward. We also want to make sure that whatever we're offering is accessible. Because, you know, as we talked about a little bit before, you know, rates have been on, you know, for example, like SSI, so like being on a fixed income are really high amongst people with psychosis. So people don't have a lot of money. A lot of folks are marginally housed don't have stable housing or food access. And so we want to make things that are really accessible, right? You know, there's a DBT skill about going on a brief vacation, for example, we have to talk about, what does that actually practically look like in the life of somebody who has who's getting 700 ollars? a month, right? Like, what does that look like? So we want to adapt the examples to actually be a reflection of their personal experience as part of that as well. But otherwise, I think the skills really kind of match on well to the experience of psychosis.   Curt Widhalm  35:53 We've mentioned your book a couple of times, I think it's fair for us to actually name it. So dialectical behavior therapy skills, workbook for psychosis. We'll put a link to that in our show notes. But where else can people find out about you and the work that you're doing?   Maggie Mullen  36:12 So first is my website, which is Maggie mullen.com. I'm on Instagram. I'm working on building that following. It's Maggie Mullen, LCSW W there. And those are the main pieces you can contact me and reach me my direct contact information is there. I really am trying right now to put the work out again of this more progressive approach to treating psychosis into the world and doing a lot of consulting and training with agencies. So that's definitely something that I'm always excited about doing with new folks.   Curt Widhalm  36:40 And we will include links to Maggie's websites and Instagram handle over in our show notes. You can find those at MTS g podcast.com. And you can follow our social media come and let us know about your experiences and getting trained or poorly trained in working with psychosis. Come in and be a part of our Facebook community, the modern therapist group, and until next time, I'm Curt Widhalm with Katie Vernoy And Maggie Mullen.   Katie Vernoy  37:10 Thanks again to our sponsor, Buying Time   Curt Widhalm  37:12 Buying Time's VAs support businesses by managing email communications, CRM or automation systems, website admin and hosting email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly with a full team of VAs gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available.   Katie Vernoy  37:41 book a consultation to see where and how you can get started getting the support you need. That's buyingtimellc.com/book-consultation once again, buying time llc.com forward slash book dash consultation.   Announcer  37:57 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.

    Which Theoretical Orientation Should You Choose?

    Play Episode Listen Later Jan 3, 2022 32:27

    Which Theoretical Orientation Should You Choose? Curt and Katie chat about how therapists typically select their clinical theoretical orientation for treatment. We look at the different elements of theoretical orientation (including case conceptualization, treatment interventions, and common factors), what impacts our choices, the importance of having a variety of clinical models to draw from, the types of practices that focus on only one clinical theory, and suggestions about how to approach choosing your theories for treatment, including some helpful assessments. In this podcast episode we talk about how therapists pick their theoretical orientation We received a couple of requests to talk about clinical theoretical orientation and how Curt and Katie chose their own. We tackle this question in depth: Choosing a clinical theoretical orientation The problem with the term “eclectic” when describing a clinical orientation How Curt and Katie each define their clinical orientations “Multi-modal” therapy The different elements of clinical orientations Case conceptualization Treatment interventions Common Factors and what actually makes therapy work What impacts which theoretical orientation we choose as therapists Clinical supervision Training Personal values and alignment with a theoretical orientation Common sense (what makes sense to you logically) Choosing interventions that you like The importance of having a variety of clinical theories that you can draw from “You need to know the theories well enough to know when not to use them”  – Curt Widhalm Comprehensive understanding is required to be able to apply and know when not to apply a clinical orientation Avoid fitting a client's presentation into your one clinical orientation Deliberate, intentional use of different orientations Why some therapy practices operate with a single clinical model Comprehensive Dialectical Behavioral Therapy (DBT) therapists run their practices and their lives with DBT principals Going deeply into a very specific theory (like DBT, EMDR, EFT, etc.) while you learn it Researchers are more likely to be singularly focused on one theory Suggestions on How to Approach Choosing Your Clinical Theoretical Orientation “Theoretical orientation actually can be very fluid over time” – Katie Vernoy Obtain a comprehensive understanding of the theoretical orientation Understand the theory behind the interventions Recognizing when to use a very specific theory or when you can be more “eclectic” in your approach Deciding how fluid you'd like to be with your theoretical orientation Find what gels with you and do more of that The ability to pretty dramatically shift your theoretical orientation later in your career Instruments for Choosing a Theoretical Orientation Theoretical Orientation Scale (Smith, 2010) Counselor Theoretical Position Scale Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Buying Time LLC Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They've got you covered. Don't know where to start? Check out the systems inventory checklist which helps business owners figure out what they don't want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/ Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/ 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! Institute for Creative Mindfulness Very Bad Therapy Podcast Petko, Kendrick and Young (2016): Selecting a Theory of Counseling: What influences a counseling student to choose? What is the Best Type of Therapy Elimination Game The Practice of Multimodal Therapy by Arnold A. Lazarus Poznanski and McClennan (2007): Measuring Counsellor Theoretical Orientation Relevant Episodes of MTSG Podcast: Unlearning Very Bad Therapy Interview with Dr. Diane Gehart: An Incomplete List of Everything Wrong with Therapist Education   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: www.mtsgpodcast.com www.therapyreimagined.com 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 sponsored by Buying Time.   Katie Vernoy  00:04 Buying Time is a full team of virtual assistants with a wide variety of skill sets to support your business. From basic admin support customer service and email management to marketing and bookkeeping, they've got you covered. Don't know where to start, check out the system's inventory checklist, which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at buyingtimellc.com/systems-checklist.   Curt Widhalm  00:31 Listen at the end of the episode for more information.   Announcer  00:35 You're listening to the modern therapist survival guide where therapists live, breed 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  00:51 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 how we are as therapists. And we have received a couple of requests for in episodes about how people select their theoretical orientations. And I think that this is a great opportunity for us to maybe gear an episode a little bit more towards early career therapists, some of the students who listened to our show, but also for those of you who are maybe a little bit later in your practice to consider how you came up with your theoretical orientation or orientations. And we're gonna dive into a little bit of our stories about this, but also what some of the research ends up saying about how a lot of therapists end up practicing in the way that they do. So, Katie, from the top of the show, what are your orientations? And how did you get to where you are?   Katie Vernoy  01:54 I think the the word that probably best describes my orientation is one that I was told not to use because it was bad, which was eclectic,   Curt Widhalm  02:06 eclectic   Katie Vernoy  02:07 ecelctic!   Curt Widhalm  02:08 lazy eclectics.   Katie Vernoy  02:11 And I think it's, it's not exactly true. But I really feel like I draw from a lot of orientations. A lot of models, maybe it's better than orientations, where there are a lot of really cool interventions that I like from CBT DBT narrative, even psychodynamic or Gestalt, or different things like that. There's a lot of really cool interventions that I've been able to kind of pick up in my my toolbox or tool tool belt over the years. And so to me, when we talk about orientation, and maybe this is a question to ask, I would say, I'm probably mostly existential, and certainly relational. And, and that's kind of where I sit. I think with orientation, though, there's how you conceptualize a case, how you treat a client's you know, so, orientation feels like a very broad thing, where case conceptualization seems more like okay, that's my that's how I'm orienting myself to a case specific interventions, I think tie to theoretical orientations. But I once had a supervisor say, pretty much all theories are the same. They just use different words, people want to make money. And orientations are different, but I feel like you can you can mix and match pretty well.   Curt Widhalm  03:33 And on that point, you're talking about Bruce Wampold's common factors that soar looking at therapeutic treatment where theoretical orientation affects treatment about 1%. Maybe some of the emphasis of where some of these questions are coming from is our therapists, education, emphasis on every class being about orientation, really not looking at the other 99% of what actually makes therapy work? Yes. Now, like you, maybe Unlike you, I look at myself not as a dirty eclectic therapist, but as a very intentional, multimodal therapist.   Katie Vernoy  04:19 Oh, my goodness, words, words.   Curt Widhalm  04:24 So, like you, I also end up using a lot of CBT. In my practice, I'm also drawn to existentialism, and very much utilize a lot of EMDR work which, for the EMDR people that I trained with over at the Institute of creative mindfulness, we really look at EMDR as being the greatest hits of a lot of other therapeutic styles that got it just naturally pulls from a number of different areas. But when we first got these cases, My first reaction was kind of, I wonder how much of how we practice is based in who our supervisors were and how they practiced at, you know, kind of a developmental stage of where we were at in becoming therapists. And if that's just stuff that because we were forced to practice in a way for a while, if that's why we continue to practice that once we're out on our own, and I'm wondering how much of that rings true for your story here.   Katie Vernoy  05:34 It certainly rings true for me, I think about some of the newer clinicians and certainly talking to like Carrie Wiita and Ben Fineman over it. Very bad therapy, it seems like they're more thoughtful than we are, or than I was anyway, when I was coming up. But I found myself trying to soak everything in and I had a psychodynamic supervisor and a CBT supervisor when I first started, and then I went into community mental health, it's very behavioral and, and CBT oriented, with some, you know, trauma informed, you know, different things that kind of layered in there. But I did find that the supervisor made a big difference if they had a strong orientation, because I that's how they framed everything. And that's why I think I, when I say the case, conceptualizations are oftentimes more along the lines of like psychodynamic or CBT. I think it's because that was how I was trained. The other piece that I was really lucky is that I also had a group supervision with several folks who are narrative, and they would talk about their cases from a narrative perspective, and would provide feedback on some of the cases that I was working on from a narrative perspective. And so I feel like there's some narrative that came in early enough that that was something that also I added to the pool. But it wasn't something I learned in school, I think it was newer, you know, I was getting ready to get licensed at that time. So to me, I feel like the people around us, primarily the supervisor, but also potentially even, you know, our colleagues in our group supervision can really impact how we see cases how we've, you know, kind of the types of interventions we try, and therefore our orientation.   Curt Widhalm  07:22 I don't know that I can tell you my supervisors orientation from my trainee years, maybe that speaks to the quality of supervision that was being given at the time, potentially, but I, I largely agree with you in the what did end up shaping up out at the time was the other people who were part of my supervision groups and kind of being pushed into recognizing that we were naturally drawn to some techniques, whether we knew it or not. Looking at a 2016 article from the universal Journal of Psychology, this is by Pepco, Kendrick and Jung, and aptly titled selecting a theory of counseling, what influences it counseling students to choose?   Katie Vernoy  08:13 Very good, very appropriate, Good, find, Curt!   Curt Widhalm  08:16 Good find Curt. They came up with three categories that probably worth exploring here a little bit for ourselves, the first topic on here does not necessarily fall into that I practice this way because my supervisor practices this way. And in fact, none of these three do. The first one is the counseling theory is similar to my personal value system. And   Katie Vernoy  08:43 that's where I remember because we did that orientation game. What was that called? With Carrie and Ben and Ben?   Curt Widhalm  08:51 Oh, the elimination game?   Katie Vernoy  08:53 Yeah, yeah. And I just I hear Ben talking about how amazing narrative is. And it seemed like it was so aligned with his values and stuff like that. I was like, I don't know that I was that thoughtful when I was in that stage of my my development.   Curt Widhalm  09:09 It's something where I really expect our audience to resonate with this one, just because we do talk about value systems as such an important factor of the work that we do, and that obviously should be reflected in the work that you do with your clients and make sense as far as how that would carry over as, as an extension of yourself and your personality to make the therapeutic alliance work. I think it's better done when it's intentional, maybe not in the way that you're describing of like looking for justification five years after a journal article is published to be like, Yeah, that's what I did. But to really be able to clarify, it's like you're giving credit to Ben for doing it. As far as saying, These are my values, this is a theory that ends up reflecting what those are. And I think that there are going to be certain theories that end up lending themselves to that more easily than others. Things like narrative therapy, where it really does have more of a social justice aspects to it. Yeah, as compared to something like behaviorism, which is going to be very much about pushing people to certain measurable outcomes, unless that's who you are as a person and why you don't get invited to dinner parties?   Katie Vernoy  10:38 Well, I think that there are things that I was trained as a therapist 20 years ago. And I think that there are, there are limitations on some of the research that was available 20 years ago, and so even if I were to come up now, I don't know that I would spend a lot of time on CBT, just based on, you know, kind of the limited transfer across different cultures and that kind of stuff, I think that there are great interventions, and I've kind of learned over the years, especially in working in a lot of different multicultural and cross cultural environments, how to make those adjustments and kind of what to hold to and what not to, but I think that there are, are definitely different pieces of information around orientation and kind of our personal value systems that I think, is a constant or a continual assessment. I don't know that, you know, I don't know that there's, you know, it kind of goes to that, like, what's what's been indoctrinated and what needs to be unlearned, and kind of the whole decolonizing therapy, but I think that there's, there's definitely things that feel inherently true to me, because of when I learned about them and and how they were just kind of organically fold it in. And I would have liked to have that assessment that personal values assessment around which theory fits best for me early enough on so I'm glad we're talking about it, hopefully, the students are going to do those assessments for themselves. But, um, but I don't know that I even thought to do it, because it was, you know, everything was kind of a truism. Like, this is what psychology is, you know, back in the olden days, when I was trained.   Curt Widhalm  12:20 And you what you're leading into, is this second on this list, which is people to series, because it's what makes sense logically, yeah, it's, oh, I can see how a leads to B leads to C. And this might lead to some more of those directive type therapies and CBT being an example of this, where but I think in, it's not just let me get to CBT. It's also being able to look at anything from a comprehensive way. And as much as I know, students, and really anybody else hates doing case conceptualizations it's an important factor to be able to see this is how people fit logically into this set of patterns as described by this theory. Historically, I have seen some pushback from educators and supervisors as far as this approach when it comes to trying to make clients fit into a theory, rather than hearing the client stories. And this is where I think most educators, most researchers when it comes to this, and we'll put some citations in the show notes. But people like Lazarus, Norcross and golden freed, all talk about the importance of learning a variety of theories. So that way you can shift to when clients don't fit a particular one that you're still able to practice in a way that makes sense for them. So having some theories that do make sense to you make sense. But don't, don't fall just into the logic trap of everything needs to follow into this set of patterns.   Katie Vernoy  14:05 Completely agree. And I want to just acknowledge that what makes sense to you may be what you were trained, which I think ties back into, it makes sense to me because that's what my supervisor taught me. And that's how the, the practice of doing therapy, this is what it is, and this is what makes sense to me. The follow on to that is the importance of either having a supervisor that has this kind of palette of different orientations and teaches to all of them and and has that as part of your supervision or having a number of different supervisors across your internship or trainee years or your associate years so that you can get your own perspective on something versus this is how it logically fits into the model I was trained by my one supervisor.   Curt Widhalm  15:02 And this is getting a comprehensive understanding, not just not just like, oh, we covered this in class last week, and I should try this out on clients. And here's parts of it that work. And because it worked, it made sense to me. But it does take a ability to get in to the depths. And I've always kind of naturally described this as you need to know the theories well enough to know when not to use them. And knowing that you should be able to shift to something else is the level of depth that you need to know. And rather than just forcing clients to do something, because the theory says that it should work means that you're maybe not quite there yet. And that's where having a more comprehensive understanding of switching between theories, or utilizing aspects of different theories, together with intention definitely helps out.   Katie Vernoy  16:04 Oh, for sure, I think to me, I see folks that are very immersed in a single theory, or a single orientation. And I think there are reasons to do that. I don't want to say anything negative about folks who do that. But to me, that wouldn't fit for me, because I would have to refer clients out who I could serve with a different theory. But specifically, I'm talking, the most frequent one that I see are, are people who are like doing comprehensive DBT. And that's their whole practice. And then there's also folks that end up doing a lot of EMDR, I feel like that's become less because there's so many people that have been trained in EMDR at this point or anything. But the DBT thing, it requires a lot to set up, you have to have a consultation team. You know, if you're doing comprehensive stuff, you have to have a group with CO leaders, there's a specific way you run your individual session. And it works really well for the folks that works for. And I think that the comprehensive DBT therapists who only do DBT would argue they know who it's not for, and they refer them out. For me, I don't think I'd be comfortable with that. But I think the level of knowledge to determine that, I think is is higher than I think some folks who initially come into a single theory, and maybe this is where the question came from is I need to have my orientation. And it's like, should I become an EMDR? therapist, or a DBT? therapist, or a CBT? therapist or a blank right? kind of therapist? And I think very few people end up with just one orientation, I believe. I think when someone's learning an orientation, you know, and I've seen this with like EFT folks, they go really deep into it. It's like they have, you know, at least a portion of their practices only EFT. I think that there is there is a and I'm talking about Emotionally Focused Therapy, not Emotional Freedom Techniques. Right? I understand there's two FTEs. But But I think that there's a necessity when you're digging deep into a very specific theory maybe to focus in on it. But I really like this idea of having that palette of orientations and intervention so that you can shift when it makes it makes sense. But what would you say for folks who are single theory that there is a different developmental stage? Or do you feel like it's folks that have a different style? Like, where does that fit? Do you think?   Curt Widhalm  18:41 You know, it's interesting that you talk about the DBT therapists, and when I talk with other therapists and in the community, and some of you are listeners of the show it sometimes I get accused of being a DBT therapist, I know I heard that recently. And I liked DBT, I've done some workshops towards, you know, learning DBT a lot of it, a lot of it makes sense. I'm not trained in DBT. But just the way that I understand where these comments are coming from is for a lot of DBT therapists, it's also ways that you run your life, and it's ways that fall into that first category of almost being value based. And with the bonus of things making sense. And also with the the third category here that we'll be leading into in just a moment, but it's a very comprehensive structured package that also immerses the clinician in needing to be in that lifestyle, too. I don't see this with other theories quite to the same extent. You know, I think they you bring up EMDR I think that there's a very big mindfulness component of it that the good EMDR clinicians that I know tends to exhibit as far as their practice. I don't necessarily see it when it comes to some of the more directive therapies that I don't see solution oriented therapists being like, standing in front of the the milk cartons in the grocery store being like, this one is an eight out of 10 solution, but this one over here is a nine out of 10 solution. Maybe they do, maybe it's just internal, I don't know. And, but the people that I really do see, stuck very much into single theories really aren't practitioners, it's researchers. And it's people whose research is based on needing to stay within a particular theory. And, you know, while I do have respect for the CBT therapists out there, it's those people who are like, well, everything's CBT, you know, that's just, you know, CBT with this or equine therapy is just CBT with more horsepower, or, but our third category is that people choose theories because they like techniques, or they like interventions that come from that theory. And it may not be the most comprehensive way of choosing a theory, it might be something that you find that a particular set of interventions works for certain situations. It's from just that description of it go further than that, like yes, yes, you know, you can't be in the middle of psychodynamic and being like, you know, what, we need some intermittent reinforcement right here. But it can be a place that starts you into getting more of that comprehensive look at a theory if what you find is that a certain technique ends up working, learn more about the theory. So that way, you can understand how it fits comprehensively in the explanation for why a client's pattern of behaviors or outlook on the world may be influenced or susceptible to being changed by that kind of an intervention.   Katie Vernoy  22:13 As you were talking, the thing that came to mind, for me, was the validity of this kind of construct. So I'm getting really far afield. So we'll see if this bears fruit. But there are some theoretical orientations that feel very rich, they feel like they have a lot to them, that you can really dig your teeth into them. They're a way of conceptualizing a case with potential suggested interventions or ways of being with the client in the room. And there are others that feel a little bit more stilted or really based on someone trying to put stuff together. So they can prove a point with their research or a slight change to something that's already present and all of that. So I guess I'm kind of pushing back on, needing to have a really in depth understanding of all of the orientations. And I know, you didn't say that, but like, there's some of this where I think about how I actually work. And I, it's almost kind of a post hoc description, saying that I'm existential, or I use narrative, or I've got psychodynamic or or CBT, or DBT, or whatever. Like, to me, it's something where and this is potentially more of a later career situation. And I'm sure you experienced this too. I have absorbed so much knowledge from so many different continuing education, things, different clinical consoles, and conversations. That to me, and this kind of talks about, I think what Diane was putting forward is that there's so many orientations at this point that it's gotten ridiculous. And so she's simplifying it doing something and we'll, we'll put Dr. Gehart's episode in our show notes, the link to it, but, but to me, I feel like there's so much I've absorbed so much that is similar. It's so much that goes together. And maybe this is about making sense and having techniques. And so it's not the strongest way to do it. But I don't know that I'm ever consciously thinking, Well, I'm going to approach this client with CBT to start and then we'll see if it goes into something else. Like I feel like I'm meeting the client. I'm hearing what they have to say I'm conceptualizing it probably from two or three or four different theories because they kind of all melded into one. And then I'm doing interventions based on my conceptualization, but it doesn't necessarily tie and maybe this just is lazy. eclectics eclecticism but it doesn't necessarily apply. Like I'm going to start with this orientation and move to this one then move to this one and that feels to in a box for me and how I actually practice.   Curt Widhalm  24:52 I think that with practice, it ends up becoming where, when you're versed in a couple of different theories, you see that certain things are going to be better approached in certain ways. If a client's coming to me, the intake phone call is to deal with trauma, I'm immediately going to go to my trauma modalities. First, as far as how I'm listening for the story developing, somebody is coming to me for something like obsessive compulsive disorder, I'm pretty much going to be going to what's an exposure and Response Prevention Plan. Part of these are where research shows some of the effectiveness part of this is really being able to look at how things make sense. And honestly, for me, part of it is how am I going to be most effective at utilizing something that I can be decently good at some theories that research shows, you know, 95% of people who get CBT by this are fixed by this. But if it doesn't fit with how and how I think about the approach, it's something where I may only be 75%, effective using CBT, with something where I might be 93% effective with something else. Yeah. And so part of that also does look at the influence of who I am. And one of the people that really led the way, as far as this kind of thing is one of those people who had a theory, and that was Milton Erickson, who was largely just kind of seen as it was his relationship with his clients. And yeah, he did a lot of strategic therapy work, but it ended up being him pulling from stuff that worked in the moment because that's what worked for him and the relationship that he had with his clients. So I   Katie Vernoy  26:49 guess the point that I wanted to make with that a new just kind of set it in a different way. But I want to make sure we're on the same page is it can be very fluid, it doesn't need to be I start with a conceptualization that is tied to one theory. And I make a treatment plan that's tied to that theory. And then if it needs to shift, I shift to a different theory. It's really to me it feels way more fluid than that. And like I said, I'm existentialist I'm, I'm a Yalom existentialist where it's really just about the relationship and being a real person in the room. So it gives me a lot of freedom to conceptualize things differently. But I think it's hard to describe it to someone that's just starting out when they're like, Okay, what do I do in therapy, and it's like, we'll be in the room, see what's happening with the client, and provide them what they need. I mean, like, that's kind of how I that's, that's my orientation.   Curt Widhalm  27:45 So I do want to point out that there are a handful of different instruments that are out there that you can look at, take it with a grain of salt. You might talk about the ways that you might view the importance of aspects that might steer you in the direction of looking at theories that might more naturally come to you. A couple that we've come across in preparation for this episode. One is the theoretical orientation scale, developed by Smith in 2010. It's 76 questions that you fill out Likert scale types, you score it, it points you to sub scales that might fall across a couple of different theories that you might want to look at. Another one is a 40 item scale called the counselor theoretical position scale. This was developed by Posnanski. And McClellan, either of these might be things where if you're looking for a questionnaire that is based on where you're kind of already existing, as a person might steer you into some directions to more easily find, I might want to research this more, you get into practicing that way, you might find that it continues to gel with you, you might find that parts of it gel with you. But if you're looking for a little bit more of a direction, if you're not quite familiar with a number of different theories, yet, these might be some starting places for you to look at as well.   Katie Vernoy  29:15 And I think the takeaway that I want folks to have or a takeaway that I want them to have is that theoretical orientation actually can be very fluid over over time, you can start with, I really want to dig into narrative and you do narrative therapy with a lot of your clients. you conceptualize it that way. Maybe you have a few other things that you're doing in the background and not just adhering to one theory. But over time, there may be something else that comes down the pike. You do a training on Emotionally Focused Therapy EFT I have a lot of people that they later in their career, start sending EFT and they're like I'm completely changing how I'm working. This is an awesome way to work with couples or even individually EFT or you Find DVT later and you start digging into that, and you really understand the conceptualization, those things. I think people get really freaked out. And part of it is, I think, the interview questions. I've even designed them, like, what is your theoretical orientation? Like, I think people get freaked out that they have to choose an orientation, and that sets them up for the rest of their career. And I don't think that's true. I think that they there there is certainly foundational work that may stick with you forever. And so you don't want to be mindless about what you choose to focus your attention on at the beginning of your career. But I think it is something where it does shift, you're going to be impacted by research that hasn't even been done or theories that haven't even been concocted yet. And so I think find things that gel with you I'll use your word there and and dig into them, but but don't fear that you're going to be locked into a particular orientation for the rest of your career you You most likely won't be,   Curt Widhalm  30:54 we'd love to hear how you came up with your theories or further questions that you might have the best place that you can do that is over in our Facebook group, the modern therapist group. You can follow us on our social media and we'll include links to those as well as the articles and measurements and citations in our show notes. You can find those at MTS g podcast.com. And until next time, I'm Curt Widhalm with Katie Vernoy   Katie Vernoy  31:22 Thanks again to our sponsor Buying Time   Curt Widhalm  31:25 Buying Time's VAs support businesses by managing email communications, CRM or automation systems, website admin and hosting email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. The full team of VAs gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available.   Katie Vernoy  31:54 book a consultation to see where and how you can get started getting the support you need. That's buyingtimellc.com/book-consultation once again, buyingtimellc.com /book-consultation.   Announcer  32:09 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.

    The January 2022 Surprise of Good Faith Estimates Requirements

    Play Episode Listen Later Dec 27, 2021 37:13

    The January 2022 Surprise of Good Faith Estimates Requirements Curt and Katie chat about the No Surprises Act, specifically how to navigate the requirement for clinicians to provide Good Faith Estimates to clients. We talk about the impact of Good Faith Estimates on the intake process, potential complications when providing these estimates to your patients, and suggestions for how to simplify and systemize this requirement.      In this episode of the Modern Therapist's Survival Guide we talk about the No Surprises Act and the Good Faith Estimate Requirement When we heard about the planned implementation of these new requirements, we decided to dive into the legislation and articles from professional associations to understand what we actually need to do starting January 1, 2022. What is the No Surprises Act and the Good Faith Estimate (GFE) Requirement? “Some folks don't have a clear sense when they come into therapy, how long they're going to be there for.” – Katie Vernoy The goal of the No Surprises legislation is to avoid surprising patients with large medical bills There are benefits and challenges with the requirement to provide good faith estimates to our clients The Good Faith Estimate requirement is to provide the estimated cost of services (fee times number of sessions) at the beginning of treatment (if asked) and at least annually, if needed How will the Good Faith Estimate Requirement impact the Intake Process for Therapy? “These are not contracts; this is not guaranteeing the therapy is going to end after that many sessions.” – Curt Widhalm We are required to determine whether someone is hoping to get insurance reimbursement We must communicate the ability to obtain a written good faith estimate from providers We are required to estimate the number of sessions and total cost of treatment We talk about when you may need to provide a new good faith estimate (and explain changes) We provided a suggestion to start with a GFE for the intake session and then provide a second GFE after that initial session Potential Complications Curt and Katie see for Therapists Providing Good Faith Estimates The requirement for diagnosis very early in treatment The requirement for a diagnosis written on paper – both for folks who don't know or have not asked before, as well as for folks who do not want a written diagnosis Concerns related to putting forward the total cost of therapy for the year The elements of bureaucracy that could negatively impact the therapeutic relationship The No Surprises Act legislation isn't finalized and may have additional components or changes Our Suggestions to Systematize the Good Faith Estimate (GFE) Requirement for Therapists “There are certain aspects of this that I think - while onerous as far as communication with our clients - have the potential to make us actually talk with our clients about their treatment more frequently.” – Curt Widhalm Consider coordinating the timeline for updating GFEs, treatment plans, frequency of sessions, progress in treatment, and a reassessment of the sliding scale Think through how you talk about diagnosis and treatment planning ahead of time The idea to create some sort of mechanism for folks to either decline a GFE or to request an oral versus paper GFE Use recommended language to create your notice for your office as well as on your website Create your own template to simplify the process, including a boiler plate GFE for your intake Create a template for GFEs for on-going treatment Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Simplified SEO Consulting Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. These days, word of mouth referrals just isn't enough to fill your caseload. Instead, 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!  That's where Simplified SEO Consulting comes in. Founded and run by a private practice owner, they understand the needs of a private practice. They can help you learn to optimize your own website OR can do the optimizing for you. Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code "MODERNTHERAPIST" 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 Article: New Billing Disclosure Requirements Take Effect in 2022 Suggested Notification Language for Good Faith Estimates Template for a Good Faith Estimate Good Faith Estimate Legislation Language from the No Surprises Act Federal Register: Requirements Related to Surprise Billing; Part II CMS.gov: Requirements Related to Surprise Billing; Part II, Interim Final Rule with comment period Relevant Episodes of MTSG Podcast: Should Private Practice Therapists Take Insurance? Make your Paperwork Meaningful   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: www.mtsgpodcast.com www.therapyreimagined.com 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 is brought to you by simplified SEO consulting.   Katie Vernoy  00:03 Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings.   Curt Widhalm  00:21 Stay tuned at the end of the episode for a special discount.   Announcer  00:26 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  00:41 Welcome back modern therapists. This is the modern therapist Survival guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about things that affect therapists, our practices, the ways that we practice the ways that we interact with clients and stay I'm going to start by talking about back when I was in high school, I had to take chemistry class, and studying the periodic table.   Katie Vernoy  01:08 Where are you going with this?   Curt Widhalm  01:10 My favorite element at the time was tungsten because will W on its butt over time, my new favorite element is the element of surprise.   Katie Vernoy  01:26 Surprise!   Curt Widhalm  01:27 I think actually, a lot of providers are surprised at the no surprises Act, which we're actually talking about today, going into effect January 1 of 2022. And many people have been over the last couple of weeks, speculating on what this means for their practices, what actions that they need to take. And it's seeming to get to be a little bit of a game of telephone out there in therapy land when seeing everybody talk on Facebook groups and this kind of stuff. So Katie, and I have done an adequate job of diving into this. And how to   Katie Vernoy  02:10 Adequate is the right word, I think.   Curt Widhalm  02:13 So we wanted to be able to talk about the big scary aspects of this, the not so scary aspects of this, and the parts of this that are TBD, because it's not even fully out there yet. And much like the Spanish Inquisition, nobody knows when it's coming. So. So we are going to include some helpful things in our show notes, you can find those over at MCSG podcast comm. I'm sure we'll be doing a follow up episode to this a little bit later, we will also include a whole bunch of very boring and dense government regulations in those show notes as well. So that way, you know that we at least can link to other things in our show notes.   Katie Vernoy  03:09 We've already started off great, very adequate Curt, very adequate.   Curt Widhalm  03:13 Yes. So probably the best resource out there, at least as far as condensing down a bunch of   Katie Vernoy  03:22 At the type of recording.   Curt Widhalm  03:24 Yes there is an article from the American Psychological Association originally created December 10 2021, that outlines what this means for psychologists. But if you are a healthcare provider of any other status, and you are operating within your license or your credential, this article pretty much applies to you too. So we're going to go through this, we're going to add little bits here in there and also make some suggestions that aren't included in this article. And continue to listen to the show and join our Facebook group for further updates on any of the stuff that we're talking about here today as we find important stuff to share. So now, actually, to the content of the show, if you haven't left yet, but the no surprises Act was part of a broad package that was signed into law during the Trump administration. This was a bipartisan bill. And this was really to be a very consumer friendly bill that prevents patients from getting surprise billing. Now, if anybody's ever been in kind of an emergency situation before, what you'll know is that you don't get a whole lot of time to be in the hospital and ask every single provider Hey, are you in my insurance network? Is this going to be covered that it's kind of just who you And not every person who's working on you is necessarily in network, not necessarily an employee of the hospital. And so what ends up happening is that all of your your treatment stuff gets submitted to insurance companies. And then, like Spanish Inquisition, surprise, there's bills that show up in the manual. And this is generally not seen as very consumer friendly, because people don't know what's coming. Yes. Having been on the receiving ends of those kinds of treatments myself in the past. Now, I kind of like where this bill is going, being a healthcare provider, in my own little practice, not liking where this is going. Because there is a lot of regulations that are being added into this that while intended very well, for kind of emergency situations are fields a little bit different.   Katie Vernoy  06:03 Yes. And I think that for private pay providers, there can be times when folks are surprised, not by Oh, the anesthesiologist wasn't in your network. And this extra special treatment that happened because of you were under sedation, cost $27,000. But it is something where some folks don't have a clear sense when they come into therapy, how long they're going to be there for. I think, as a profession, I think we're very good at making sure someone understands the fee before they come into the first session. They know what they're going to be charged when they sit down with us. I think the part that feels both, I guess positive, but also onerous is having to say like, Hey, this is how long your treatment is going to be. This is what it's going to cost and, and giving so much information. I mean, it's it's a lot of information that you're having to provide very early in treatment to a client. And they basically will hold you to it, and then they're given information that they can hold you to it if if it does shift, too, dramatically. So I see that I see the point. But I also see that it's going to be a lot of work. Especially I think just to set it up, I think that there's a way to systematize it. And we can talk about that when we have our kind of discussion around suggestions later. But to begin, it's going to take some work.   Curt Widhalm  07:32 And so the main crux of what you're talking about here is providing clients with a good faith estimate. Yes. Before we get into what the good faith estimate is, let's talk a little bit about the intake phone call with clients. Because I think certain aspects of this, many providers are doing in one way or another where in many jurisdictions were required to discuss our fees with clients before they come into our first session. Yes, it's, you know, no surprises. It's not that they're showing up in our office, it and then all of a sudden being like, wait, what that we yeah, do provide that, usually verbally in an intake phone call, what that good faith estimate now adds to our work is in that intake phone call, we need to start having language around, are you planning to submit a claim to your insurance company for the services that you're going to receive for me, those of you who are in network with insurance companies, that's all to be determined in the future. As far as how that works with insurance companies, we're really talking to those cash paying clients, those out of network therapists, those who provide super bills, if you have a hybrid practice, half, listen to this, turn off the insurance side of your brain. But in that initial phone call, you need to ask clients, are you planning to submit this for a claim? Now, the way that most of us are already doing this is around this language Trooper bills? Hey, do you want a super bill for our services?   Katie Vernoy  09:11 And I also do "Do you want me to do courtesy billing" and actually take the reins on, you know, kind of getting insurance information and that kind of stuff? So I think those of us who are that have a sizable portion of our practices that are private pay, navigate this, but there are some clients that come in never discuss insurance. And I think that the the shift that I'm going to make us I'm going to ask that directly versus kind of allowing it to organically happen in conversation because if somebody comes says, What's your fee? I say $200. They say okay, like, I don't necessarily take that extra step. All the time about that. I mean, sometimes they'll say, you know, do you have insurance benefits? And do you want me to do courtesy billing or would you like a super bill, but I've not been diligent about For folks that don't seem interested, so at this point, we have to ask the question, we have to know about that. I don't know what we do with that information, but we just have to ask, we have to know, that's probably more of the to be determined.   Curt Widhalm  10:12 Well, so from the APA article, what we do after asking if they intend to submit a claim to their insurance is inform them, that they can get a good faith estimate of the expected charges, and that we can provide it to them in a written document if they want. And that needs to include things like a CPT codes, the the billing code for those service sessions that you're intending to do, it needs to include information about the client on it, and the anticipated number of sessions. Yeah, and I think that this is a part where I'm seeing some of the chatter in the therapist community around. Some of the conversations are well, what if people hold us to, you know, you said, this was gonna take 20 sessions, and it took 40. These are not contracts, this is not guaranteeing the therapy is going to end after that many sessions. And I suggest being clear with clients about that, that, yes, as far as I can tell from this vantage point, if you follow treatment, if things go, Well, this should take X number of sessions.   Katie Vernoy  11:27 And then I think the other piece, if you truly think it's going to be 20 sessions, I think, put down 20 sessions, if you think it's going to be longer term treatment, I think you you know, you have to do this, it needs to be a good faith estimate for the next 12 months, I think you do it as an annual or to the end of the year. And maybe you do all your good faith estimates in January. But each new year of treatment for each client, you have to do a new good faith estimate. And each time you change the fee, or the cadence of treatment, the way I'm reading it is that you need to then do a new good faith estimate. So if somebody increases the number of sessions, like they go from once a week to twice a week, or they shift from twice a month to one month, you know, like you're gonna want to adjust down. It feels onerous. And I think that there's probably a way to make this pretty streamlined if you have a form and you just are changing that number and that number. But the part up front that I get worried about is that it's supposed to have the clients diagnosis. And we're talking about an intake call where people can request these good faith estimates. And so I'm assuming you put at that point to be assessed or to be diagnosed at the first session or something like to me, it seems like some of the information requested doesn't really hold up when you're just getting a good faith estimate from a potential client.   Curt Widhalm  12:51 Sure. So I'm gonna go back two points that you made and then come to where you're talking about here.   Katie Vernoy  12:57 Okay. Okay.   Curt Widhalm  12:59 Some of us have clients who are lifers, that   Katie Vernoy  13:02 yes, they are Yes, both you and I are in that category.   Curt Widhalm  13:05 So what I intend to do with those clients is, hey, you generally come 50 weeks out of the year, here's your fee for 2022.   Katie Vernoy  13:17 Done,   Curt Widhalm  13:17 Done, there you go.   Katie Vernoy  13:19 Yeah, I think it's supposed to be in a form. But we can argue if it can be verbal, or if it has to be that whole form.   Curt Widhalm  13:27 I'll give them a form. To your second point. I wonder if the implementation for a lot of therapists is very standard going to have the first session be, actually to Bill 90791 as an actual diagnostic interview for your first session, that would have your appropriate rates, go back to our CPT code episode and hear us talk about most therapists don't actually bill for that one. Yeah. But that, I think, actually, if I step back, this whole process might actually make us follow through on things that we're supposed to be doing a little bit better if we're not having formal diagnostic first sessions, if you're concerned about putting a good faith estimate out to a client that you've talked to for about five minutes on the phone, and four minutes of them are about what a good faith estimate is that you can actually create a space to say, here's a good faith estimate of what this first diagnostic session is going to costs. And you'll get a new good faith estimates for our sessions after that session based on what comes out in that diagnostic interview.   Katie Vernoy  14:49 So, private pay providers are now going to have to act a little bit like insurance providers and diagnose in the first session and predict how much treatment is going to be needed.   Curt Widhalm  15:01 yes.   Katie Vernoy  15:03 Welcome!   Curt Widhalm  15:05 well into your other points is, if you, misjudge or if services need to continue, it's not like your relationship with the client just has to stop, you do get to provide new and updated good faith estimates   Katie Vernoy  15:22 Yes   Curt Widhalm  15:22 as anything changes, like you said, if you're going to more sessions a week, if you change your fees mid year, if any number of different things changes, potentially even diagnostics, then you're going to want to provide good faith estimates that are updated. And I would recommend that you put language on those updated ones that this replaces the previous Good Faith Estimate from whatever the previous date is.   Katie Vernoy  15:52 And it does say in the language, and I don't know if this is in the APA article or the actual legislation, but it does say that when you provide a new Good Faith Estimate, you do need to identify what is different. And so if it's, hey, everything's rolling along, same fee, same number of sessions next year, I think it's saying, this is continuing. And it's you know, there's no changes in the fees, no changes in the predicted number of sessions this year, this is for this year. I think for folks where you're changing fees, or dramatically changing the cadence of sessions, I think that would be an important thing to put and definitely like your language of this replaces the previous Good Faith Estimate. One thing I'm thinking about with this is that if you've got a niche that that generally you know, or your lifers that generally have this is how many sessions you have per year. And so maybe it's 48, or 27, or whatever it is, you know, depending on the cadence of their treatment, shifting from every other week, to once a week back to every other week to once a month, like assuming you're kind of still in that number of sessions per year, I think you probably are fine. Changing fees, definitely a good faith estimate. But like if you've said, This is what you're what we were looking at this year. I think that could I think that could work. What do you think?   Curt Widhalm  17:15 I'm not a lawyer?   Katie Vernoy  17:18 Yes, nor am I.   Curt Widhalm  17:21 It's probable, and, you know, any challenges to this are still to be determined. This is all, you know, this is what regulations are going into effect. The HHS has not you know, had any opportunities to enforce any things yet. So we'll wait for somebody to get punished, and then we'll be able to tell you what they're doing. But realistically, it seems like a good faith estimate is exactly that. It's good faith that Yes. Hey, you know, you typically come to three out of four sessions a month, in case you come to more, you know, some months you do make a ball. So good faith, I'm going to put that you're gonna make all of the sessions over the next like five months. And we can evaluate at that point, you know, what's needing to be changed. There are certain aspects of this that I think well onerous, as far as communication with our clients have the potential to make us actually talk with our clients about their treatment more frequently? Yeah. And I think that that's part of what's scary to a lot of therapists is that clients are gonna see, I spend how much on therapy each   Katie Vernoy  18:40 year? I know, that's the part that I'm like, oh, yeah, that's gonna be rough. Most people don't want to think about it.   Curt Widhalm  18:49 I could buy several cars for this. Right? I think if you know, you're not wanting to sticker shock your clients on January 1 With, here's your good faith estimate of 50 sessions at $100 per session, or 200, or 300, whatever your fee is, yeah, that they can see some therapists breaking it down and say, Alright, here's only six months of anticipated treatment. And I'll just put out a new good faith estimate when that one runs out. But I think that that makes us be able to talk about clients progress, as far as what do you think that you need is continued services going forward and to actually review your treatment plans with them more frequently?   Katie Vernoy  19:37 Yeah, I think it's actually a good process to to align this with a treatment plan. I think process wise, I see it as being something like every January 1, I put out my good faith estimate. But I think there's an element to that where, you know, someone coming in in December and then giving a new one to them. January feels silly. So but I do think talking to folks at their treatment plan anniversary, or every six months or whatever your timeline is, and then talking about cadence talking about, you know, how they're feeling, you know, what they're thinking about. I think that's a good process. And I know when I was working in community mental health that was, you know, like, you talked about termination. From the beginning, you know, and I feel differently in private practice, like you might a lot of my clients are lifers, but I think it is, it's really easy to get complacent, when you're just kind of meeting every week, and you're not actually taking the time to look at what are we actually working on? What are you getting from this? You know, what is your financial situation compared to what we're talking about? I mean, for folks that do sliding scale, this could also be an opportunity to SPSS sliding scale and saying, okay, you know, my fee is going to be x January 1, and, you know, this is what you've been paying, you know, is that still appropriate? Are you able to increase towards the, you know, can you decrease the subsidy, so to speak, you know, like, you can have those conversations, it's just a money conversation that a lot of people don't like to have. And so I think this kind of thoughtful, you know, kind of transparent conversation about number of sessions length of treatment, Cadence. And money is important and needed, but pretty uncomfortable for a lot of folks   Curt Widhalm  21:27 being the optimist that I occasionally am, that I think that there are some providers out there, especially when it comes to things like sliding scales, who don't know how to bring the conversations back of, yeah, hey, you got a job. And now you can afford the fee that we had agreed upon before. This does provides those clinicians with an opportunity to have a better touch point, as far as renegotiating some of those sliding scale things.   Katie Vernoy  22:01 It's a natural benchmark. I think the other thing that is interesting on what's being required in these good faith estimates is the client diagnosis. We mentioned it kind of like, you know, do the diagnostic session separate and then a good faith estimate for ongoing treatment. But for some of my clients, they may never see their diagnosis unless I do this, right. And so for folks that don't do super bills, or don't talk about it, don't request their records. And so I think that's another thing for folks, you know, before they provide their first Good Faith Estimate, you may want to be ready to have that conversation because it does show up on the billing, or does show up on this form. And so being able to make sure that your clients understand how you diagnose why you've diagnosed, what you've diagnosed, and what it means how it's impacting treatment or not, it does mean that we need to diagnose our clients. And I think some folks are unlikely to do so when they're completely private pay.   Curt Widhalm  23:06 And I think for people who provide super bills, if this worries you, you're already doing this. It's just you're now with the potential of a more explicit conversation with your clients. And helping clients as Katie just mentioned, to understand what this process is. And, again, this is all very good spirited as far as being consumer friendly. And that's, you know, where it does put some of these onerous things on our behalf. But I think it has the potential because of all of these extra contact points in talking about treatment, and talking about monies impact on treatment, that clients are going to get better outcomes, which maybe I was gonna say if clients get better outcomes, that's good for you as the therapist.   Katie Vernoy  24:02 Sure, sure. I think there's, there's, there's an element of this that feels very paperwork and could take away from the relationship, you know, like, if you have to explain a tough diagnosis that that, you know, wasn't something that was in the regular conversation that can that can impact the relationship. If you have to really dig deeply into some of this. I think it's life. I think it's it's therapy, it's good therapy, but I don't know that it's necessarily I'm not going to just, you know, rainbows and sunshine about like, hey, you need to do this, because I don't know, I think that there are ways that you can make a benefit your client, I don't know that it's necessarily designed to benefit outcomes. The thing I was thinking about, which is an open question, there are folks who do not take insurance because they don't want a diagnosis and they don't want to have anything on record around diagnosis, whether it's based on their job, whatever some reason, they don't want to have a diagnosis. My assumption I'm not reading anything in here that you have to have a full DSM diagnosis, you could do a V code, you could do something that was subclinical. Is that how you're reading it? Or is this an open question where we have to determine like if people want to refuse a good faith estimate, written in good faith estimate? Are we allowed to do so?   Curt Widhalm  25:18 So for those people who are not in network, and if you know, the diagnosis question is a thing. If people, you still have the obligation to ask people, if they are planning on submitting their claims to their insurance company, sure, sure. If they are, you're still required to provide the proper diagnosis to them, you're not not just one that is reimbursable. And so if you are treating somebody for a Z code, if you are treating somebody for something that is traditionally not reimbursed, that is still the diagnostic code that you're supposed to put on there, that has not changed that is already in place. And if you're not doing that, that's insurance fraud. Spanish Inquisition is coming after you.   Katie Vernoy  26:07 Okay, so you didn't answer my question. But all of what I said, What you said was, I agree to if someone does not want to submit any claims to insurance, doesn't want a super bill barely wants a record? Can they decline one of these good faith estimates?   Curt Widhalm  26:24 Absolutely.   Katie Vernoy  26:25 So that they don't have any diagnosis on any paper anywhere?   Curt Widhalm  26:30 Absolutely.   Katie Vernoy  26:31 Okay.   Curt Widhalm  26:33 You as the clinician still need to chart your treatment plans and what it's based on and all that kind of stuff, whether your clients want a good faith estimate or not?   Katie Vernoy  26:42 Are we required to diagnose a client?   Curt Widhalm  26:44 you need to have a reason for treatment, and you need to have a treatment plan that is based on something other than a client just showing up? And you started a session with? Where do you want to start today and ending it with? You're where you need to be? That?   Katie Vernoy  27:03 That may be a whole other conversation. But   Curt Widhalm  27:05 I mean, that that is acting within the scope of your license that   Katie Vernoy  27:08 Sure, sure. So we can have a conversation about diagnosis, but from what you're reading, we could either put a non clinical DSM code and for this Good Faith Estimate, or someone could decline it if they don't want to have a piece of paper with their diagnosis on it.   Curt Widhalm  27:28 Sure, yeah.   Katie Vernoy  27:30 So we may also, at some point, need to put together a, I am declining a Good Faith Estimate form that people sign,   Curt Widhalm  27:38 you know, that's a great idea. You know, it's not like a subpoena where you have to, like, throw it at a client if they're running away from you. Anyway, there are   Katie Vernoy  27:50 Oe I would prefer for an oral, Good Faith Estimate versus a written faith, Good Faith Estimate. I think these are the things that are kind of the to be determined, we'll wait and see if anybody gets sued or or in trouble. But I think there are probably some some reasons why these would not be customer friendly, or consumer friendly, right, is all I'm saying. So we'll we'll table that for now.   Curt Widhalm  28:14 So there are some other requirements that I think are important for everyone to be aware of. You have to prominently post that clients can and are entitled to a good faith estimates. And this needs to be put on your website. It needs to be prominently displayed in your office. I'm I'm on Amazon right now, ordering one of those neon like scrolling things, just put it up behind me in session.   Katie Vernoy  28:46 Oh, that sounds awful.   Curt Widhalm  28:50 Or really just posting a paper a piece of paper that says you're entitled to a good faith estimates.   Katie Vernoy  28:57 And the APA article has both samples of the good faith estimate itself as well as notice the language for the notice. And it has instructions on it. Well, we'll link to those in the show notes. But I think it is big enough that it might be not quite a poster, but still a piece of paper on your wall. And then for your website. I think my suggestion What if you have a section on fees, this may be a reason to post your fees on your website. People have different feelings about it. And I think that would be the appropriate place to have it listed. is in that that section of your website.   Curt Widhalm  29:36 To be clear. You don't need to put on your website. Just a general I expect people's treatment to last 25 sessions   Katie Vernoy  29:46 No   Curt Widhalm  29:47 the language that you need to put out there is   Katie Vernoy  29:51 You can request a good faith estimate.   Curt Widhalm  29:52 Yes, exactly.   Katie Vernoy  29:54 And that's in that APA article. I think the other thing that I was starting to get to get in the weeds and I think this is is more kind of standing questions that will be to be seen. There are a difference between convening providers, which is the person providing the primary service and CO providers, from what I can read the convening provider is the person who has been asked for this good faith estimate. And maybe it's a primary provider, maybe it's just the person they thought to ask. And if there are co providers who are providing treatment with you for the identified patient. So for example, you've got a an eating disorder treatment group that, you know, you've got different folks either in your group practice, or that you do a lot of work with, you may end up having to put together kind of this full package of good faith estimates where everybody's services are on there. I think that's a little bit more detailed than we need to get for today's conversation, I think typically, you're just going to be doing your own services. But for folks who have group practices that maybe share an identified patient with another provider, or have a little complexity, you probably are going to want to reach out to your professional association or legal counsel to identify how best to take care of those good faith estimates is my opinion.   Curt Widhalm  31:10 Yes. If this sounds like a lot of extra steps, you're right. And some of the things that I'm seeing across the healthcare industry is that this does impact smaller businesses a lot more than group practices and agencies, because it is a lot of extra steps and does have time deadlines that oftentimes you're going to need to provide this in writing to clients who want it within one business day. And if you have a very, very busy schedule, this is something that you're going to deed to accommodate, you're going to have to get these systems in place. And you know, our friends over at simple practice that we've seen some chatter in the simple practice community requesting that some of this stuff be added to their platform, I hope that a lot of the EHR systems, we'll be addressing this so that way, it does help to streamline these things. But this is stuff that whether you like it or not, it's here. And, you know, we're trying to give you just a even if this is a, hey, I have to go and look at this stuff. And I need to make some changes now go and make those changes, because this is things that our world is changing, we have to adjust to as providers and our clients are going to be overall probably better for it even if that means that we're not.   Katie Vernoy  32:47 So I want to just before we close up, I want to talk through what I see as a potential path to try to make this as efficient as possible. And so I'm stealing one of your ideas, and then putting together the rest. So I think what   Curt Widhalm  33:00 your plan is everybody quits and go find retirement early on some cheaper cost of living base.   Katie Vernoy  33:09 No, everybody become coaches... Um, no, the plan is, I really like this idea of having a boilerplate, good faith estimate for your diagnostic session. So your 90791 I think the difficulty unless there is like some sort of a form created in your electronic health record, you may have to create this separately, but putting together that good faith estimate. So it is sent over with all of your intake paperwork. And it's part of the the process. So this is the fee, this is the service. I think that the nuance and you can have all of your information, the nuance is the clients name and those types of things. And so I'm going to look in simple practice myself to see if I can figure out a way to do it if if they don't fix that themselves, or don't put that together themselves. But I think even creating, you know, a form that you can upload and send to them where you can, you know, kind of do that that becomes with your intake paperwork, it goes out immediately you're in compliance. I think the next stage is having that good faith estimate that is for ongoing treatment, has all of your information already in place has all of the services and fees in place and then it goes into you know, there's a little bit that you have to fill out for each client that has their information, their diagnosis, and then the number the expected number of sessions, and that goes out after the first session.   Curt Widhalm  34:43 I think it's brilliant, until they change things and that's addressed. In some future episodes. We do know that there is language that is written into this no surprises act that even four out of network therapists might be needing to submit some of this paperwork directly to a client's health insurance company. That part of the law or the regulations has not yet been written. We just know that it's coming. It's reserved in there. And that's what some of the future languages for your member professional association, check out any guidance that they have, as those regulations continue to roll out, we will almost guaranteeing an episode in the future on what that means, especially for those of us who aren't used to talking with insurance companies and what kind of mean now, so we kind of want to hear you lamenting these kinds of things. I can share your thoughts with that in our Facebook group, the modern therapist group, and share it with us on our social media. We'll include links to all of that in our show notes. And until next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  36:02 Thanks again to our sponsors simplified SEO consulting.   Curt Widhalm  36:05 These days, word of mouth referrals just aren't enough to fill your caseload. Instead, most people go to Google when they're looking for therapists. And when they start searching, you want to make sure they find you. That's where Simplified SEO consulting comes in. It's founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website or they can do the optimizing for you.   Katie Vernoy  36:29 Visit SimplifiedSEOconsulting.com/moderntherapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code MODERNTHERAPIST. Once again, visit simplified Seo consulting.com/moderntherapist and use the code modern therapist all caps.   Announcer  36:54 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.    

    How Can Therapists Actually Retire?

    Play Episode Listen Later Dec 20, 2021 38:59

    How Can Therapists Actually Retire? - An interview with David Frank, financial planner for therapists Curt and Katie talk with David about managing finances, including student loan debt and retirement. We look at when to start saving, what to do when you're starting to save for retirement later in life, and how much is too much to save. David also shares his concept of a Money Date and how you should start looking at your financial picture. He also talks about financial planning and when to seek a professional for support. Interview with David Frank, Turning Point Financial Life Planning David Frank is on a mission to ensure every therapist has access to unbiased and fiduciary financial advice! Through the firm he founded, Turning Point Financial Life Planning, he helps therapists navigate every element of their financial lives: from understanding your practice P&L and building a personal budget to managing student loan debt and investing for retirement... and everything in between. Dave earned both his undergraduate and MBA degrees in finance and he also completed a certificate in personal financial planning. He's worked for over twenty years in investment banking, corporate finance and now personal finance. Don't let his love of the tax code and spreadsheets scare you off! You're just as likely to find him with his nose buried in one of Pema Chodron's books as reading up on the latest finance planning techniques. In this podcast episode we talk about: Managing Personal and Professional Finances How perfectionism can get in the way of saving The importance of “just getting started” in saving for retirement Saving money is a practice, not something you figure out once Why it is important to save money as soon as you can Navigating Student Loan Debt Student loan debt and how overwhelming it is to look at these debts The desire to pay off this debt as quickly as possible David's advice to save at least one time your annual income before aggressively paying off your student loan debt The comparison of interest rates on your debt versus returns on investing money Retirement and Investing in your Future “Starting to save and invest young is such great advice… and… it's advice for time travelers” For younger folks, the advice is to save as soon as possible What to do if you are closer to retirement age and you haven't started saving for retirement How to determine when you can retire “No one does this money thing perfectly, even if we start out of the gate pretty strong.” What to do when life happens and you have to start over David's own story of having to start over Societal fear due to 2008 and the Great Recession David Frank's Concept of “Money Dates” Reserve time each week to look at your money Start understanding how much you need to save Idea: go to the Social Security Administration Website to see what you're entitled to in social security How Much Money to Save The money mindset concerns that can get in the way of saving (or even looking at) your money How much money is too much money to save? Emergency funds and the feeling of safety and security The risks of saving too much money Quality of life questions when you are underspending Online tools to identify what you need in retirement, so you know when you've saved enough Actual numbers of what to save for retirement and what you can spend now Financial Planning – When and why to seek help with your money The complexity of the decisions related to paying debt versus investing The number of options available to each person when making decisions on our money Get feedback on how well you are doing on your practice financials and saving for retirement Risk planning, financial planning, estate and incapacity planning The importance of understanding your values when you look at how to spend your money Financial planning when you don't have a lot of money Choosing what you sacrifice when you decide to invest in shiny objects The problem of “shoulds” and getting financial advice from other therapists Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Simplified SEO Consulting Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. These days, word of mouth referrals just isn't enough to fill your caseload. Instead, 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!  That's where Simplified SEO Consulting comes in. Founded and run by a private practice owner, they understand the needs of a private practice. They can help you learn to optimize your own website OR can do the optimizing for you. Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code "MODERNTHERAPIST"   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! David's Website for Turning Point Financial Life Planning David's Finance Quickstart Guide David's Quickstart Intensive Coaching Session (use code MTSG for 20% off) David on LinkedIn Social Security Administration Website   Relevant Episodes of MTSG Podcast: The 4-1-1- on your 401K Making Bank as a Therapist Overcoming Your Poverty Mindset Don't Take Tax Advice From 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: www.mtsgpodcast.com www.therapyreimagined.com 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 is brought to you by Simplified SEO consulting.   Katie Vernoy  00:03 Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings.   Curt Widhalm  00:21 Stay tuned at the end of the episode for a special discount.   Announcer  00:24 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  00:40 Welcome back modern therapists, this is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for all things therapists. And that includes money and how we're setting ourselves up for running good practices, taking care of ourselves, both while we're working and towards retirement so that way, we don't have to do this forever. And we can potentially retire someday. And here to help us talk about this is David Frank. He is a financial planner and the founder of Turning Point financial, and he's here to help put the fun back in funds and take the ire out of retirement. So thank you very much for joining us today.   David Frank  01:29 Brilliant, thanks so much for that introduction. Kurt. I'm super excited to be here and to talk about, yeah, all things Money and Finance and even the dreaded R word of retirement.   Katie Vernoy  01:40 I'm so glad you're here, we had a lot of fun working together around the conference. And we definitely I feel like you're a friend of the show and a friend of mine. And so I'm so glad you're here talking about that.   David Frank  01:51 Thanks   Katie Vernoy  01:51 Because I think there's a lot that needs to be discussed. On a previous episode Curt and I had been talking about one of the retirement plans that therapists have is suicide, which is horrible. And, and part of that is just not planning not making enough money. And so to me, I feel like this is an important conversation for us to be having. And you're a great person to do it because you're a financial planner, who has chosen to work specifically with therapists. But before I get ahead of myself, the first question we ask everyone is who are you? And what are you putting out to the world?   David Frank  02:26 Yeah, so as Curt mentioned, my name is David Frank, and I am a financial planner, and the founder of turning point, financial fat is a financial planning firm that I began and it is focused exclusively on helping therapists or mental health professionals take care of their finances. So that's what I'm putting out into the world. That's what I'm doing. My kind of mission is to help people live better lives to help your listeners, your therapists out there live better lives, and also grow their impact in the world. Because when we get sort of some of this money stuff out of the way, we can be more present for every element of our lives. And I think it's less about the money and more about the actual feelings and feeling better about money and not being so stressed and overwhelmed about it.   Curt Widhalm  03:08 What's wrong with you if that you chose to work with therapists? How does somebody be like, You know what there there are people who are easy to work with with money, and I'm up for a challenge. Why? What brought you to the the mental health world as far as your client population here?   David Frank  03:31 Yeah, great question. Well, so within the financial planning community, much like within the therapist, community and mental health community, there's this like raging debate going on about whether niching down and really specifically defining your target audience or target market is a good idea or not. And when I started turning point, when I started my own business, the big thing I was worried about is like, is anyone actually going to show up and want to work with me, like actually pay me money for my services? And the other the secondary concern was like, will I be able to add enough value will I actually be able to, like, really understand what's going on for folks and really help them in a meaningful way. And I became super convinced that the solution to both of those anxieties was to define a niche of who I really wanted to work with. And it was a very, what's the right word, I was just very stressed about getting the right niche. And at that time, I was, I was seeing my own therapist, and I had been seeing this guy for several years, and he was awesome. I was working with kind of a life and business coach, and I was agonizing over this decision. And finally, my coach reflected back to me something that was obvious to him, but was invisible to me. And he just said, Why don't you work with therapists? And I was like, Oh, my it was just like a light went off. That's the wrong metaphor, but it just it felt so right. I love talking to therapists, like I sometimes I think like a therapist. I love learning about their business. And it just seemed like a population that I could help and like you say, like, maybe maybe I'm up for the challenge.   Katie Vernoy  05:01 What do you think therapists get wrong when they think about retirement or saving money or taking care of their finances?   David Frank  05:08 Yeah, I what I see is something that not just therapists get wrong, but just generally most people get wrong. And that's this idea of having to figure it all out or get something perfect, rather than just simply getting started. And when it comes to managing finances, both personal finances and professional finances, like your private practice finances, I think the key really is simply just to get started. And so if we think about saving for retirement, I mean, man, just even saying that makes me feel a little bit overwhelmed, right, like, there's so much there to navigate and figure out. But I think the key is to just sort of get started and meet yourself where you're at and just say, Okay, what you really need to do to save for retirement is just that to start saving. So understanding if you can put away even if it's just $5, every month, just get started, build that muscle, build the practice of saving some money and moving it, even if it's just moving it to a dedicated checking account where you're beginning to build up savings, then like down the road, you can come back and sort of figure out, okay, I should probably be investing this money rather than simply putting it into a checking account or something like that. And it is like it's a practice, this stuff is not a project that you sit down one day and get it all done. And then you're just good. It's kind of like a mindfulness practice is really the way I often think about it and encourage others to think about it is to carve out some time, every week to just spend with your money stuff, both your internal stuff, what comes up for you, when you're dealing with money and finances, and with the external stuff of the accounts that you have in the amounts of those accounts and how you navigate it. So I'm just a huge proponent of just sort of getting started and make taking those small, little steps. And I feel too often people get hung up that like, No, I have to make this big, monumental shift, that perfectionist tendency that so many of us have, can really hold us back.   Curt Widhalm  06:57 So I think in your own way, you've answered a couple of the questions that we would normally ask here, which is, when should people start saving? And how much should they start saving, which I'm hearing you say, early, and whatever you can. So that's kind of the first part of this, for maybe some of our listeners who are earlier on in their careers who are facing things like massive student debt, where it's like, well, I should be throwing money at, you know, getting the government off my back or blowing providers off my back. What do you say to somebody in that position where it's very earlier on where they might be kind of death, avoidant, as opposed to starting to think about investing in themselves?   David Frank  07:44 Well, yeah, a couple of things I want to say in response to that. And first, Curt, I think you hit the nail on the head, start saving as soon as you can, there's this this magic of compounding what we talked about in the financial world. And that just means the sooner that you get started saving, the longer you have, or the longer you give those investments to grow. So the amount that you need to save can are like the percentage of your income that you should be saving toward retirement, it can change dramatically depending on when you start. So if you're starting to save for retirement, say in your mid to late 20s, from mid to late 20s, all the way through retirement, that's like 40 years for most of us. And so if you start that early, you could save like 15% of your income and be absolutely fine. The longer you wait, the greater percentage of your earnings that you'll ideally need to set aside. Now I don't want anyone to hear those numbers and kind of like freak out and prevent them from from even getting started. Because anything is better than nothing in this sort of situation. So that's part of the answer. And we can probably talk more about that. But the the student loan issue, I think is a huge one. And yeah, I mean, I really feel like it's so it's so easy to want to avoid student loans and not even look at them. And what I would say is that, regardless of the type of debt, whether it's student loan debt, or a mortgage or auto loan, or really almost anything else, I don't encourage people to start aggressively paying off debt until they've saved, you know, roughly about one times their their annual income through a combination of emergency funds, retirement account savings, and even just, you know, ordinary savings and other other investments. The one exception to that might be really high interest rate credit card debt, which you might want to pay off. But student loans, especially, the only way that you can really get into trouble with student loans is to ignore them and not look at them. There are so many amazing options in terms of different income driven repayment plans out there. If you have federal student loan debts, I would encourage you to start saving and start looking at your student loans and considering what might the right path be for you because there are so many good options out there. Unfortunately, because there are many options. It's a little confusing and overwhelming to navigate. But there are definitely great resources out there. So super long answer To your question, allow you guys to jump in.   Curt Widhalm  10:03 And if I can provide, you know, maybe a little bit of a perspective on this, you know, if you're looking at student loans, if your rates are like 5 6 7 percent in interest, even that can feel scary. But when you look at like stock market returns over the last couple of years, money that you could be saving 5% on by putting into your loan, you could have been getting returns of 1015, or more percent, depending on how that kind of stuff is invested, where you're using that same money to make your retirement come sooner. This is where having some of the ability to kind of sit and look at some of this stuff. And sitting with somebody like David would, I'm sure walk you through some of these kinds of comparisons of here's how you can make even very little money work for you.   David Frank  10:49 Yeah, I think that's that's an excellent point, Curt. And like that's, that's right. Like, it's always great to be investing the money and seeing really great returns from the stock market, like we have seen over the last couple years, really over the last 10 years, it's been an insane period, where there's been really healthy returns. And you're right, like you could have not pay down your student loans whatsoever. Because yeah, they're probably in the neighborhood of 5 6 7 8% interest each year, something like that. And that's just it's so complicated. Like there's so many factors to think through that I think yes, the more you spend some time just sort of looking and learning yourself, the more comfortable you'll start to be with it. And that way you can kind of avoid making more rash, emotional decisions, which is sometimes when folks get themselves in trouble. And yeah, you know, I'm having a conversation with financial person, who you who you trust, and who can help you make the right decision for you. Because there there is no one right decision really ever when it comes to all these things. It really is personal and helping a client or helping the person sitting across from me determine what is the right move for them, given their life's their their life, rather, their goal, their anxieties around money, their worries, how do we manage all those different things?   Katie Vernoy  11:59 I like that you're talking about it as individual decisions. I think there are some things we're kind of the cold hard numbers with some therapists are great at math, many therapists are not great at math, that's kind of a trope that I don't actually like, I think it's this thing of, of being able to actually look at the cold, hard numbers of what do I save by paying the minimum payment on my debt? Versus what do I earn from even putting something in a very risk free I mean, the stock market isn't necessarily risk free, you could make 10%, or you could lose 20%. You know, there's, there's so much there. And I think some people can hold that risk and are used to that, and some folks can't. And so I think looking at what, what makes sense for you with the emotional makeup of how you're looking at your money, the amount of bass that you have and can play around with as well as what your debt looks like. It seems like understanding that is really important. I think when we're looking at folks who are first starting out, which is kind of Kurt's question, which is like they have student loan debt, most likely, they are not earning a lot. And so you're saying kind of look at the numbers identify what's going to make the most sense, save a year's worth of salary before you really aggressively attack your student loan debt, I would recommend probably paying minimum payments. So you don't start? Well, yes, fee is as well. But like, I think there are folks that want they want to be debt free. And I think there's also a lot of folks who know that most people are never completely debt free because of mortgages or, or car loans or other types of debt that can be accrued. But when you look at folks who are a little further on, and whether it's age wise, or career wise, they're further along, and maybe they haven't saved for retirement, what would you say to them, because I think for folks who are early on and they can save the $5 a month or whatever, that's awesome. And I think that there is that compounding that you were talking about. But there are folks that I've talked to even that are like, I am in my 50s I'm in my 60s, I haven't done anything. And I just don't want to have to work forever. And so what would you recommend for folks who are further on in their life who are maybe further on in their career? What should you say, you know, how do you determine what you should save? How do you determine how and when you can retire? I mean, for folks who are later on I think there's there's sometimes a bigger question mark than folks for starting out. I mean, the message when you're first starting out when you're younger, and you're newer in your career, like just save, start it, you've got a lot of time it'll grow, we promise. But for folks that don't have that time, it's especially people who have recently seen their parents, colleagues and friends go through, you know, 2008 or, or different times when retirement just dropped out completely. I mean, there's some fear there's some societal fear around investing. Potentially you have to look at too.   David Frank  14:47 Yeah. No, I like the way you teed up that question too, because I Yes, starting to save and invest young is such great advice. And I also like to describe it as I'm like, It's advice for time travelers, right? Because it's like yeah, that is a lovely thing, but like who actually does that? I mean, some people do for sure.   Katie Vernoy  15:05 Curt and I both did because of the backgrounds that we have. So we both are very fortunate. But not everyone has that.   David Frank  15:12 No, well, just like as an aside, like, I also have like that similar background, like I have an undergraduate degree in finance, I have an MBA in finance. And so like, right out of the gate, in my early 20s, I was like, I gotta be saving, I got to be putting all this money in a 401k. And I did that from like, 22, or whatever to like, 32. And I was doing great. Like I was killing it. And then you know, life happened. And like, I went through a really rough period in my life, I ended up unemployed for like, three years. And guess what, like, I burned through all those savings. So I thought I had done all the right things. And I had, but like, life just happens. And so the story that I told myself at the age of 35, when I was like, essentially broke and starting over was, like, there were a lot of nevers like this is I'm never gonna have the same amount of money, I'm never gonna have the security, I'm never gonna feel comfortable. It's just like, it's kind of like it's over for me. And the truth is that life had all kinds of twists and turns in store for me, and that most of what I was telling myself then wasn't true. So why do I even tell that story? I think the point is, is like a no one does this money stuff perfectly, even if we start out of the game strong, so just be kind and forgiving to yourself, number one. And number two, you really don't know what the future holds like there can be tremendous improvements made in a really short amount of time. So with that, as background, I would say, again, I have this concept I call money dates, which is just set aside 30 minutes, every day, every week rather, or so every week or so 30 minutes or so put it on your calendar and just treat it as if it were, you know, a client appointment and be like, I'm going to sit with my money stuff, and just look at it every week, and just see what's happening. So that I think, especially if you're find yourself later in life, and you use the specter, you have worry or fear about retirement, just start that practice, start getting familiar with what's happening, start understanding maybe how much you might need to save. Yeah, and also try to bring someone else into it with you. Maybe that's a significant other, maybe that's someone in your personal life, who you feel comfortable having this conversation with, just to sort of make it seem less private and scary. That could also be someone like me, like a financial professional, that you have reason to believe would be trustworthy, and would give you good advice. Because there are always options, there's always hope. There's so many things, different levers, you can pull. And the last point I'll make on this is that if you're really worried First, I would go to the Social Security Administration website and just log in, create an account, see what your you'll be entitled to in terms of social security benefits, it might actually be a little bit more than you're suspecting. And that's just like so that that can provide a really solid base. It's not like you have to pay for everything yourself in return in retirement, we do have a bit of a backstop. So start there, and then begin to think, okay, beyond that monthly payment that I'll likely get, what more might I need? And how might I start to get there,   Curt Widhalm  18:05 I'm imagining these money dates of just sitting around with your financial statements and staring them in the eyes and doing the 36 questions to make you fall in love. Alright. Sounds great. But I don't know also, that it's that far off, when it's actually being able to look at this stuff intently as you're describing, and kind of shifting this from maybe more of the personal finance section to you also work with people as far as their finances towards their practices as well. How did how did those conversations look?   David Frank  18:39 Yeah, I mean, they they really run the gamut, you know, you know, what, what most people want to know, is just like, Am I doing okay? Like, is this okay? And I think the answer is, it's kind of this, I'll give like someone like something I read on the cover of a Buddhist magazine, which is like, your perfect just as you are. And you could use some improvement. I feel like that's always kind of like where I kind of began with this. Yeah. It's, it's, it's just like, that's just the truth, you know, and like, so everyone, like, it's a similar practice of just being like, okay, let's, let's look at your practice financials. When's the last time you looked at your profit and loss statement or your p&l? And for a lot of people, it's like, well, the last time I had to, which is when I had to prepare my taxes last year, and like, from there, like I'm not really sure. And so it's like, okay, let's no big deal, a very common experience. And we can and we can do better. So we can just sort of look at it and just sort of spend time with those numbers and just be like, I don't know what any of this means. Right? Like it's they're confusing. These financial statements are confusing. And every therapist that I've ever met, whether they're self described good at math or terrible at math, can understand them. Because this is just simple math. I think it's more about creating room and space for the uncomfortable feelings that come up. When when folks start to, to work with their practice finances, and it's Working to sort of sweep out of the way limiting beliefs around Oh, I'm just no good at this, I'll never figure this out. Because I guarantee like you can figure it out. And sometimes sure you need some support from a professional like me or a peer or whomever. But it's just spending time. And yeah, asking those 36 questions to fall in love with your practice, P&L, I think is, it's not a bad place to begin.   Katie Vernoy  20:23 That's funny, I think there's, there's so much emotion around money and security. And, and I think everybody, you know, there's a lot of different episodes, we've done with different folks on, you know, kind of money mindset and stuff. And we can link to those in the show notes as well. But I think that there's this idea, you know, we've got the folks that haven't saved anything and just, you know, they're living in a way or practicing in a way where they're barely making enough money to survive, or they're just not thinking about it, or whatever, you know. And then there's folks I've interacted with on the other side, where they don't pay themselves a lot, they save a lot of money in a, like an emergency fund, or they're investing a lot. And one of the questions that you had suggested we talk about is can you save too much? And so, so I wanted to ask about that. Because I think that there are folks who feel very safe, when they have a lot of money saved or set aside. And then and then they don't touch it at all. And to me, I feel like there there's some benefit to that. But I think to a point, and then there's also I think some potential things that can get in the way if you need a gigantic emergency fund.   David Frank  21:41 Yeah, I mean, well said exactly. And I kind of like talking about this too, because having money saved wherever it is, whether it's an a retirement account, or an investment account. It for a lot of people, it feels like safety and security. And I think on some level, but you know, money touches pretty much everything. I might argue everything in life, like every moment of your day, is impacted by money, even if you're just like carving out enough time to not be working or thinking about money. That's that's time, I guess, theoretically, you could be making money, or something like that. So it's so intertwined. And we get so many messages from society around money and why it's important what we should be doing with it. That yeah, that at that end of the spectrum, where it's just like, I want to squirrel away and save, because it creates safety and security, I think, yeah, I think I think there is a risk of saving too much. And it's the question I always ask is sort of, you know, what, what is important? Like, if you find yourself saving a lot of money, ask yourself what is important about having so much money in this account, or what is important about having a big emergency fund, you know, what comes up that there's, there's certainly something going on, and I think it isn't necessarily bad. And yet, I would say if you are constantly finding yourself having to live from a place of restriction or scarcity in that, like, oh, I can't take that vacation. Because I I'd rather be saving money. I can't even maybe take a professional training because even though I feel really passionate about doing that, I need to be saving money. If you find you're constantly saying no to things that would nourish you that would make your quality of life better, then I think there's something there's something you need to look at. And again, it's it's it's likely an emotional issue. And I think that's that's another good opportunity to, you know, work with a professional or also there's like so many, like pretty good tools online these days to help you assess where, where am I really in terms of saving for retirement? How much? Like, how safe do I do I need to be? This is like a personal story about saving so much for retirement, I had a friend who lived in New York, he worked for, I can't remember who he worked for. But he had, he had like a pension, like a really generous pension. And he was putting a ton of money into his 401k. And he was like three years away from retirement. And like, by any measure, he had all the safety and security at least financially that anyone could ever hope for. And he was so looking for forward to retirement, and then the pandemic hit. And he he died of a heart attack, just a sudden heart attack. Totally unexpected. I mean, the reason I share that is like It was tragic. It was horrible. And, and it's life, right? Like we're never we're not promised anything. So I think it's got to be a balance. Yes, save and plan for the future. And just know that there is no such thing as complete safety and security because our life's journeys can end really at any point. And I think we just need to acknowledge both of those facts that yes, we want to be living in the moment and making our current life as good as reasonably possible. And also be planning prudently for the future and then balancing those two and it's tricky.   Curt Widhalm  24:50 Besides just like squirreling money away and the places to put that money and how to spend that money. Are there other considerations of how therapy should be taking care of themselves and their assets. You know, like with your friend example here, I'm sure that part of the extension of this is looking at things like wills and power of attorney type things.   David Frank  25:14 Yeah. Yeah. All that fun stuff. That's yeah, like, I think of it as like, risk risk planning, and then estate and incapacity planning. And as a comprehensive financial planner, those are things that I that I help folks look at as well. And they're things that many of us don't want to want to look at. But yeah, you know, you know, I think when it comes to like, sort of estate in an incapacity planning, and that's the type of work that I will help clients think through, and you almost certainly need to work with a professional attorney licensed in your state of residence to put a plan like that in place. So many folks think, oh, estate planning, that's something for rich people. And yeah, that's true. And it's also pretty much for all of us. So like, putting in place like a professional will, which really just ensures that your your clients are cared for in the event, you can't continue to show up for them the way you do today in your practice, and also having like personal incapacity and estate planning documents in place, powers of attorney, you know, wills, maybe maybe a trust to depending on what state you live in, these are uncomfortable things to think about. It's not comfortable to think about our own potential, passing our inevitable passing, or our potential incapacity. And I think it's really important. It's really, I think, I view this stuff as like an extension of loving kindness to, to your future self, to your clients, to your family members and loved ones. And having having a thought partner to think through what are the right pieces of that plan to have in place for you, I think is is really important.   Katie Vernoy  26:46 The balance between living now and saving for the future, I think is a really tough one. I think along the lines of we could die at any moment. But we also could live longer than we expect.   David Frank  26:57 Yeah,   Katie Vernoy  26:57 I think the retirement age of 65, which, you know, came into place when people lived to be 70 or 75. You know, I think people living into their hundreds, I think that there is there is a lot longer that people theoretically could be retired. We also know there's a lot of therapists who practice well beyond that, because it's it can be a good quote unquote, retirement career. But to me, it seems like there's there's a lot to consider both in how do I live well, today, but also, how do I save enough to really live a long, long life, you know, like, the hope is that you're going to live and be in retirement for 3040 years. Right. You know, I think that that seems that's what I want. And so, if we're looking at identifying, I don't even know if there's a there's an answer here. And it probably is, you know, appropriately and it depends answer. But is there a percentage of our income that we should say, versus a percentage that we should and reinvest into our businesses? Or a percentage that we should use to enjoy our lives? Like, like, Are there standard typical percentages that people can kind of keep in mind when they're trying to make some of these decisions? If they are currently doing that on their own or with a, a non professional thinking partner?   David Frank  28:27 Yeah, that's a great question. And I think you're right, that my answer is going to be prefaced by It depends.   Katie Vernoy  28:33 Of course,   David Frank  28:34 and yeah, you know, and obviously, nothing we've covered here today, including what I'm about to say is advice for anyone listening, right? Like, I don't know, you personally, listener, whoever you are. So I can't give advice that's, that's tailored to your particular situation. But in general, going back to the theme of it, it also depends when you've started saving. So if you're starting to save for retirement, and you're somewhere in your mid to late 20s, targeting saving 15% of your, of your pre tax income. So a quick aside, like it's difficult to know, like, especially if you're self employed, you have your own private practice, how much money am I even making, the best place I think to go and look for that is on the first page of your federal income tax return. I know that's like a scary place like no one wants to go to unless they're absolutely forced to. But there's so many good numbers on it. And there, you will find your total income on the very first page, I think it's like line 16 or something, and that'll tell you your total income. So I would say find that number. And then say if you're in your 20s, multiply that by 15% or 15% of that, that's ideally how much you should be saving every year. If you're in your late 30s, I would say that number should be closer to 25% of your total income. And then if you're around 50, late 40s 50s, then that number starts to get closer to even 50% which is like a scary number. So that's that's kind of aspirational, like who can really do like that's, that's really, really tough, which is why I don't want those numbers like they're not carved in stone. They're rough guidelines. And if you find yourself for not meeting them, that would be a typical human experience, right? Like most people aren't going to consistently meet those. That's okay, just continue doing the best the best you can. And then like, once, if and when you can hit those numbers, then it's like the rest of your money, you need to figure out like, what, what is the right balance for you, and then it totally depends like is, if you can hit your savings targets of let's like, roughly, for most people, it's gonna be like 15, in the range of 15 to 25%. Like, that's mostly realistic. And that's like a pretty solid number that we can really begin to work with that opens up options for yourself for your future self, then they spend the rest of the money in the way that feels best to you, like, yeah, reinvest some of that. reinvest in your practice, like do do what feels what gives you energy, like kind of like, like, you know, what gives you joy? Like that's, that's really how I think it's important to think about   Curt Widhalm  30:53 when you're working with clients, I'm imagining that some of the depends that you're talking about here and getting to know them probably comes very much like therapy, and what do you value would you are hitting some of these financial goals and how you should spend it that for some clients, it might be, alright, you need to start spending this money, let's talk about buying a second house. Whereas for somebody else that might be, you know, what's you know, and see what kinds of, you know, charitable contributions that you can make? Do you ever find yourself in those very, very positive positions, but also on the flip side of that, like, hey, maybe you shouldn't get that doctorate, because it doesn't fit within your financial plans, or any kinds of other like, hold up like, this doesn't seem to fit with the lifestyle and values that you've talked about?   David Frank  31:46 Yeah, I mean, what I like to say, and this is not an original phrase that borrowed it from someone else in the personal finance industry, but I like to say like, you can have basically anything you want, you just can't have everything. So if you really want to do something, for whatever reason, I always encourage a little bit of self reflection, just sort of asking what what is it about, for example, getting a doctorate that feels so important and vital to you? And then if you answer that question to your satisfaction, like that's not it's not my life, it's not up to me what the best use of your money is, if it's really something that's vital and important to you, then the question is, well, what are the right trade offs? So let's, let's just look with some clarity and say, This is how much this is going to cost. In the case of a doctorate, there's student loans and options like that, and just be as clear eyed as we can about the future and say, Okay, here's why you want to do this, here's the why it's important, or here are the elements about it that are important for you. And here's the numbers associated with that, let's just figure out how to make it work well. And sometimes when when, when folks see the other the sacrifices and other areas of their life that they might have to make, suddenly they realize, actually, maybe this isn't what I want, because there are competing employer priorities that are actually more important. And I just, I sort of forgot. So sometimes what I do is just remind people just reflect back to them, what they've told me, or what they've demonstrated to me is important to them. Because as human beings we do with like, we see like a shiny object, and we want to chase after it. And sometimes that shiny object is like really something you should be pursuing. And other times, it's something that's just a distraction, and we just need to be reminded of what's more important.   Katie Vernoy  33:23 I love that I think it's really important, I guess that's the right word, I can think of here to understand yourself your values, and put put an individual plan together, I see a lot of shoulds you should be making this much money, you should be doing this, you should be doing that. And I think being able to really talk through with a knowledgeable person, you know, what, what actually are my values around this? What are my life goals? And how do I actually plan for those life goals versus someone else's, and and even really looking at individual circumstances, I've had folks that have told me that they don't want to take insurance because they get $5 less than their full fee. And I'm like, you're listening to advice from people in California where they get half of their full fee, you know, and so, like, you know, all of these shoulds and the kind of impromptu financial advice from other therapists and Facebook groups I think is something that we really need to fight against so that people can look at their own numbers, their own situation and make their own plan and so I love everything that you've said. And I appreciate your your thoughtfulness and your understanding of the emotional aspects of it that really make it hard for some folks to do this in a clear eyed way.   David Frank  34:43 Yeah, well thank you that's very kind and and yeah, I just think that word should I hate that it's just like stop shooting all over yourself like there is no once i Mister like they're just there is no right answer really for any of this and Yeah, like advice. I just like, I get so triggered Maybe is there I don't know what the right word is. But like when people give advice, I heard this in a webinar I attended the other month. And the speaker said, All advice is autobiographical. And I'm like, what does that mean? And what he meant was that anytime someone is giving you advice, they're speaking from their own experience. So they're really giving advice to themselves, like, oh, I should have done this in the past, or I should be doing this right now. But I'm actually not, or, or whatever it is. And so advice can be good. But whether it's coming from a professional, like a financial advisor, or a colleague that you know, somewhere, or someone you don't know, but in a Facebook group, just ask them to explain. They're like, Oh, okay, interesting point. Why do you why do you say that? Like, what, what is the thinking behind that? And you may discover that, oh, that, that that piece of advice applies for them, because it's autobiographical, but it's sure doesn't apply to me. Um, or you might find it does apply to you, and great if it does, but it is also individual,   Curt Widhalm  36:01 where can people find out more about you and turning point financial, if they want to reach out to you and work with you?   David Frank  36:10 Yeah, so the best thing for people to do is to navigate to my website, and access my finance quickstart guide for therapists. And that'll give you a sense of what you should be thinking about in your fancy financial life. And it also gives you a good sense of what it might be like to work with me. And my website is turning point hq.com. So that's like turning point, a bridge, the abbreviation for headquarters. And yeah, there's a ton of good resources on there. And I think I will even by the time this airs, we'll have a little simple worksheet that folks can work through to help them determine how much they might, they ought to be I don't, I'm gonna use the word should how much they might want to consider saving for retirement so so they can navigate to the website and find all that good stuff.   Curt Widhalm  36:51 And you've got an offer for our listeners as well.   David Frank  36:56 I do for just a special offer. For the listeners of this great podcast, I'm offering 20% off my QuickStart coaching intensive. So navigate to my website, under the Services description, you'll find more information about that. And when they're scheduling that meeting, if they just enter the code, MTSG, or something like that, I will offer them 20% off when it comes to pay me.   Katie Vernoy  37:18 Yay. That's awesome. Thank you.   Curt Widhalm  37:20 And we'll include links to all of that in our show notes. You can find those over at MTSGpodcast.com. And make sure to join our Facebook groups, modern therapist group, and follow us on our social media for updates on everything that we're doing and connecting you with some of the other wonderful people in our community, much like David. So, thank you very much for joining us today. And until next time, I'm Curt Widhalm with Katie Vernoy and David Frank.   Katie Vernoy  37:48 Thanks again to our sponsor, simplified SEO consulting.   Curt Widhalm  37:52 These days, word of mouth referrals just aren't enough to fill your caseload. Instead, 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. That's where simplified SEO consulting comes in. It's founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website or they can do the optimizing for you.   Katie Vernoy  38:16 Visit simplifiedSEOconsulting.com/moderntherapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code MODERN THERAPIST. Once again, visit simplified Seo consulting.com forward slash modern therapist and use the code modern therapist all caps.   Announcer  38:40 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.

    Should Private Practice Therapists Take Insurance?

    Play Episode Listen Later Dec 13, 2021 36:41

    Should Private Practice Therapists Take Insurance? Curt and Katie chat about the latest data from SimplePractice on private practice clinicians billing insurance. We explore the most common set up for clinicians (a hybrid insurance/private pay practice) as well as how therapists bill insurance, the disparity between private pay fees and insurance rates (and how different these disparities are across the United States), how strategies for growing private practices are affected by who is paying, and how to set yourself up for a successful hybrid insurance practice. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: Demystifying the most Common CPT Codes E-Book from SimplePractice Looking at the most common make up of therapists' private practices (hybrid: insurance and private pay) The theories about whether to take insurance of not The process of starting a practice (credentialing timeline, marketing, etc.) The benefits of being on an insurance panel (e.g., nearly 100% close rate) The income differences for clinicians at different stages of practice development The average number of appointments per week by type of practice (insurance, hybrid, or private pay) and what that means for your income How well insurance reimburses in different states (and comparing these rates to typical private pay fees) Financial considerations when looking at the insurance rates you will get in your area How to set up your practice if you choose to take insurance The most frequently billed CPT code (as well as others to consider) The controversy around 90837 and how to make sure you get paid Different strategies to build a sustainable business with an insurance or hybrid private practice Our Generous Sponsor: Simplified SEO Consulting Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. These days, word of mouth referrals just aren't enough to fill your caseload. Instead, 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!  That's where Simplified SEO Consulting comes in. Founded and run by a private practice owner, they understand the needs of a private practice. They can help you learn to optimize your own website OR can do the optimizing for you. Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code "MODERNTHERAPIST" Resources mentioned: 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! Demystifying the Most Commonly Used CPT® Codes for Mental Health   Relevant Episodes: Busting Insurance Myths Make Your Paperwork Meaningful Noteworthy Documentation Negotiating Sliding Scale Special Interview: Open Path Psychotherapy Collective   Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated) Curt Widhalm  00:00 This episode is brought to you by simplified SEO consulting.   Katie Vernoy  00:03 Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings.   Curt Widhalm  00:21 Stay tuned at the end of the episode for a special discount.   Announcer  00:24 You're listening to the modern therapist Survival Guide, where therapists live, breed 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  00:40 Welcome back Modern therapists. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about oh things, therapy, running our practices, that all things therapy, we don't really talk a lot about what we do with clients, but talking   Katie Vernoy  00:58 sometimes we do   Curt Widhalm  00:59 sometimes. But today, we are talking about an ebook that was sent over to us by our friends over at simplepractice. And this is called demystifying the most commonly used CPT codes. And Katie and I come from very different places, when it comes to insurance, and Katie's got a hybrid practice, I have a cash pay practice where we do super bills, and I understand some of this stuff. And Katie understands a lot of this stuff a lot more. And we wanted to be able to give our take on things and help you make some decisions on whether or not insurance is right for your practice.   Katie Vernoy  01:47 Yeah, I think it's something where I am actually in the majority Curt and I don't know that that's well seen the hybrid practices 51% At least have simple practice users and 61% of simple practice users billed insurance this year, and have an insurance portion of their practice, but only 10% are just insurance. So to me, I think when someone comes on to a Facebook group or in a networking situation and says, Hey, should I accept insurance? I feel like a lot of people are like, no, don't take insurance private pays the best. But I think a lot of us in the background are quietly accepting insurance, at least for a portion of our practice. So there's a lot of detail in this report that talks about kind of regular rates, you know, how many sessions are being billed and that kind of stuff. And so I would recommend looking at it, we'll link to it in the show notes, as well as a link to an interview that we had with one of the authors, Barbara Griswold, that when we talked about kind of insurance myths, I think, I think we're coming back around to insurance myths that that episode is quite some time ago. So I think we're going to have some new things to talk about here. But to me, I think the hope in this conversation is that there are folks who will, maybe are considering insurance and shouldn't be. And there are folks who are feeling like they shouldn't accept insurance, but that might actually be better alignment for them. Because I think there's a lot of things that are stated as facts by people who are either like you solely in self pay or private pay practice, or folks who are in very different states. And there's there's a lot of misinformation that I think it's shared or inaccurate information for someone's individual situation. So what are your thoughts? What do you know, as a private pay practice, about taking insurance? And why would you tell people not to take insurance? Maybe let's start there.   Curt Widhalm  03:55 The more of these conversations we have the less that I'm finding myself telling people what they should do. And I will speak broadly to the   Katie Vernoy  04:05 Fair enough.   Curt Widhalm  04:07 Why I see people making some of the decisions that they do. And I know and this is stated in the eBook. Our friend Dr. Ben Caldwell is quoted as saying many clinicians want the stability of income and to not have to market themselves and paneling with insurance allows them to focus on clinical care rather than spending time on marketing. And I think that this is true. There are a number of people who are in our profession who just want to see clients and do work and not have to deal with the stressors of where my next clients coming from. They don't want to deal with a lot of marketing aspects going out to networking sort of things. And for those of you who that's your jam have that be your jam. I am not one of those people, myself, I am. I love the networking and the marketing aspects. It takes a while to be able to build up a reputation in the community with referral sources. Not everybody can afford to take the time to build the practice that way you need the income sooner. And I think one of the themes that you'll probably hear from me a lot throughout today's discussion is just kind of you have to do what's right for you. And there's no one size fits all approach on this. But I also in kind of setting up my practice when I was initially considering applying to be on some of the insurance panels, and was talking with some people in my community, who were panels and hearing how long it takes to actually get panels. Hmm, I found that I was getting clients who were cash pay clients in the meantime, of what that paperwork length of time was going to be anyway. So my practice started to develop cash pay, even while I would have been waiting to get paneled in the first place. So maybe it was just that I was kind of eagerly out there going out and seeking clients and marketing anyway, that at the time was just kind of where, oh, if I'm getting them anyway, why do I need to accept a lower rates of insurance, to see the same people that I'm already getting into my practice?   Katie Vernoy  06:35 That's a really good point for myself, I actually started my private practice while I was working in community mental health, so I didn't have time to market or network or do any of those things. And I, you know, I put my shingle out in an area that didn't have many clinicians. And so I did get some private pay clients while I was credentialing, but I was credentialing without having any clients at all. And without even trying to get clients it was like that was my escape plan, I was going to credential on the side, you know, kind of send those things in. And as I started getting insurance panels, then I was kind of adding clients to my practice. So I think there are different ways that people go about starting a practice. And I think you know, whether you credential or you have someone help you credential, that that is a time gap. I think for some people, it's been up to six months, I don't know what the current timeline is right now. But it can take a long time to get panels, which can be ideal for someone that needs to stay in a community mental health job or a group practice job before they can really go out on their own. I think at this point, once you are paneled, for some panels, you can almost fill up your caseload in a couple of weeks. And so it becomes a an a way to have some solid income. And that stability, because I honestly can say with my insurance based portion of my practice, which is very tight, tiny at this point that I'm going to be private pay very soon. But what I was in the height of my hybrid practice, someone would call, I had a similar specialty or was close enough, and I took their insurance. And it was almost 100%. Close, right. Whereas with the private pay, you know if your marketing well, and your networking well, and all of those things, they may come in already knowing your fee, they may come in already knowing your specialty, and it could be a pretty high close rate. But I've heard more like 10 to 30% close rate sometimes for private pay clients, especially at the beginning.   Curt Widhalm  08:36 Oh, and speaking of the beginning, I also hear in our larger therapist discussions within the therapist community that some panels require people to be licensed for two years, before they can even get on the panel in the first place. And for those, you know, very energetic, freshly licensed people, if that's another limitation, as it was, you know, when I first started my private practice, it was shortly after I got licensed that if it's not even an option to you, and you're looking at developing some of these other marketing and referral network streams. I can say from my vantage point that if my fee is twice as much, and I'm closing only a third of the clients, if that still balances out as far as the number of sessions that I'm seeing, I'm actually potentially even working less than I am if I am panels and seeing fewer clients.   Katie Vernoy  09:36 Well, that's assuming that you're getting the same number of calls, which you don't.   Curt Widhalm  09:41 That is very true, I'll grant you that   Katie Vernoy  09:43  So 100% of 10 versus a third of three is is actually 10% of the clients so so just a little a little math, I think it it does take a while to build a private pay practice it is much more cost efficient as far as your time, and that actually is not necessarily totally true, we should talk about fees in a second. But I think it's something where overall income is very different in the beginning. And then again, very different, when you get to your kind of stable number I think for at the beginning and insurance practice, you can immediately get up to that 50 or 60,000 a year, probably, with a private pay practice, that's going to take a little while, but then you're going to get up to a much higher number, you know, and these are just made up numbers. But like that 100,000 A year or 75,000, a year or 120,000, a year, I think is more likely in a private pay practice than it is in a an insurance practice, or a hybrid.   Curt Widhalm  10:47 And looking at the data from simple practice here, kind of reflecting what Katie is talking about, they have a nice little graph that shows the average number of appointments per billing type in the last 30 days. And those who are doing self pay only, the average number of appointments for the median, I guess, is 28. self pay only over 30 days, that's   Katie Vernoy  11:17 pretty low   Curt Widhalm  11:18 the upper 75th percentiles 55 sessions over a 30 day period. But you compare that to the insurance only. And it's 20 and 46, which are below what those self pay therapists are in   Katie Vernoy  11:36 that. Yeah. And the insurance when the way that that's talked about is those insurance only practice, folks are typically like new group practice, associates kind of that are billing, just insurance, the practices only they're using associates or other folks in the practice for insurance only. So I think the the thing to look at is the hybrid, and the hybrid actually has a lot of appointments. You're looking at it. So what are the numbers for the hybrid practice   Curt Widhalm  12:06 So medians at 55 sessions? That's compared to 28 for the self pay, and the upper 75th percentile is 80 versus 55.   Katie Vernoy  12:17 Yeah, so it's, it's, it's a, it's a fuller practice. Now, whether or not you want a fuller practice, they don't actually say overall income for folks, which I think is interesting, and might be interesting data for them to look at. But I think it's so variable, I think it's hard to say. But I think determining whether you take insurance at the beginning, obviously, if you're not licensed long enough, that's going to be a factor. But I started paneling. I was five years licensed, I was ready to be out of community mental health, or I wanted at least an escape route from Community Mental Health. I got paneled pretty easily. It took a while, but I was still working. And then I was able to start adding clients afterwards. I think if you are able to kind of do the pace of building a private pay practice, that may be the right move for you, depending on where you live. And I think that so the the initial one is, can you have your income ramp up, you know, slowly? Or do you need to have it ramp up quickly? Once you get, you know, panels, I think that's that's the first thing to think about. They didn't say kind of how long insurance clients stay versus private pay. I've got a mix. In my practice, I found that I think more private pay clients are going to finish sooner than insurance clients. But But what is your experience of that? Because you've had private pay for a long time? I mean, do you have a churn rate that's pretty high, where you're having to constantly get new clients? Or do you have clients that stay for long term I mean, I'm a long term therapist, I've got clients for years. So it's, it's a different model.   Curt Widhalm  13:54 I have mostly clients who have stuck with me for quite a while. And while I do have some churn in my practice, I would say as far as my particular caseload goes, that's probably somewhere around 10% of my my caseload. Now, it doesn't mean that I have the same, you know, 90% of the clients forever, but I do tend to have my repeat people coming back after a couple of years off. And so I see relatively few new clients in my practice. So most of my people are lifers. And yeah, you know, I imagined that, you know, if I preview that I'm going to retire in like 30 years that that might create some panic for some of my clients now just knowing that things are going to end so I may not   Katie Vernoy  14:49 We are both long term therapists.   Curt Widhalm  14:51 Yeah   Katie Vernoy  14:52 You may not be the best to say that. And maybe that's another thing potentially if you are a clinician that already has has more of a short term model, if you're already going to have churn with your clients might as well get the best bang for the buck and do private pay or have a huge referral source and get insurance. And so I think it's, it's something where there's a lot of factors in what is going to be the right mechanism for you. The other thing is, is there are very different rates that people charge across the country. And simple practice has that in there, as you know, kind of their private pay full fee. There's also very different insurance rates. And so I don't know if you looked at this chart, but it's, it's crazy, because as California being one of the most expensive places to live, we actually are our middle the middle of the pack or lower part of the pack on what the median insurance reimbursement rate is.   Curt Widhalm  15:51 And looking at this, I have to imagine that a big piece of this is supply and demand, because some of the states with the highest reimbursement rates are South Dakota, North Dakota, Minnesota. And while there is the Twin Cities in Minnesota, there's a lot of rural area out there. And so I have to imagine that some of the higher rates are being either commanded by therapists were like, look, there's nobody else in town to take your insurance, and they're doing a good job of advocating for themselves for higher reimbursements. Or the insurance companies are trying to draw more practitioners to work in these areas. And, you know, in California, like the building that my office is in, I think that there is and don't quote me on this, I think that there is roughly 8 million therapists that work in my building. And so a, and obviously, not all of us are handled with insurance companies. But I have to imagine that the insurance companies could panel every single therapist and be like we have so many people that we only need to pay you $8 per session.   Katie Vernoy  17:09 Well, I think the problem is that's there's I mean, we could have whole conversations about ghost panels and people being fall and stuff like that, because I certainly still get calls from folks. And they they basically are searching for weeks trying to find someone who accepts their insurance. So I also think that there is a an issue in California with insurance because the the average fee, or the median fee for California I think, is $100. For insurance reimbursement, and 150 is the private pay fee, although the the one in 2018, apparently was 130. So there's, there's a big difference. And you and I are both double insurance rates or more. So it's, it's a huge difference. And if you've designed your fee, and they have some information in this about how you can set your full fee, but if you design your fee based on what you need to make, and the insurance reimbursement rate is half of that, that's a huge difference and needs to be a consideration you I would have to see double the insurance clients to make the same amount of money that I make with my private pay clients there, when we look at places like Oregon, their regular full fee is 165. They're one of the five most expensive places to live, but insurance reimburses them at 130. So that's only a $35 difference, you know, and it's still per session, blah, blah, blah. But it is much closer, it's not half of what the fee is, or, you know, two thirds what the fee is. And, and it's a lot more approachable. Texas is another one that they reported on the average private pay fee, or the medium private pay fee is 125. Insurance is only 88. But it's still only a $37 difference. And so and it's also costs a lot less to live in Texas and live than it does to live in California. And some of these fees. You know, Oregon was the highest one they reported at 130. But if you've got a private pay fee, that's typically around 130 to 150. And insurance is paying you 130 It's not functionally different. And if you've got an almost 100% close rate, and can be choosy. And insurance practice may be awesome. Because you don't have to do the marketing. There's consistency insurance is going to consistently refer to you most when I was taking mostly insurance I had to put outgoing messages saying I'm not currently taking new clients. So people would stop begging me to call them back. And so it's it's this thing of there are places in the country in the United States where taking insurance makes a lot of sense.   Curt Widhalm  19:57 And especially when it does save you some of that time to go out and markets and to pay for SEO and fancy websites and all of that kind of stuff. And this is really where you're looking at your cost basis. And, you know, that's having to look at your finances. And that also includes how you value your time in putting that stuff together. So if it is functionally the same, and it does save you a bunch of other time, makes sense.   Katie Vernoy  20:30 I think the big caveat is the number of clients you're seeing, or need to see to make the money, the total money that you want to make. And then also the amount of time that you'll spend on insurance billing, there are some panels that are great, not a lot of, you know, denied claims, not a lot of work on that part that you know, you get paid easily, you know, I have one panel that I'm still on and I'm getting ready to go off of, but I, if they could just pay me a little bit more, I'd stay on it because I get a direct deposit, almost, you know, a few days after the session. And I've got clients paying 10 or $20, to see me like it's, it's amazing, it's really cool. However, there's other ones where I will charge something, they'll pay me once, they won't pay me another time. And then I have to chase it down. And so when you get into more of that, there is a bigger amount of time that's spent on kind of managing the billing and tracking the billing and doing all those things. A lot of that became really easy when I did it through simple practice. So I will, I will acknowledge them for that, that I at this point, I push a button, it goes through, it tells me if it's been denied, and then I can chase it down. But most of the time, I don't even need to worry about it because I don't have to chase it down.   Curt Widhalm  21:51 Now, one of the other things that I hear from you and some of my other friends who are panels is also that you take the copay, but then you might be waiting several months for the rest of the payments to even find out if it's been approved or not. And one of the considerations of having that cash pay practice is my clients give me the money, and then all of the money is mine. Yeah, right up front. And so yeah, there's, you know, anywhere that gets into, alright, you're getting paid, but when and how and are you able to tie those things back to the specific sessions that, you know, might move you into a, this is gonna be a big part of our discussion here, move you into a different CPT code.   Katie Vernoy  22:43 I think there are definitely situations where people don't get paid right away. And I think sometimes it is due to shifting from an individual contract to a group contract. Or if there's like, I had a situation where I wasn't paid because I had left the panel. And I billed for three sessions for a couple of clients right before I was off the panel. And they said I was off the panel, even though I submitted the claims before the final date, you know, like and so I had to go in and fight them for that. But otherwise, most of the time I get paid right away, like within days, and it goes directly into my bank account. So okay, so I think that there, there is a wide array of experiences here. I think if you have a panel where you're not getting paid, or if you get clawbacks meaning they think they say, Hey, we thought it was covered, but it's not give us the money back. I've never had a clawback. Maybe I should knock on wood here. But like, that sounds awful and horrible. And I think that there are things where we can just say there are times when insurance companies are evil and and are they unnecessary evil? Some people say yes, some people say no, but But yeah, I think there is typically a financial stability when you take insurance. However, if you're not getting paid that financial stability doesn't actually exist. And so you want to be pay attention to it. But let's go to the what you were talking about the kind of the CPT codes as well as number of clients. Sure. So the vast majority of clinicians that bill through simple practice, and this is like over 100,000 users, not all of them are mental health therapists. Some of them have other types of practices. But the vast majority, like 10 times the number of sessions were billed as 90837, which is the 60 minute session or 60 Plus minute session versus 90834, which is 38 to 52 minutes, which fits into that 15 minute hour, right? And insurance companies assume that therapists are going to build that 15 minute hour. And they say that most of our colleagues are billing the 15 minute hour but we know thank you simple practice that most of us are billing 90837 which means it's 53 minutes or more. And it means you actually have to be working clinically with a client for 53 minutes or more. And I think some people may fudge that it can't be you waiting, it can't be the documentation. It can't be the scheduling time that you spend in the in the session. It's actual clinical time. That being said, some folks are getting pushed back and they're having to prove medical necessity for the longer session, which is the 90837. I think that is BS. I think it's it's something where insurance companies, I mean, and the rates for 90837 are way higher. So you do a 52 minute session. And it's like $40, less than or $30, less than a 53 minutes session. It's ridiculous. It's, you know, and so insurance trying to get people to bill last are saying do these shorter sessions? Well, Ben's idea is that we'll just do these 90834, you can do a session, as short as what was it? 38 minutes, you could do a 40 minute session. And then if you can see more clients that way. And that might be a way to make more money in less time, because you do a certain number, there's this is in the thing, but like a certain number of 40 minute sessions, versus a certain number of 60 minute sessions. You know, it's about the same and you're spending less time. And I don't agree, sorry, Ben, I just don't agree. Because it's not just the session time, it's also all the paperwork. But then there's also the clinical case management. If you've got 20 people in crisis versus 30 people in crisis. It's a very different workload.   Curt Widhalm  26:41 Yeah, I, I see where Ben is coming from on this from just a nuts and bolts number thing, and I will always remind people that Ben has not been a practicing therapist for several years.   Katie Vernoy  26:59 And love you, Ben, we love you.   Curt Widhalm  27:03 And, honestly, you know, we do have a lot of love and respect for bed and all of the work that he does, and, you know, simple practice, and practice learning and everything that he's got going on. But I think it's easy to forget the Practice Management sides of things. Yeah. And a lot of the managing caseload sides of things that I'm sure that he will very much acknowledge that he's a little bit out of touch on. It's just not practical. I mean, it's just, it's, it's somebody saying, like, well, if people want more money, why don't they just work more? And?   Katie Vernoy  27:46 Well, I think the argument isn't actually the, to work more, it's, Hey, do shorter sessions, so that you, you have less time in the chair. But it's like, but there's, you know, like, even the task switching of seeing one client versus the next client. I mean, that's not even to mention what we just talked about with billing and, and case management. So I get it. And I actually think that that the other message I want, I want to add to Ben's message and say, Why not allow for some of these shorter sessions, because you could see your client twice a week for 40 minutes. And, and have more of that flexibility of billing code. I mean, there's also information in here, and I'm sure this came from Barbara, which was about, you know, kind of using some of these other codes, like, you know, 90846 is the client is family therapy without the clients you can talk to parents and have it paid for, you know, there's there's crisis codes, there's a lot of stuff there that I think is pretty interesting. But, but you can use insurance a little bit more flexibly, you know, and Bill for everything, it's just then you're taking the time to build for everything. I think the other thing is, I think there was a statement like to avoid burnout See, five to seven clients, five days a week. And 25 doesn't sound bad, but 35 sounds awful. And so I think that there's, there's a need to assess your for yourself. If you have 35 clients and they're mostly insurance, I would recommend having a biller so you're not chasing down, you know, fees, you're not dealing with benefits, checks, that kind of stuff. But if if you can see 35 clients a week, then you're different than me. I can't do it. I don't know that I can do 25. So I think it's something where it's it's sorting out what that looks like. And you can you can do some simple math and I think you had started it. You can make a good living seeing mostly insurance clients. It just is really important that you all have your systems are very clean. Probably you have a biller, at least someone to check benefits and chase down things you know, because insurance on simple practice is literally pushing a button once it's all set up. But it's sorting out how many clients you actually want to see. And do you want to do some of these other things? I mean, to your point earlier, I would rather go out and do some networking, then see another client, right at times, you know, like, I would rather write a little blog post or do a podcast episode with you then see another client, like, when I've gotten through the number of clients that's comfortable for me in the week, I could make more money seeing more clients. But I choose to do that in other ways, and to charge more for those times.   Curt Widhalm  30:33 And it's not that we don't like seeing clients. It's that for   Katie Vernoy  30:38 other things, too. Yeah, exactly.   Curt Widhalm  30:42 So, you know, I do hear and read in some of the therapist forums about, you know, some of these clawbacks things that are happening, some of the rejections of that 90837. Is there anything that can really be done about that?   Katie Vernoy  31:00 There's some specific things in the e book. And I think that the most important thing is to make sure that you're writing actual start and stop times, you know, simple practice defaults to either an hour or 15 minutes, and it starts on the hour, or the whatever the time is that you set the appointment, making sure you actually have the time in there to the minute, if you see somebody for less than 53 minutes that you down, code it to 90834. And I think you want to make sure that you know, we've got different episodes on documentation, I can put in the in the links in the show notes. But it's something where being able to document medical necessity for a longer session, that kind of stuff. I think it's important. I think I got something from one of the insurance panels I was on that basically said, You need to make sure that your notes show that you spent that much time and so anyone that's been in committed mental health knows like, you have to have enough interventions. In your note for that for that long of a session. You know, if you're going to go a full hour, or 53 minutes, plus, you need to make sure your documentation shows that you're not processing one thing. And that's all that you've put down in your note. So those are the things that you can do. It's just Ben's idea of doing shorter sessions and seeing more clients may keep you under the radar radar of insurance companies, they don't see you as overusing 90837. I just don't think it's worth it. I think just do the documentation, make sure that you're you're staying true to the start and stop times and hope for the best.   Curt Widhalm  32:36 Overall reading through this, I can say that my reaction is insurance companies aren't paying as badly as I had thought that they were. Yes. And I don't know how to convey to our listeners how much it actually pains me to say that, that. But there are a lot of individual factors that you have to decide for yourself that if you're wanting to see clients, you're wanting the marketing and the phone calls to be kind of funneled to you being on a panel makes sense. If you're somebody who needs to get out of the office a little bit more, you want to put in a little bit more of that work, and you want to operate partially or fully outside of the insurance systems. There's pathways for you there to both have their advantages and disadvantages. But I was really surprised to see that out of the 1000s of users that simple practice has those rates are a lot closer than I would have expected them to be.   Katie Vernoy  33:49 Yeah, well, and I think a big point there is that if you're wanting to have an accessible practice, and you're wanting to do that, for a lot of clients, insurance is potentially a better way to do it, because clients will pay, I think the median copay was about $15. Whereas if you slide down to $30, or 50 $60, or $70, or $80, you're going to make less than insurance. Now, if you're doing it for a couple of spots, you're doing it through open path or you're doing those kinds of things as a small give back, I think that's very much appropriate. But if you're doing it for your whole caseload, where your whole caseload is sitting around the median insurance fee, you will make the same amount potentially more because you will not have to market it yourself. Your clients will pay less than they're paying you now. You just have to get through the the insurance paperwork and that kind of stuff. So I think I think there's going to be different factors for everyone. But if you're sliding your fee, down to 100 or below $100 typically anyway You may make more on insurance than you are right now.   Curt Widhalm  35:04 We would love to hear your feedback and what you're doing with your practice. And the best way to do that is join our Facebook community, the modern therapist group, you can also let us know on our social media. And we'll include links to all of that and the stuff from simple practice and what Katie mentioned in our show notes, you'll find those over at MTS G podcast calm. And until next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  35:30 Thanks again to our sponsors simplified SEO consulting.   Curt Widhalm  35:33 These days, word of mouth referrals just aren't enough to fill your caseload. Instead, 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. That's where simplified SEO consulting comes in. It's founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website, or they can do the optimizing for you.   Katie Vernoy  35:57 Visit simplified Seo consulting.com forward slash modern therapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code modern therapist. Once again, visit simplified Seo consulting.com forward slash modern therapist and use the code modern therapist all caps.   Announcer  36:22 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.  

    When Clients Have to Manage Their Therapists

    Play Episode Listen Later Dec 6, 2021 35:19

    When Clients Have to Manage Their Therapists Curt and Katie chat about the work (or mental load) therapists often give to clients that is really ours. We talk about requiring our clients to do things that are not helpful to treatment like: manage our time, do excessive paperwork, negotiate through our money stuff, be guinea pigs, or teach us about their culture or other differences. We also look at the impact of these abdications of responsibility on the therapeutic relationship and the clinical work.     It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: When we give more work to clients (that isn't really good therapy) The mental load or emotional labor that therapists can unwittingly add for clients Time management and the impact of poor practices on clients Being late, managing the shape of the session, scheduling The difference between being authentic and being irresponsible The care you show when managing rescheduling and the impact on the relationship What can come up, especially related to attachment wounds The problem when you consistently forget to get back to your clients Paperwork as a burden on clients, especially when clinicians don't read the paperwork The message you give when you don't follow up on a client's homework When outcome measures feel like paperwork that is solely for the benefit of the therapist, rather than something that feels relevant to the client Feedback Informed Treatment (FIT) poorly implemented Delayed billing, not providing superbills timely Allowing a balance to accrue The power dynamic and power imbalance when clients owe therapists a sizable amount The labor we're giving to our clients when don't have structure on payment (sliding scale fees and payment plans) How our own money stuff might come into these conversations Adding new theories or trying new interventions on clients without a strong clinical rationale The danger to the client's trust in the process if we throw new interventions in each week The mental load of asking our clients to teach about their own experience or navigating therapist bias Identifying a lack of fit or when treatment is over (rather than forcing our clients to do so) Own our humanness and set ourselves up for success Why this work sometimes gets handed to clients (rigidity, therapy culture) Our Generous Sponsor: Simplified SEO Consulting Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. These days, word of mouth referrals just aren't enough to fill your caseload. Instead, 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!  That's where Simplified SEO Consulting comes in. Founded and run by a private practice owner, they understand the needs of a private practice. They can help you learn to optimize your own website OR can do the optimizing for you. Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code "MODERNTHERAPIST" Resources mentioned: 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! Very Bad Therapy: A Clinical on Unprofessionalism   Relevant Episodes: Work Harder Than Your Clients Clinical Versus Business Decisions How to Fire Your Clients Ethically How to Fire Your Clients Ethically Part 1.5 Diversity and Cultural Competence Special Populations   Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated) Curt Widhalm  00:00 This episode is brought to you by Simplified SEO consulting.   Katie Vernoy  00:03 Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings.   Curt Widhalm  00:21 Stay tuned at the end of the episode for a special discount.   Announcer  00:26 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  00:41 Welcome back, modern therapist, this is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about therapy about our practices, things that we do to have more successful practices and leave our clients in better places promote healing in the worlds. And today's episode is inspired by a client's comments about the work that therapists make clients do outside of the work that therapists make clients do. And this is the ways that we make our clients do some of the practice stuff for us, or that our bad practice habits end up giving people bad therapy experiences. So this is not necessarily about the clinical work, but things that we do that potentially start to affect the clinical work. And going through kind of some brainstorming on this. And we posted this question the night before recording this out on our Twitter feed, we got exactly zero responses from anybody. So this is a list of things to   Katie Vernoy  01:55 Maybe we should have put it in our Facebook group, where we get responses. Next time guys next time.   Curt Widhalm  02:01 But we came up with a list of things, this is probably a non exhaustive list. And you can go to our effort mentioned Twitter or Facebook group and continue to add meaningfully to this list. But things that clients have identified are also the importance of being on the other side of the couch things that we've identified, the end up just being bad therapy experiences. So Katie, what first comes to your mind on this.   Katie Vernoy  02:33 I think the the thing that comes first to my mind is probably the way that we manage time. Because for me, I worked in a clinic mental health clinic, a mental health clinic where time seemed very dynamic and fluid and things just never started on time. And it was something that bothered me, I equally participated in it. But it's something that I found is important for me, I want to make sure I'm on time that if I tell my client that we're going to reschedule that I have a time available for them and, and that I manage time properly within my session. But I have heard from clients that that is not always the case. In fact, I'll link to this in the show notes, there was an episode that I supported very bad therapy on where a client who reported on their story was given tons of paperwork after their therapist was 30 minutes late to the intake session. And just the types of things with that are just hugely problematic. But like if we're not respecting your client's time, if we're not rescheduling and like managing the rescheduling process, if we're going over which I have to admit, sometimes I go on that one where we don't manage time properly. In this session, we're forcing our clients to kind of work around us or manage the time for us. I know as a therapist, I'm always tempted to manage the time for my therapist, she actually is good with it. But like I still am like, oh, well, I know we need to finish. You know, like, I feel like when that's happening there is there's work that the client must do that doesn't seem fair.   Curt Widhalm  04:21 And the way that this plays out is I've had people describe this to me as we understand that therapists have their own lives, have their own reactions have their own shit that just comes up and a lot of things that we encourage therapists to be out about, you know, hey, I'm going to a conference that's gonna affect our sessions that we need to reschedule things. But I've heard statements around this as far as like, Oh, I'm going to a conference. I need to reschedule. I'm needing to move a couple of people around I'll get back to you in a couple of days with what your options for rescheduling for next week might be. And then not following up with the clients that ends up putting the clients in positions of do I need to call back is my therapist actually going to follow through. So these are really kind of small afterthought things that can have a great deal of impact on our clients as far as pushing some of the scheduling responsibility back over to them. Now, parts of the ways of getting around this is if you have a good, you know, scheduling system that allows for clients to be able to put themselves on your schedule, hey, you know, I'm going to this conference next week, we could spend a few minutes right now doing this or set a reminder for, you know, tomorrow to check back and I'll have my availability up there, and you'll be able to book an appointment for what's available. And that can be one way of helping to alleviate this problem.   Katie Vernoy  06:08 Yes. And I think that the message that we send, if we don't immediately take care of it, or, or have a solution for it, I think is one of I don't care about your session. I mean, to me, it's respectful to take the time to to do the rescheduling, especially if you've got a couple of minutes that aren't going to take away from clinical time. And I think the the message of I've got a few things to move around, and then I will get back to you and not getting back to kind of put somebody in a in a hierarchy of how important they are to you. And to me, it just feels, I think it hurts the relationship when you disregard them. And you don't get them scheduled immediately. Or you don't show the importance of getting them scheduled and taking care of their time immediately. In my opinion.   Curt Widhalm  07:00 You know for some of the clients that I've seen that have described this, it's their people who seem really high functioning in many areas of their lives.   Katie Vernoy  07:11 Sure.   Curt Widhalm  07:11 But this does bring out a lot of attachment wounds, especially if there's been relational traumas in their lives. And it might not be something that is at the forefront of your mind as a practitioner, when you're managing your practice of looking at just how deeply impactful those between session contacts or absence of contacts can end up happening with clients from all walks of life, but particularly from these clients.   Katie Vernoy  07:41 And I want to cover another element of this because there was a period of time, not lately because of the pandemic. But when I was traveling a lot, or I was doing a lot of things, I did reschedule a lot. And some people would say that de facto is disrespectful to clients, and you set your weekly time and you keep it and that kind of stuff. And for me, and maybe that's why I've gotten very comfortable with rescheduling. But if the communication is open, and there's a clear value that you hold for them and their session time, I think you can reschedule maybe not as much as you want. But I think that you can still do it. But I think if you forget to call them back, and you make them be the ones that reach out, I think that's when it gets problematic. I think folks can live their lives travel all they want, do what they want. I think it's just take care of your clients in the process. Hold those times make sure that you make it available for them, and help them to reschedule don't make them do it.   Curt Widhalm  08:36 So is kind of shifting gears here a little bit. But also speaking on responsiveness. You brought up paperwork. So first of all, there's just the sheer amount of paperwork. Yes, and depending on the kind of practice that you have, sometimes agencies are going to have mountains and mountains of paperwork. And from a bureaucratic standpoint, it might be because there's multiple people within the agency who are interacting with a client if there's a medical component of the agency justifying paperwork, and I don't want to do that. But for, you know, more private practice II type places that there can be a lot of good intentions with paperwork, but a complaint that I hear from some of my students, some of my clients about other therapists experiences is does that paperwork ever actually end up getting used for anything or is it just filling stuff out for filling it out sake?   Katie Vernoy  09:42 Yes, yes. I think that's the piece that I that really bothers me. I know. Like when I go to a doctor's office, you know, whether it's an intake or an annual appointment or whatever, so much paperwork, and they clearly don't have time to read it and then they asked Be the Same questions right afterwards. And I know that that happens with therapists as well. I personally probably have a couple too many pieces of paperwork that I feel like I need to have. And they are really just kind of forms that people sign. But all of the assessment stuff I do read, and I am, it's clear when I see my clients that I read it, but I think there are a lot of folks that feel like they have to have all of this information. But there's arguments about having it at intake before intake after intake, you know, like people can argue clinically when they want to ask for all this information, but having so much paperwork to get through to walk in the door, and then have it clear that my clinician has not read it drives me bonkers.   Curt Widhalm  10:46 I was at a presentation several years ago at this point that the speaker was a psychiatrist who was talking about the last days of one of their parents being in a hospital, end of life sort of things. But every doctor that was making their rounds, they learned after a couple of days that they just needed to ask the doctor before saying anything like have you read the chart that. So this is this is not just particular to therapists experiences that overall in healthcare we can get, especially when we're busy really into that habit of just kind of making our clients catch us up on things rather than going back through notes, you know that that P part of SOAP Notes of even just going back and following up on what I also hear from a lot of clients, which is following up on homework, that we assign clients to do things. But if we don't bring it back up in session, we're giving them a pass to not do it. But yeah, it also backs up the quality of our work, or the emphasis on the suggestions that we make when we do ask and follow up on referrals on homework tasks on different ways of doing things that if clients are like, alright, I don't need to do this, or if they're the ones like I did the homework, do you want to talk about it? But the answer, probably Yeah.   Katie Vernoy  12:19 Yes, yes. And I know I've had that happen, where I either failed to write down the specific homework assignment in the progress section of my note, or the plan section of the notes, sorry, or I was kind of waiting to see if it was relevant. And I think in truth, that means that the client may feel responsible to bring it up and feel like they have to manage it, and or they just start start disregarding it. So I think that's a really good one. And I think being able to manage our own documentation properly, so that we can have that continuity of care from session to session, I think is really important. And if we're not managing the continuity of care, you know, I think we joked and a few probably in a few different presentations and conversations about self care, just like, Oh, what was most you know, what was most, you know, resonant with you last week, you know, when you don't remember what you talked about like that that's really making the client, it puts them in the driver's seat? I think there are clinical reasons to do that. But I think if you're structured enough that you're actually asking for homework, follow up.   Curt Widhalm  13:33 And you don't want to be that therapist, it's kind of doing the, you know, the psychic out in front of the audience, like I'm sensing, sensing an H over here. Was there something in your last week that that starts to age? Hey, speaking of things that we can overload clients with your this is from your list, lots of outcome measures without either buy in about it, or showing what you're doing with those outcome measures.   Katie Vernoy  14:06 Yes, yes. Yeah, I think the thing for me is on my therapist for a while was doing feedback, informed treatment. And I was like meh and and she did drop it. So that's good. Maybe I shouldn't say that outloud   Curt Widhalm  14:21 maybe they weren't doing feedback, informed treatment. It was just feedback informed treatment flavored therapy.   Katie Vernoy  14:28 Maybe No, I we did talk about it a little bit. But I was also anyway, that's a whole other conversation that I can have with my therapist. But I think when I'm thinking about that, that was my experience of like, I don't want to do feedback informed treatment. I'll tell you if I need something different. Stop asking me questions. Stop spending time in my session on this paperwork that you want me to fill out is kind of how it felt to me. So I'm, and I knew what it was like I didn't need her to explain it to me. So I also was having my own experience of it. But back in Community Mental Health, there were tons of outcome measures that were put together to, for funding streams, like we had to show progress, we had to do this stuff. And, you know, we had to do them quarterly or different things like that. And theoretically, if you actually use those, clinically, I could see the benefit. But most of the clinicians didn't, they just had to get it done. And so it had that piece of like, here, fill out these 27 different scales. And then we'll be done. And we can get back to the business of therapy versus actually using them clinically. And so to me, first off having 27 different scales, and I exaggerate a little, I think is is overkill, and I think not using them clinically is is just bureaucracy at its worst.   Curt Widhalm  15:48 And don't just blame this on agencies. There are people who, if you are some of my fit people out there, you know what I'm talking about, but it's for the people who think that they're doing fit that aren't, that are just kind of taking up session time, they're not explaining how they're using this information with clients that really just ends up Compounding this problem. Yeah. Now, on the opposite end of too much paperwork is maybe not giving enough paperwork, and not necessarily just assessments, but this is following through on things like super bills. And yeah, letting you know, months and months stack up before clients are reaching out to you and saying, Hey, I'm thinking that, you know, my insurance company isn't going to reimburse me for things that happened last year, that you're getting that far behind. Yeah, you know, the this is things that now start to impact potentially the the contracts that you got clients into your practice with, as far as, you know, if part of clients decision making processes, I'm coming to you because at least I'm getting a few dollars back on my therapy sessions, because of a super bill. This is something that starts to have a financial impact on clients.   Katie Vernoy  17:20 Yeah, I definitely have had clients that I forgot I was doing a super bill for and they reminded me fortunately, it was not too far out. And we were still able to get it done. But I think that's, that's hard. I mean, that's part of the process that we say we're going to do. And if we don't do it, and they and they have to remind us, I mean, granted, this is them getting their money back. But if we've said, Hey, I will provide you with a super bill, we need to live up to that into the bargain. I think there's also courtesy billing and different things. We talked about some of this stuff in work harder than your clients on ways that you can show up better and and maybe even in some of the other conversations we've had on kind of the highest level of customer service, I'll look back and see what we've actually done episodes on, then put those in the show notes. But I think, to me, I think if we're not billing timely, and like with insurance, billing, if we're not billing timely, and we don't get paid, I think we just hold that. Like, if we didn't do it, we don't get paid. But if we're billing really late, and we're also not collecting payments until we know what the copay is going to be, or until we know how much has been covered. We can end up with big balances that clients have. And we know there's there's a lot of guidance around that. But I think that can start to happen. Even if you don't bill or don't charge them a reasonable copay. Like, except like once a month. That means for some clients, that's fine, and you can figure out the cadence with them. But I think if we're not doing things timely, and all of a sudden a client owes like 1000s of dollars or hundreds of dollars for some clients, it's it's overwhelming, and it creates a little bit of a rupture within the therapy relationship.   Curt Widhalm  19:02 It really does heighten the power imbalance that not only are the traditional therapist client power balances there, but then it's also this is somebody that I'm indebted to, and especially if it's multiple sessions that for whatever reason, that therapist hasn't built the client, then clients might not actually be bringing that up. And, you know, not everybody's great at budgeting their money. So if they get hit with multiple sessions of Yeah. You're then putting yourself into, at best trying to work out a payment plan with them. versus, you know, potentially, it being the end of the therapeutic relationship and somebody that owes you money just as potentially gone.   Katie Vernoy  19:56 Yeah, I mean, I think that is loss of money for clinicians, and I think we should be pretty motivated to not do that. But I think about like setting up payment plans or even like a sliding scale when there's not any structure to it's like kind of pay what you can. There is a clinical element to this, I think. But I think there's also some emotional labor that we're giving to our clients to try to figure out what they can say they can afford that feels acceptable to you, or what their timeline is for the payment plan, or whatever it is, and all of a sudden, this relationship has become very different. And I feel like the more structure that the therapist can give, the less we're putting our money stuff on our clients, because I think sometimes sliding scales and pay payment plans and stuff like that are very needed. And sometimes they're because clinicians aren't willing to turn folks away or refer folks to appropriate resources. And so then it becomes this weird push pull of, well, if you can get high enough, then maybe I can see you. And, you know, it's it really becomes this weird dynamic. And maybe that's overstating it, but it feels really strange to me, I feel like it's been a lot, it's a lot easier when someone has a specific copay, or I say, This is my fee, and they say yes or no.   Curt Widhalm  21:13 Why longer that I practice, because of some of these points, the more that I look at things from a practice management, and that it simplifies things. And I look at it from a legal and ethical end to that, it's acknowledging that as the providers, we have the responsibilities to set boundaries, especially around kind of more taboo sort of things in polite society that we don't talk about money in this way. It puts us in the position of even if we're very equal, driven in the way that we approach the work that we do with our clients that this is just kind of handing off all of that responsibility as you described.   Katie Vernoy  22:02 Yeah. I mean, I feel like there's probably a mechanism to have a Pay What You can practice, and I am thinking of someone in particular, and I have a sense that she's probably doing it very well. And so maybe I'm gonna reach out to her so you know who you are, I'm reaching out to you. But I feel like it has to be handled very, very well. And there needs to not be kind of this ulterior motive around it, because then it's like, I'm putting my stuff on you versus really opening up my practice to exactly what you can pay. If you can pay $2, or you can pay $250, you're in the door is a very different thing, then, what can you pay? Can you pay this? Can you pay that? Well, I can only do this, can you do that? Like it just this the bargaining, I feel like just creates a completely different relationship. And maybe maybe I'm too in my own money stuff and need to solve it. But I feel like that's putting our stuff onto the clients.   Curt Widhalm  22:58 So switching gears here, some, a lot of us love to add new skills to our practice, add new tips, add new interventions, add new theories, and you're encouraged to practice them. Yes. But clients who know that they're the ones who are being practiced on, it should be done in a way that they are buying into, it's not just, I came from this workshop this weekend, and this is the first time that I am using all of these interventions, that that is doing therapy that is not practicing therapy, and that is doing therapy poorly. And   Katie Vernoy  23:40 yeah,   Curt Widhalm  23:41 go ahead.   Katie Vernoy  23:41 I was just gonna say, I know that I've been guilty. Sometimes I'm like, this is such a cool intervention. And I was thinking about you the whole time. And I think it would be great. And then we try it. And sometimes it's cool. And sometimes it's like, Oh, I was way more excited about that than I really thought about it. So I know I'm guilty of this.   Curt Widhalm  24:01 And I think it's natural, especially earlier in our careers to want to try out and especially as you're trying to find what your theory is that part of getting a theory is just trying things out and being able to see what works for you. But I've had clients respond back or heads supervisees clients that this ends up becoming discussions and supervision of, well, that's nice, but what's your success rate with this that makes them even just question the effectiveness, whether they're, whether the clinician is good at it or not. That just kind of devalues the belief that it's actually going to work from the clients end.   Katie Vernoy  24:47 Yeah. Yeah, I think the longer I work with a client, the more we're able to kind of play around with new things, see what's happening, but like if it's especially a newer client, where it feels like I'm coming in each week with a completely new theory. Without a lot of understanding, yeah, it feels like I'm just grasping at straws. And so I think it is important, regardless of how excited you are of an orientation, or a new new intervention that you really, how does that flow into the work that's already happening? Is it relevant? Or is it just does it just sound like fun? I think some of the folks who read us putting a mental load on our clients will probably think this is what we were going to talk about. So I want to make sure we do talk about it. This is what we talked about all of the podcasts, I didn't want to miss it. What I put together my little list, which is us, not having knowledge, especially cultural or specific demographic kind of information, and asking our clients to teach us, I think this across all of our clinical episodes is basically what every clinician who's talking about a population of folks that we didn't necessarily learn about in grad school, says is that what they get wrong, is that they make clients teach them. And they also make bad assumptions and all of that. And so then the clients, if they stay has to do the work of teaching us they have to do the work of navigating our bias, they have to determine if it's if we're the right therapist for them. And so I think, I don't know that we have to go deeply into this topic, because like, probably three quarters of the episodes of our podcast, maybe that's an exaggeration, half of the episodes of our podcast on this very thing. But I think what we're requiring our clients to teach us about that, all that makes them them from the ground up versus coming from a place of I have some knowledge, and how does that impact your life? And tell me a little bit more about your particular perspective? I think that is an emotional load that I think is extremely harmful for us to put on the clients.   Curt Widhalm  26:56 And I think if you approach that as more likely to be harmful than not from that approach. Yeah, it's not to say that it doesn't work. And you know, despite all of the experience that I have in my career, that sometimes it's even just owning my side of the street of here's my experience with this particular presentation, this particular culture, even sharing with them from session to session. Here's what I've been reading about since last time, as it pertains to this area that demonstrates a better way of handling this, as opposed to, hey, why don't you teach me about your fill in the blank difference of culture from mine, that assumes kind of that dominant thing. So if that dead horse is not already beaten.   Katie Vernoy  27:54 But we'll, we'll, a link to a section of our podcast episodes that has a lot of those types of beginning beginner information that you can start with if you've got a client that has some differences that you don't know much about.   Curt Widhalm  28:09 And I think that that goes into the next thing on your list here, which is identifying a lack of fit overall, yeah. With and this doesn't have to be just immediately before the first session, but even in the first session or so appropriately, being able to say, I don't think that I can help you. Or there's somebody who is better at helping you or my skills, don't line up with what you need out of therapy at this point. And then providing a warm handoff to somebody who can, that, you know, it's hard enough for many clients to, especially first time therapy seekers find a therapist that meets many of their requirements, costs, location, specialty, this kind of stuff. And then to just kind of throw those clients back to the beginning of the process is a very difficult aspect of just where our healthcare system is. But this is part of why we build the networks that we do to say, Hey, I know somebody who might be a better fit for you on this than I am. And being able to own that in a non shaming way.   Katie Vernoy  29:27 We've talked about this a few times, and we have a couple of episodes on how to fire our clients ethically, if you've started down the path and recognize that you're not the right therapist for them. And so being able to, you know, whether it's identifying that you're not a fit anymore, or they might need somebody else at this point, I think that's our responsibility and not our clients kind of fading away. And to that point, we need to be the ones that identify the end of treatment, when it's clinically relevant. If it's like, Hey, I've got what I need. I'm going to come back later, or those types of things that can be either collaborative, or the clients choice, the client can always choose to end treatment. But if you're recognizing it's time to end treatment, and you don't say it, because you don't want to lose a client, then the client has to say it later. And that's not fair to them.   Curt Widhalm  30:19 So all of these are extra considerations for helping your clients having good experience with your management of your practice of being able to come to therapy for the reasons that they think that they're coming to therapy for. And, you know, I think that we've probably got a upcoming episode here to be recorded, but helping to talk with clients about what realistic expectations of therapy are, yeah, that if we're really honest about it, it's, you know, realistic expectations. If your honest list is, I'm going to be late on emailing you things, or I'm going to be chaotic and scheduling you. But we encourage you to own your stuff. If you wouldn't feel comfortable owning that to potential clients. These are ways of being able to consider the impacts and really being able to look at your own therapeutic relationships with your therapists of what goes beyond just what's happening in the therapy room.   Katie Vernoy  31:31 And I think there are many of these things that probably each of us, you know, I'm talking about you and me, as well as, as all of our listeners, we there's many of these things that we've all done at some point. And I think part of it is being human, we get excited about a treatment and we try it before we really think through the whole clinical plan, or we're late or we forget to get back to our client or whatever it is like I think all of us have at least a few if not all of these somewhere in our history. I've been a therapist for 20 years. So of course these things have come up. But I think if we can own our humaneness and set ourself up for success, we minimize these things. Yes. And I think if we don't get overwhelmed, we don't, you know or don't aren't consistently in a state of overwhelm, I think we can manage these things a lot better. I think the reasons that I came up with it, sometimes these things happen that I think are worth investigation, and maybe in another conversation about clinical orientation, or how we view ourselves in the profession. But I do feel like there is a rigidity that sometimes happen. And I've seen this in in some different kinds of topics. And we talked about it a little bit in some recent episodes. But when we feel like our clients need to take on this emotional load, because it's their responsibility, or it's part of the clinical element of things, you know, clients must do this, because it's their thing. I just, I feel like I need to remind folks like, therapy is a weird beast, we do things in a particular way. And is there's a culture that we've created around what therapy is what the relationship looks like, all of these things that our clients may not know. And so the fact that they should remember their appointment time, or they should do, they should always be the one managing their scheduling, or whatever it is, you know, like, if there's something that they should do that if they don't do it, then it's clinically indicated. And I create sometimes there's clinical communication that can happen there. But when we when we put our filter of what a good therapy client does over someone who maybe has never had therapy or has never had therapy with you, you're putting stuff on them that I don't think is necessarily accurate.   Curt Widhalm  33:54 So, we'd love to hear your thoughts on all of this stuff you can let us know on our social media or come join our Facebook group, the modern therapist group. And until next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  34:08 Thanks again to our sponsor Simplified SEO Consulting.   Curt Widhalm  34:12 These days, word of mouth referrals just aren't enough to fill your caseload. Instead, 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. That's where simplified SEO consulting comes in. It's founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website or they can do the optimizing for you.   Katie Vernoy  34:35 Visit simplified Seo consulting.com forward slash modern therapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code modern therapist. Once again, visit simplifiedSeoconsulting.com/moderntherapist and use the code modern therapist all caps.   Announcer  35:00 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.

    How to Be Accessible Beyond the Sliding Scale

    Play Episode Listen Later Nov 29, 2021 33:42

    How to Be Accessible Beyond the Sliding Scale An interview with Lindsay Bryan-Podvin, LMSW, about how therapy can be accessible (and not just financially). Curt and Katie chat with Lindsay about capitalism versus money exchange, the social enterprise model, and how therapists can make a good living without feeling like greedy capitalists. We also explore the many different types of accessibility and the importance of setting your fees based on your needs and values rather than as a mechanism to single-handedly fix the broken system or to meet an artificial money goal.     It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Lindsay Bryan-Podvin, LMSW, Mind Money Balance Lindsay Bryan-Podvin (she/her) is a biracial financial therapist, speaker, and author of the book "The Financial Anxiety Solution." In her therapy practice, Mind Money Balance, she uses shame-free financial therapy to help people get their minds and money in balance. She's expanded her services to help private practice therapists with their money mindset, sustainable pricing, and authentic marketing so they can include financial self-care in their work. She lives with her partner and their dog on the traditional land of the Fox, Peoria, Potawatomi, and Anishinabewaki peoples also known as Michigan. In this episode we talk about: How therapy can be more accessible (and not just monetarily) The money “shit” that gets in the way of us thinking about other options for accessibility Decreasing stigma and the notion that therapy is by and for white folks Are we making our practices accessible for all sorts of folks? ADA compliance, supporting neurodivergent and disabled folks Cultural competence, the ability to apply that in sessions with clients who are different than us Being embedded in our communities Taking therapy out of the shadows The challenges in getting out and having a larger voice How accessibility is intertwined with therapist visibility How to become part of your community in effective and impactful ways Financial ways to make your practice more accessible beyond sliding scale Social Enterprise Model: intersection of what you do well, what values you stand for, and what can you get paid well to do Feeling like a greedy capitalist What it means to be paid well How to think about setting your fees Fee-setting based on what you need to survive and thrive (not capitalist principles) The problem with “know your worth” The big cognitive shift required to move from community mental health pricing and work-life balance, fees Tying money to quality of life, not specific monetary goals Getting to “enough” not more and more Capitalism versus money exchange The wealth of knowledge we have as therapists (and how therapists take it for granted and/or devalue it) Sharing your knowledge as a mechanism of accessibility to your whole community To practice self-care, you have to be able to afford it Our Generous Sponsor: Trauma Therapist Network Trauma is highly prevalent in mental health client populations and people are looking for therapists with specialized training and experience in trauma, but they often don't know where to start. If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There are so many types of trauma and so many different ways to heal. That's why Laura Reagan, LCSW-C created Trauma Therapist Network.  Trauma Therapist Network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work and what they specialize in, so potential clients can find them. Trauma Therapist Network therapist profiles include the types of trauma specialized in, populations served and therapy methods used, making it easier for potential clients to find the right therapist who can help them.  The Network is more than a directory, though. It's a community. All members are invited to attend community meetings to connect, consult and network with colleagues around the country. Join our growing community of trauma therapists and get 20% off your first month using the promo code:  MTSG20 at www.traumatherapistnetwork.com.   Resources mentioned: 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.mindmoneybalance.com https://www.instagram.com/mindmoneybalance/ Lindsay's podcast: Mind Money Balance   Relevant Episodes: Lindsay's previous podcast episode: Financial Therapy Katie Read: Therapists Shaming Therapists Negotiating Sliding Scale Making Access More Affordable Asking for Money Reimagining Therapy Reimagined   Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated)   Curt Widhalm  00:00 This episode is sponsored by trauma therapist network.   Katie Vernoy  00:04 Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit traumatherapistnetwork.com to learn more,   Curt Widhalm  00:27 listen at the end of the episode for more about the trauma therapist network.   Announcer  00:31 You're listening to the Modern Therapist's Survival Guide, where therapists live, breed 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  00:47 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 we don't do things that maybe we should do. And both Katie and our guests today are looking at me like, where is this going? And honestly, this is just one of those rambling intros that we have. So rather than making this more awkward, we're joined once again by Lindsey Bryan Podvin. She's been a guest to the show before spoken at therapy reimagined with us, talking to us about money and ways that we could be looking at it for our practice. So thank you for joining us again.   Lindsay Bryan-Podvin  01:35 Oh, yeah, I'm really happy to be here. This is my favorite thing to chat about, and to be in community with you guys. Again, it's fun.   Katie Vernoy  01:43 Oh, we're so glad to have you back. And we'll definitely link to your previous episode in our show notes. But for folks who haven't heard from you for a while, or for our new listeners, tell us who you are and what you're putting out into the world.   Lindsay Bryan-Podvin  01:57 Yeah, so as Curt mentioned, my name is Lindsay Bryan-Podvin. I'm a social worker, and financial therapist, and I have kind of two arms of what I'm putting out there into the world, I have my clinical arm, and then I have my consulting arm. So in my clinical world, I'm doing financial therapy, which is helping clients with the emotional and psychological side of money, which spoiler alert is all of it, I think. And then, on the consulting side, I know you all know that therapists have money, shit, and we have a lot of hang ups about it. And so in my consulting arm, I help mostly other therapists, though, over the past year, I'll say that other kind of helping professionals have woven their way in, whether it's dietitians, acupuncturist, Reiki healers, because I think a lot of us get similar messaging about what money is and what it isn't. And so I help them work on their emotional and psychological relationship with money so they can have sustainable and profitable businesses. And I do, like outside of the the hands on work, or the zoom work, I suppose I have a podcast and Instagram, a pretty active blog and an email list that keeps me using my creative side of my brain.   Katie Vernoy  03:13 Nice. I love it.   Curt Widhalm  03:15 One of the big discussions that's been in the social justice aspects of our field, especially for private practitioners, and admittedly also here on our show, is talking about things like accessibility and being able to make our services go beyond just those top paying cash pay clients. Can you walk us through kind of what you hear in these discussions about accessibility for practices, and especially as it relates to some of these monetary issues?   Lindsay Bryan-Podvin  03:50 Yeah, I think as therapists we get really stuck on accessibility being only a monetary issue. So we think about solving for that problem by sliding our scale or by offering pro bono spaces. But we forget about all the other ways in which we can and should be accessible if that works in alignment with us. So as I think you guys were talking with Katie read about like the the the money talk that comes up on therapists forums and how there's so much guilt and shame and, and judgment about what people do or don't do, whether they do or don't take insurance, whether they do or don't slide their scale, but that's where most of us get stuck. And there are so many things beyond sliding our scale and the fee that we charge that can bring about accessibility for our practices and in our communities.   Katie Vernoy  04:45 What are some of the things that we can think about beyond sliding scale because I think I get stuck there as well with and maybe this is just our focus is that we're so focused on the monetary aspects and our own money shit as you described it, and We aren't thinking about what else isn't making us accessible.   Lindsay Bryan-Podvin  05:03 Yeah, I think taking a few steps back before a client even finds our website or finds us on a therapist directory, really thinking about how can we make our field more accessible by talking about what is therapy, I think in a lot of communities, we still have these stigmas that therapy is buy in for white people. And it's done on a couch with, you know, a person who's got reinforced elbows and they're smoking a pipe, right? You know, like, we have that imagery. And if we are not talking to our communities about what therapy is and who it is for, and how it can be helpful by not just talking about what it is, but also the stigma reduction, we don't even get people landing on our websites or knocking on our, you know, figurative door, right. So being in our communities and talking about what it is and who it's for, and how it can be helpful. And also talking about just the ins and outs of therapy, that it is confidential. I think in a lot of communities, there's a fear that if I go to a therapist, then you know, my mom's cousins going to find out about it, or that my employer will be told about it, or that my partner will be told about it. So I think there's some education that has to happen on the backend before people even get to our doors. And then in terms of other measures of accessibility outside of this scale. Let's get really granular on on what is accessibility? Do our clients see themselves reflected in the way that we practice therapy? Can clients who have disabilities, either neurodiversity or physical limitations, do they have actual access to our offices? Are they ADA compliant? Do we offer you know, nowadays, so many of us offer basically zoom therapy? Which makes it so much more accessible? Are we operating on bus routes and public transportation? Is there easy parking, like the literal accessibility piece? And then the cultural competency piece? Can they speak my language? If I don't speak English? Do I have somebody sitting across from me in the therapy room? Who gets what I'm talking about? When we talk about cultural competence? Not just thinking about, you know, whether or not you took a class on Southeast Asian Studies. But what does that mean? And how does that show up in our spaces, and being embedded in our community beyond just like, hiding in this little bubble, where we're kind of shrouded in mystery, I think, taking therapy out of the shadows and making it more commonplace in our communities, like we are healers in our communities. And we shouldn't be hiding behind the walls of like mystery what when there are community events, I would love to see more therapists out and they're out and about, as sponsors, as networkers and things like that, like, we also have to take ourselves out of the shadow. So there's, there's a lot of different ways we can talk about accessibility.   Curt Widhalm  07:59 So I love what you're saying, I completely agree with getting out there. There's some some stumbling steps that can happen in putting ourselves out there, because so much of our history is in being shrouded to the, you know, the shadows. And sometimes the responses that I hear from clinicians is, oh, that person went out and was talking about this, but didn't represent themselves. Well, it isn't representing the field. Well, do you have any advice as far as taking some of these steps? You know, look at you, and all of the things that you post in your newsletters and social media and this kind of stuff, money seems to be kind of like a fairly neutral ground as far as being able to talk about relationships with money. For those who are looking to maybe take some other steps as far as making this accessibility happen, that might be around more unique issues to communities. Do you have any suggestions on how people might find the confidence to be able to make those steps?   Lindsay Bryan-Podvin  09:03 Yeah, I really like this question. Because I think that accessibility and visibility are are intertwined. And visibility isn't just social media. So let's say you do want to be more accessible in your community and you do want to be more visible in your community, but you're talking about something that is more sensitive, like you know, sexual trauma, then yeah, maybe going on in doing an Instagram live about it isn't probably the most appropriate way because you don't know who's on the other side of it, you really can't create a container of people to make sure that it's safer or at least safer. So maybe in that instance, it's going to, you know, a high school and pulling a you know, having a group of 30 kids that you are talking to about this in like a speaking engagement setting or maybe it is going to the healthcare system and sitting down and talking to the medical social workers about what you know, or to the nurse midwives about what you know, right there. Different ways to get out and become a part of the community that don't involve these kind of one way one sided communication methods. Does that make sense?   Katie Vernoy  10:11 It does, I think this idea of making the whole profession more accessible to folks and all folks, and not just the kind of historical white people and the, the, the patches and the pipes. I think that to me is, it's really, really important. And I think it also is only a first step. Because when they get to our door is there still is I think, you know, financial accessibility concerns for a lot of folks. And so are there financial ways to be accessible that don't involve involves sliding your scale?   Lindsay Bryan-Podvin  10:48 Yeah, of course. So, undoubtedly, money is a real accessibility issue. I'm not just saying like, Oh, you know, just get out there. That's it sounds it? All. Right, exactly. Exactly. An email newsletter is not going to fix accessibility. But as you guys have also talked about on this podcast, it's not the responsibility of an individual therapist, to fix the broken medical system salute here. And at the same time, there are more creative ways to provide services to people in your community that are might be easier on their pocketbooks. So group therapy is also a really great option, because you as the clinician are still generating the revenue that you need to, and the people on the other side are usually paying you less dollars per session. Insurance, I know there's a big again, it's not your job to accept insurance if they don't reimburse you well, but accepting insurance is a measure of accessibility. And even if you aren't accepting insurance, helping your clients out, walking them through what a super bill is, you know, spending a little bit of time in session, making sure that they know what that means and how to actually get it done. That, to me is incredibly helpful. So providing a bit of space in the in the session to talk through how you can do that, particularly if they have anxiety, or they've got some ADHD, you know, they might need a little extra hand holding to get those things done. There are depending on your licensing board, I've seen some people do sponsored therapy spot. So it's a little bit different than a pro bono. It's Think of it like a scholarship for therapy. So the way that I've seen this work is for clients who pay a full fee, you essentially tell them look by you paying a full fee, a portion of your fee goes towards sponsoring somebody who would not be able to afford therapy with me. So you're still getting income, but you're also having the clients who are able to pay your fee, kind of some buy in that they are also kind of helping out other people in the community. So those are some different ways to be accessible, that don't involve sliding your scale doesn't mean you have to do all or any of them. It's just different ways to think about it.   Curt Widhalm  13:04 On of the things that you talked about in your presentation at the therapy reimagined conference, this social enterprise.   Lindsay Bryan-Podvin  13:12 Yes.   Curt Widhalm  13:14 Can you tell us more about that, what it means for people who maybe didn't attend the conference and what the social enterprise model is and how this might fit in for therapists?   Lindsay Bryan-Podvin  13:24 Yeah, I think so many therapists struggle with this idea of charging for services because we've internalized so many things about what money is or what it isn't. And the social enterprise model essentially says, look, there are three things to provide something that you can feel good about doing. And also know that you are being compensated fairly for it. And it exists at the intersection of these three things. One, what do you do well, what values do you stand for? And what can you be paid? Well to do, and as therapists I think, if we can think about ourselves at the intersection of that, of existing, and I do this really well, these are in alignment with my values, this type of therapeutic intervention is in alignment with my values, and I can be paid well to do that. You know, that you are contributing to the greater good of the community by making sure that you're not just wringing out your clients for the most dollars you can get right? I think so many of us think that if I charge money, then I'm a greedy capitalist, but it's also about am I being compensated for the skills that I offer and the transformations that I'm able to help facilitate in a meaningful way?   Katie Vernoy  14:41 I know that there are a lot of different perspectives on how you decide how much money to wring out of your client. And, and and you mentioned the episode with Katie Read and we've had other conversations as well, just about the shoulds. And you know, how I should set my fees and those types of things. Yeah, and to me, it feels like there's so much nuance. It's it's a wide open space, there's a lot of shit. So people feel like it's not wide open, but I feel like it really is. What advice do you have on on setting those fees? Because when we're in that space where I can be paid well for it, it's aligned with my values, and I can do it well, like, it can be hard to figure out like, and what does being paid? Well mean, that I can feel good about?   Lindsay Bryan-Podvin  15:30 Yeah. And I think that's such a good question. Because this idea of what does it mean to be paid? Well, is so skewed in our field, my first job, I was making $32,000, you know, with a master's degree, and I don't think that's an unfamiliar number or salary for people to hear. And so when a lot of people go into private practice, they hold themselves to that standard, oh, well, I was making 40k or 50k. I think that's a reasonable salary. I think that's what I'll try to make. So we haven't thought beyond what do we actually need to survive and thrive. And that's where doing things in alignment with your values can be really beneficial. So when it comes to fi setting, you're not just thinking about what are you charging your clients? You're also thinking about? Does that fee sustain me and allow me to practice financial self care? Which means Can I take care of my financial needs? Yes, but do Am I also able to support my mental, my emotional and my spiritual self. With that? I know, I was, I was loving your episode on burnout. And I love the modeling that the two of you did by saying, Look, we're going to hit pause on the therapy reimagine conference, we also have to build in time off and time for restoration, there is a study that says we need, I think, oh, shoot, I'm going to botch it. Now. I think it's eight or 10 consecutive days off in a row to actually unplug from work. So making sure that you have that built in to your time off. So making sure it covers your time off making sure it covers your health insurance. Unfortunately, we live in a society where your healthcare is tied with your employment. So when you're self employed, you have to make sure that you can cover your health insurance, you have to also make sure that you're thinking about your future self in traditional employment, we often have access to retirement plans or programs. And when we move into entrepreneurship, we are our own 401k or four, three B plan. So we have to make sure that all of those things are taken into account. And we don't want to be overworking ourselves. When we show up exhausted and burnt out and watching the clock, we are not being good clinicians we just aren't. And just taking stock of our own energy, my full pre pandemic was 18, I could comfortably see 18 clients a week that felt like a good fit for me, I wasn't burnt out, I wasn't presenting my clients, I had downtime to get the things done, I needed to do and I charged accordingly. Now, my max is 12. I have found that doing zoom therapy. While there are so many advantages of it, like I genuinely really like it, I find that literally the physicality of sitting still and staring at my screen and just what really watching so much harder for nuances through the screen takes so much more energy out of me and I can no longer comfortably and competently feel like I'm a good practitioner when I'm seeing 18 clients when I've had to scale that back to 12. And then what do I have to do to make up for that income? So that was a long answer of saying it depends. You have to figure out what money you need to be bringing in and you need to make sure that you're not just thinking about comparing it to what you use to earn an agency job because you were likely being underpaid there.   Katie Vernoy  18:47 It's hard not to feel like a greedy capitalist. With that it means you have to charge a premium fee mostly   Lindsay Bryan-Podvin  18:56 Yeah, yeah.   Curt Widhalm  18:59 Give me advice for people making that jump to those premium price because I'm sure that there's a lot of our listeners who might be considering leaving an agency job and being like, you know, I know you know my session value in this agency and this aligns maybe with my values but in going out and charging somebody three four or five times that fee in order to meet my money goals seems like it has a lot of opportunity to bring up some that imposter syndrome and really being able to balance that for those individuals you have any guidance on what to really look at hopefully beyond just kind of know your worth.   Lindsay Bryan-Podvin  19:43 Yeah. Oh my god. Thank you for saying that because also the Know your worth thing. That's a trope I used to find myself repeating. And then a friend of mine who's a behavioral economist, she shared with me Jaquette Timmons and she's goes Lindsay You have to stop saying that because we as humans We don't have a worth. So instead, she invited me to reframe it as charged the value of what your services are worth to give yourself a little bit of psychic distance there between like, I'm worth $300. Now it's like no, the value of my services are worth $300 an hour. So anyway, tangent aside, how can you come into charging fees for your services, I think there is a pendulum swing that I see happen when people try to get out of the mentality of sliding their scale as low as possible to charging premium fees. And so they go from being in spaces where being a good therapist means charging very little into spaces that are like, You need to be a six, seven figure business owner, and you need to be charging premium fees, which can be as we know, a big jump cognitively. And so I always invite people to come back to your values, your lifestyle needs, your unique financial goals. And I'm not about bashing the people who are saying, Oh, you need to make six figures or seven figures. My practice does generate six figures. But I don't think that is a magical goalposts where all your problems are suddenly solved. I think this chase this money charge, the premium fees, you have to work more can backfire. In that it forces us to work more meaning when you have that mentality of I have to work harder, I have to chase this x figure goal or this premium fee number. What happens often is you get into this space where I'll just use myself for an example that that 12 clients Oh, I saw 12 clients a week, I made enough money to hit my goals. I started to cultivate work life balance. But now what if I saw twice as many people, I could make twice as much money? What could I do it twice as much money. And then all of a sudden you forget about why you did it in the first place. So coming back to how much do I need? How much do I desire and is the money that I'm charging, allowing me to do things in alignment with my values, let's say family is like the most important value to me. And I want my 10 consecutive days off in a row with my family. And I want to go somewhere where I don't have to worry about you know, finding activities for us to do or cooking a bunch of food, I want to make sure that I have enough money to pay for that Airbnb to pay for takeout and that Airbnb is conveniently located to a lot of like outdoor activities. That's a goal that I can kind of reverse engineer my way. And to me, it's also modeling for your clients, you don't necessarily have to say to your client, like, Oh, my financial goal was this, this and this, and I was able to achieve it. But you're also modeling for your clients the importance of taking time off of adhering to your boundaries and practicing self care. So again, that's a tangent of an answer. But I guess the long and short of it is as you move towards charging premium fees come back to like, what your WHY IS, and when you feel that anxiety to work more and charge more and go harder, you actually may already have enough.   Katie Vernoy  23:02 I like that I think the piece that resonates for me is this, the letting go of I must get to this number, I must make more money. And I think for me, there's also this big push of like we must leverage we must, we must continue to grow and expand. And I think there's a point at which we have enough I mean, there, there may still be challenges that we need to do. But there's this, this freedom and not having to constantly grow and, and make my business bigger and make my business more successful. Like there's each person has to decide where they land or where they land for a time and you know, different seasons of what I need and what I want and what's most important to me, but it feels like it and this is kind of circling back to the the social enterprise model and kind of this idea of capitalism versus money exchange and, you know, clarifying all of that, but but it seems like when it's completely tied to values, what you're positing is that feels better than just making money for money's sake. And so, so tell us a little bit more about this. Because to me, I feel like I'm just starting to grasp the idea I was I was too caught up in the greedy capitalism, to understand kind of what what we were what we were starting to talk about with a social enterprise model.   Lindsay Bryan-Podvin  24:24 Yeah. So to bounce off of this idea of what is the difference between capitalism and money exchange? I think it's important to note that capitalism is a is a political economic system that we we know the dangers of right it is propped up by the unpaid and underpaid labor. So the person or people who are in charge, get the greatest amount of profit available. And as such, as we kind of touched on earlier, it's a system where we give all the praise to the people who Make a lot of money because they must have worked hard and simultaneously shamed the people who didn't make a lot of money because they must have not been hard workers. And we've we bought into that idea as a society so much so that you know, at the time that we're recording this, if you're on Twitter right now, you can see people rallying around Elon Musk saying like, yeah, he shouldn't have to pay taxes, he worked really hard. So we've got all these people saying, like, yeah, we save the billionaires instead of let's make sure we have a safety net that people can't fall through for the greater good of our society. So that's capitalism. And there's a lot of problems with it. And even if you disagree with it, unfortunately, we live in that society. Yeah. And money exchange, on the other hand has been around since the dawn of time, whether it was literal dollars or coins, there has always been an exchange of things for other things, or things or other services. And when we think about small business owners, which is most private practice owners, if we can think about ourselves as kind of the community farmstand, it helps to shift that mentality. So for example, if I go down to the farmers market, and I purchased a half a dozen eggs, I'm helping to support sustainable agriculture in my community, I get to know the person who grew my crew, my eggs, I don't think we're growing eggs, but you don't I mean, maybe if you're vegan, actually, you're growing your eggs. So you're growing your eggs substitutes? Got it? So we want to think about as therapists, how can we kind of fit into that model, where what we do in charging for services, and helping people in our community is a win win. Because when we have a healthier person in our community, because we are helping them with their mental health, what is that ripple effect on the community? And how can that be beneficial?   Curt Widhalm  26:57 It sounds like, you know, this is what a lot of practitioners do by going out into the community and sharing even some of the things that you were talking about at the top of the episode of just going and talking about mental health and about their practices and doing some, I guess, pro bono work and in the way of psychoeducation, or community education that helps to make that Win Win happen.   Lindsay Bryan-Podvin  27:25 Yeah. Yeah, absolutely. I think it's so so powerful. I think when we are in our spaces where we're surrounded by other mental health, folks, we forget what the baseline is of mental health knowledge. Oh, yeah, forget, just like what a wealth of information we have, like the other day, I did a presentation for non mental health care providers about what financial anxiety is, and tips to cope with it right. And for anybody in the therapy field, they'd be like, that's like, entry level CBT, maybe if you're lucky. But for this group of people, it wasn't that they don't, it's just we forget how much knowledge we have, and how valuable explaining some basics of how our minds and bodies and thoughts are connected, can be a huge value for other people in our community. So just don't take what your knowledge is for granted. Get out of your academic kind of echo chambers and go talk to people who aren't in the mental health care field. And that is really where you can offer a lot of wisdom and value in your community.   Curt Widhalm  28:33 So once again, echoing stop hanging out with therapists.   Lindsay Bryan-Podvin  28:41 That might be a theme. Yeah.   Katie Vernoy  28:44 Maybe it's stopped just hanging out with therapists   Lindsay Bryan-Podvin  28:47 That's a good reframe  Katie   Katie Vernoy  28:49 I know, I just it's really hard. I know, for me, and we've all spoken for therapists, we've all kind of done that thing. And I'm sure, just from the way you described it, Lindsay, you've got the thing. Like, that was a really nice reminder. And like, it is so dismissive. When a therapist comes up and says that to you, you're like, Yeah, but why did you need that reminder? You know, so I think it's that piece of when you start talking to folks who are not therapists, you recognize this is really important information. And it's not going to be discarded as Oh, I already knew that because it is this new piece that's coming in, that then allows, and this is, I guess, going to do accessibility thing. It allows this information to be disseminated more widely widely. It's something where they then are able to implement it, and maybe some people wouldn't need therapy if this information are readily available and was there first and so I think I'm putting the pieces together, Lindsay, I'm starting to see but it's it's really sharing the knowledge. It's making sure that you're available and that you've set up a fee system that makes sense for the folks that you're Working with but it's, it's this additional piece of you know, maybe you get creative and you do sponsorships or I mean there's people that have whole mechanisms for nonprofits to donate for, for scholarships for therapy. So I, there's, there's so much creativity that doesn't require an individual to slide their scale to an unsustainable fee. But this notion of just be accessible for all with all of these other pieces, I think is is hard to do. If you're not making enough money to survive, and you're seeing 40 clients a week,   Lindsay Bryan-Podvin  30:33 Ding ding ding that is exactly it. We cannot care for other people in our community when we don't take care of ourselves. And it's, you know, we hammer on this message as therapists but we forget that in order to practice self care, we need to be able to fucking afford it. Like we just do.   Katie Vernoy  30:48 Yeah, exactly.   Curt Widhalm  30:52 And it's not just kind of the big luxurious, affording things like yeah, you know, that eight to 10 days, go and do a vacation if that's your jam, but it's also being able to afford the consistent little things of and you know, it's going home at a decent time of night. It's being you know, not spending your your off hours catching up on notes, or it's having all of the other systems and everything else that we've talked about on this podcast of being able to have the convenience of being able to afford shutting off at each and every day.   Lindsay Bryan-Podvin  31:30 Yeah, absolutely in in those are the things that we know, make. The biggest difference is that consistency and that predictability, that predictability that you can power down the predictability that you can pay your bills that helps to give us that mental space to rest and to be safe.   Katie Vernoy  31:51 Where can people find you?   Lindsay Bryan-Podvin  31:53 My website is called Mind money balance. It's the same name as my practice. My podcast is of the same name. My Instagram handle is of the same name so people can find me on any of those places.   Curt Widhalm  32:08 And we'll include links to Lindsay's stuff in our show notes. You can find those over at MCSG podcast calm and also follow us on our social media and join our Facebook group, the modern therapist group. And until next time, I'm Curt Widhalm with Katie Vernoy And Lindsey Bryan-Podvin.   Katie Vernoy  32:26 Thanks again to our sponsor, trauma therapist network.   Curt Widhalm  32:30 If you've ever looked for a trauma therapist, you can know it can be hard to discern who knows what and whether or not they're the right fit for you. There's so many types of trauma and so many different ways to heal. That's why Laura Reagan LCSW WC created trauma therapist network. Trauma therapist network therapist profiles include the types of traumas specialized in population served therapy methods used, making it easier for potential clients to find the right therapist who can help them. Network is more than a directory though it's a community. All members are invited to attend community meetings to connect, consults, and network with colleagues around the country.   Katie Vernoy  33:07 Join the growing community of trauma therapists and get 20% off your first month using the promo code MTSG 20 at traumatherapistnetwork.com Once again that's capital MTS G the number 20 at Trauma therapist network.com   Announcer  33:23 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.

    Peer Support Specialists

    Play Episode Listen Later Nov 22, 2021 53:27

    Peer Support Specialists An interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFT on what peer support specialists are and the value they bring to treatment teams, as well as the challenges and best practices in implementing these roles into clinical programs. Curt and Katie talk with Kemisha and Amparo about their experiences in these positions, exploring how their lived experiences created the successful integration of a more holistic approach to support clients. We also talked with Jeff about his journey in implementing one of these programs from scratch.   It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFT Kemisha Fields, MSW: Kemisha Fields was born and raised in South Los Angeles, CA. As a former foster youth, she has taken a professional interest in the commitment to serving the needs of children and families as a Children's Social Worker working in Dependency Investigations. She has studied many modalities to bring healing to those in need. Kemisha is a life, long learner inspired by the abundance of opportunities available to enrich the lives of the people she serves. She earned her Bachelor of Science Degree in Psychology from the University of Phoenix. She received her Master of Social Work degree from the University of Southern California. Currently, Kemisha is a Doctoral Student of Business Administration with an emphasis in organizational leadership. She has extensive experience working with children, families, and individuals as an agent of support and guidance. Kemisha has a strong background in case management for an array of populations inclusive to at-risk youth, individuals with intellectual disabilities, commercially sexual exploited children, victims of trauma, and families within the dependency system. As a lead Dependency Investigator with Los Angeles County Child and Family Services, she has direct practice with assessing for child abuse and neglect in hostile environments. Kemisha works directly with County Counsel to investigate and sustain infractions of the Child Welfare and Institutions Codes. Jeff Kashou, LMFT: Jeff Kashou, LMFT is a manager of clinical product and service design for a mental health tech company that provides telemedicine to those with serious mental illness. Previously, he ran a county mental health program where he helped develop the role fo peers for adolescent programs county-wide and collaborated with peers to create management practices to support their professional development. In this position, Jeff developed a practice guideline for the utilization of peers in behavioral health settings for the County of Orange. Jeff has also served on the Board of Directors for the California Association of Marriage and Family Therapists, where he helped lead the association to support the field of Marriage and Family Therapy and those with mental health issues. He consults as experts in mental health for television productions, to ensure the accurate and helpful portrayal of mental illness and treatment in the media. Most recently, Jeff and his wife Sheila wrote a children's book, The Proudest Color, that helps children of color cope with racism that will be on shelves this Fall. Amparo Ostojic, MPA: Amparo Ostojic is a mental health advocate with personal lived experience. After working for the federal government for ten years, she decided to pursue her passion in working as an advocate to help promote recovery in mental health.  She has worked as a peer specialist for a mental health clinic as well as volunteered leading peer support groups. Amparo has a close connection with the Latino Community and feels it is her duty to do everything possible to prevent and reduce the suffering of individuals living with a mental health condition. Amparo created a Spanish speaking support group in East Los Angeles to offer free peer support to members of her community. Amparo has a bachelor's in business administration and a Master of Public administration. Amparo is a certified personal medicine coach and is working on becoming a National Certified Peer Specialist (NCPS). In this episode we talk about: What a peer support specialist is, how they work What peers can uniquely bring The hiring process, qualifications, and what that means for individuals seeking these jobs The difference in perspective that peer and parent partners can bring to treatment teams The importance of lived experience Comparing holistic versus medical model treatment The medical model and the recovery model complement each other The importance of advocacy for individuals (with the support of the peer support specialist) How peer support specialists are best integrated into treatment teams and programs The potential problems when the peer support specialist role is not understood How someone can become a Peer Support Specialist Certification and standardization of the peer support specialist role SB803 – CA certification for Peer Support Specialists Legislation Ideal training for these professionals How best to collaborate with a peer support specialist What it is like to implement one of these programs The challenges of hiring a peer support specialist Exploring whether there are systems in place to support peer support specialists with their unique needs The recommendation for a tool kit and a consultant to support programs in implementing best practices The Recovery Model and peer support specialists in practice Multidisciplinary teams may have pre-existing bias and prejudice against folks with lived experience, the role of stigma in the interactions The shift that happens when peers become part of the team (specifically related to gallows humor and the separation of “patients” and “providers”) Demonstrating the value of this role and the use of the recovery model Prevention and Early Intervention How to be successful with peer support programs and the benefits at many different levels Our Generous Sponsor: Trauma Therapist Network Trauma is highly prevalent in mental health client populations and people are looking for therapists with specialized training and experience in trauma, but they often don't know where to start. If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There are so many types of trauma and so many different ways to heal. That's why Laura Reagan, LCSW-C created Trauma Therapist Network.  Trauma Therapist Network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work and what they specialize in, so potential clients can find them. Trauma Therapist Network therapist profiles include the types of trauma specialized in, populations served and therapy methods used, making it easier for potential clients to find the right therapist who can help them.  The Network is more than a directory, though. It's a community. All members are invited to attend community meetings to connect, consult and network with colleagues around the country. Join our growing community of trauma therapists and get 20% off your first month using the promo code:  MTSG20 at www.traumatherapistnetwork.com.   Resources mentioned: 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! RAND Report: How to Transform the US Mental Health System Los Angeles Times Op-Ed: Our mental health laws are failing Wise U Training for Peers Advocacy through Cal Voices ACCESS Program SB-803 National Certified Peer Specialist NCPS Excellent guides and toolkits on how to integrate peers in clinics: Association of Home Social Rehabilitation Agencies Meaningful Roles for Peer Providers in Integrated Healthcare Toolkit Philadelphia Peer Support Tool Kit   Relevant Episodes: Fixing Mental Healthcare in America Serious Mental Illness and Homelessness Psychiatric Crises in the Emergency Room Advocacy in the Wake of Looming Mental Healthcare Work Force Shortages   Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated)   Curt Widhalm  00:00 This episode is sponsored by Trauma Therapist Network.   Katie Vernoy  00:04 Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit traumatherapistnetwork.com To learn more,   Curt Widhalm  00:27 listen at the end of the episode for more about the trauma therapist network.   Announcer  00:31 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  00:47 Welcome back modern therapists. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is part four of our special series of fixing mental health care in America. And today, we are shining a spotlight on peer support specialists and the role that they have in our behavioral health care system. And a lot of the advantages that these kinds of roles bring in, as well as some of the difficulties of getting peer support implemented despite a lot of very positive evidence in their role in treating mental and emotional disorders that happen in our world.   Katie Vernoy  01:27 I'm really excited about this particular episode, we've got two sections. The first one is we're joined by two folks who've worked in the peer support specialist role who are both still in social work and in advocacy. First off, we've got Kemisha Fields, who's a Master of Social Work who is was actually somebody I worked with, and she did a great job in one of the programs I was running. And then also person I was introduced to by one of our amazing friends of the show on Amparo Ostojic, who is an MPA and also someone who works in advocacy specifically about peer support specialists. So I'm really, really looking forward for all of you to listen to that and learn about what that role is. And we recognized also and I, I had a little bit of this, but Jeff Kashou LMFT is someone who has in the past actually implemented one of these programs, and he was able to talk with us about what it was like as a director, putting those things together. So take a listen.   Kemisha Fields  02:30 So my name is Kemisha Fields. I enter social services call for like 17 years ago, I took a entry level position at a homeless shelter. So that was my entry into social services. And from there, I've just kind of progress and work my way up. And I've worked with different populations. So I've worked with the homeless population. I've worked with individuals who are struggling with substance abuse. I worked in recidivism. I've worked in community mental health, and now I'm working in the child welfare system.   Amparo Ostojic  03:10 So my name is Amparo Ostojic. And I've been in mental health advocacy and peer support. For the last four years, I have worked to increase awareness about mental health, especially in the Latino community. And I worked as a peer support specialist for a mental health clinic for about seven months, I currently still do advocacy in the mental health space. And I work with individuals that want to know more about how to live, a quote unquote, normal life, even with my severe mental health condition.   Curt Widhalm  03:50 A lot of mental health clinicians, they may have heard of a peer specialist. I have found that a lot of my travels and talks in therapist communities that many people don't know what a peer specialist does, can you help us understand what a peer specialist does what their role is in the bigger part of the treatment systems.   Amparo Ostojic  04:13 So a peer specialist is basically a role model of positive recovery behaviors. So it's meant to give hope to someone living with a mental health condition and help them not feel as alone in this recovery process. So, in essence, a pure specialist will share their personal lived experience of mental health and oftentimes offer examples of what it's like to deal with a condition. And you know, what they've done to get better, such as tips or a really useful tool is, for example, the living successfully plan or the wrap plans, where you go over with a client what it is like to be in a healthy space, what it's like to see warning signs, and when it's time to call your psychiatrist or go to the hospital. So kind of teach them about themselves and guide them in their self determination of managing their their health condition.   Katie Vernoy  05:17 So you're really talking about from a place of your own experience and knowledge helping someone to plan for themselves,   Amparo Ostojic  05:26 right. And a lot of it is teaching them to self advocate for themselves, and put themselves in the driver's seat of their health condition. So for example, a lot of times, it's kind of directed from the top as if the psychiatrist or therapist is telling them what to do, or kind of teaching them what they should do. Whereas if your specialist is on the same level, and there's no sort of hierarchy of who knows more, there's a relationship of learning from each other, and really sharing what it's like to live through this. I was given the example where it's like, Is it someone that you want to work with, like someone that's like a biologist that knows about like the forest or something or someone that lives in the forest, because that personal lived experience is really key to understanding things that someone else that hasn't experienced them wouldn't really know, or perhaps hasn't dealt with.   Curt Widhalm  06:26 When you started in this, you started as a parent partner, how was that process of getting hired?   Kemisha Fields  06:34 So the qualification for a peer partner or parent partner would be a life experience in one of the systems of DCFS, Department of Children and Family Services, probation, and I believe education, like do individual education plan. And so my entry into being a parent partner was through my son's IEP, Individual Education Plan. And, you know, it just kind of happened by chance, a friend of mine recommended me for the position and I follow through with it, the interview process, or the application process, they I was asked what my qualification to being a parent partner, so I did have to disclose some important information regarding my own experiences with my son. And we just, I remember asking, like, anybody could have kind of said, like, oh, yeah, I have this child that has a special needs, like, how did they confirm that information? So I was looking for them to kind of want some sort of documentation from me, and they didn't. And so, at the time, the executive director says, usually confirmed based on the series of questions they asked me during the interview about different programs that may have been introduced to, to my son, which I found quite interesting, like, Okay,   Katie Vernoy  08:07 how was it for you to disclose personal things to get a job, because that seems like that would be a pretty vulnerable way to enter into a position.   Kemisha Fields  08:19 Very much so and because it's the opposite of what we've always been told, typically, in interviewing process, you don't share too much personal information, just your professional history. So it was a little different. But I always been transparent with my struggles with my son. So it was it was just a little different in I didn't know this person, but it was okay. I you know, I feel comfortable through the process. And I didn't, it was okay for me to, you know, share my experiences. Being a parent of a special needs child.   Curt Widhalm  09:01 I have to imagine, and this is prior to being hired in this position. Did you have somebody serving in that kind of a role for you, somebody that you relied on while you were going through your child's IEP process and all of the struggles that that usually entails?   Kemisha Fields  09:19 That is... I love that question. I absolutely love that question and Yes, but very informal. So I did not have a formal being like, Whoa, this is your parent partner, and she or he's going to help you through this process. What I have was professionals who kind of just stepped up I had one of the very first school psychologists who helped me through the process of my son's assessment, what to look for what questions that I should ask and she helped me not on a professional level but a personal level. She kind of walked me through that process. So I was grateful for that. So I've had a lot of support with my son, just from individuals who cared enough to show me what this looks like and what questions I should be asking. So I appreciate that.   Curt Widhalm  10:20 I have to imagine that working with the mental health systems, the people in those roles, there has to be some difficulties in getting integrated into the more professional sides of the organizations, what kinds of challenges to peer specialists end up having, trying to help clients be able to advocate for themselves and fit into this professional system as well.   Amparo Ostojic  10:45 The professionals, such a psychiatrist, therapist, they usually operate from the medical model, which is very top down, like I mentioned, and it kind of has this perspective that I no more in teaching the patient how to, you know, work with medications, or live with this condition, where as peer specialists work from the recovery model, that look at everything, the main four points are home, community health, and purpose, that's really important, like your reason to get up in the morning, right? That sometimes the recovery model is not taking us seriously, it's a more kind of holistic approach, looking at the person. And in the medical model, you're looking at the condition like it's a problem to be solved. And I'm looking at the person as the whole and how their whole life could be better. So my focus may be different than a psychiatrist, their focus may be to reduce the symptoms, and let's say get rid of hearing voices, things like that, or as my role is really to make that person as a whole better. So for example, I usually medications is a big thing must take medications, or as my role may not necessarily say that I typically never tell the client, you know, don't take medications, but I really allow the client to the side that and some other parts of the medical team may not like that. But also, my role may not be taken as seriously because, for example, in my experience working with a mental health clinic, they worked with people that were homeless, and I would say extreme cases. So as someone with bipolar disorder, they kind of put me in this category that, you know, I probably couldn't offer as much. And my perspective wasn't as valuable. So it was really hard. Working with therapists or psychiatrist that saw me as someone that was in the space of like, part of the problem. I don't know how to describe it. But it was really hard, because at the beginning, I definitely felt like I wasn't taking seriously. And it took a while to gain trust, and get there super for me clients. And those were one of the challenges,   Curt Widhalm  13:01 I have to imagine some of the providers are like, you're just completely undermining all of the treatment by using trust, none of this professional experience that we've learned. How did those conversations go? Because it seems like so much of a treatment plan would be developed from, you know, the scientific and medical model sorts of approaches. And then for somebody to come in with lived experience to be able to be like, maybe the medication thing is something that you want to talk to your doctor about.   Amparo Ostojic  13:33 Well, I take medication, and there was five years that I didn't from when I was 20 to 26. And I was fine. I think, you know, I used to run marathons, I was super fit. And there was a time that I didn't think I needed medication. But then having more episodes, I realized that it does benefit me. So I never really tell a client, don't take medication. But I'm not as I guess pushy into that they may need I needed something to happen for me to sort of learn my lesson and realize, you know, it's it's easier, my life is a little easier with medication. And that may not be the case for everybody. So I definitely don't think they see it as me undermining them. But the recovery model and the medical model are supposed to complement each other. And I think that's the hesitation at the beginning. There's no better treatment or a they say they're supposed to complement each other and offer a level of understanding and acceptance and validation that sometimes the professionals can't offer because they haven't lived through that. So for the most part, I'm never, you know, moving them away from medication or therapy and validating their experience but perhaps they may tell me, you know, I didn't like my psychiatrist. And this is what happened. And I will be honest and say I've had psychiatrist that didn't work with me and didn't work for me. And I had to find a different one. Or I had to advocate for myself and say, you know, this side effect is, is not working for me, you know, maybe this is working, like, the symptoms are, you know, improving. But, you know, it's, it's making me sleepy, and then I can't get to work on time, things that are important that sometimes I think clients are afraid to say, because, you know, like, the main symptom that they're after is maybe under control. But other aspects of your life have completely lost balance now.   Katie Vernoy  15:42 Yeah, I think for me, and I was that person at one point. So   Kemisha Fields  15:46 You were!   Katie Vernoy  15:48 But I think the thing that felt very powerful when I entered into that program, and saw how it was set up was that the team had set up this structure to make sure that each member at the table was heard that each person was allowed to share ideas. I had been in other programs where folks were subjected to that hierarchy, where the therapist or the psychiatrist got the most air time, they're the ones that were making the decisions. And to me, I think, whether it was making sure that the parent partners were supervised by the director, and or really having a culture of, we are all here supporting the family. And we all equally bring important things to the table, I think it was really effective. I think we just get worried because I did see even with programs that were and maybe it was because it was intense now that I'm thinking about it, because like less intense programs, sometimes folks were using either parent partners or bachelor level providers to do like, copying and filing. And it's like, no, no, these are mental health providers, these are people who are at the table. And so to me, I think when when people are able to integrate into the team, it can be really good.   Kemisha Fields  17:05 My personality type wouldn't have allow for that, if I'm honest. Like no. And I think when you come in and you kind of demand a level of respect, you get that level of respect. So I've never had a problem, I think, in my whole career of value, my experience as a parent partner, it laid the foundation for so much of the work that I do now. So I'm still connected to a lot of those colleagues, who at the time were clinicians and I, at that time, I wasn't even I had not completed my undergrad studies yet. And we're like the best of friends. So my experience as a parent partner is one that is really great. And had you know, a lot of good things have come out of that for me,   Curt Widhalm  17:59 I want to change the conversation here a little bit to talking about how people can become peer specialists and what the certification process is like. And I understand that that's quite different in many different parts of the country.   Amparo Ostojic  18:15 Yeah, and even within California, each county has different guidelines. So first of all, California just passed SB 803, which is going to allow pure support specialists to have a certification, which will hopefully increase the use of peer specialists in mental health clinics. So 48 states now have peer certification, including California. And the, the principles are pretty much the same. But how a peer support is used in different parts of a state or country is going to vary. So it's difficult if someone moves to another state or another county, and they try to use the same principles. It may not work as effectively. And it's basically it's not standardized right now. So it's hard for someone working in that field to have many options of going to different places, and even like a client that's moving from another county and experiencing pure services in a different way.   Katie Vernoy  19:26 So if someone were to want to jump into this, where it sounds like it's starting to become more regulated, there's certification in 48 states, that's great. What does it look like? How does someone become a peer support specialist?   Amparo Ostojic  19:39 There's a few organizations that are considered certified to train for peer support. And, for example, the training that I took was an 11 day course, where, you know, like 40 hours a week, and you learn the principles of peer support. And then To become a certified peer specialist, you need 3000 hours of supervised work or volunteer experience providing direct peer support. And you need a letter of recommendation from a professional and from supervisor that has overseen your peer support. And then there's an exam that you would take and pass. And that's how you would become national certified peer specialist. And on top of that, like I said, California is still in the process of creating their peer support guidelines. So in addition to that, you know, whatever guidelines that they'll come up with will be the California guidelines for certification in California,   Curt Widhalm  20:45 a lot of research gives you more credit than being a middleman, that when we look at outcomes for treatments, when we look at treatment, we see that peer counselors, we see that parent partners are more effective towards client outcomes than even just working directly with licensed professionals. And a lot of it is due to a lot of the problems that therapists just kind of face and being approachable themselves for the mental health system themselves that there is a down to earth Ness that having that lived experience really does embody that, yes, you can get through this. And I've got some experience to be able to say that not only do I actually demonstrate that I know what you're going through, but that you can get through it, there's a way through this, that there is a light at the end of the tunnel. How do you think that peer partners, peer counselors can be trained should be trained to best exemplify that part of treatment,   Kemisha Fields  21:51 I would say they should be trained the same way that any other team members trained in I know, from a clinical perspective, there's a different type of training that comes into play. But for our child and family team specialists that you know, we have trainings, usually agencies are sending you out to different trainings, and I I believe that parent partners should be a part of those trainings, if they are not already a part of those trainings. And that should and will help them in their role as a parent partner with the life experience on top of that,   Katie Vernoy  22:32 how can therapists psychiatrists, other people in mental health clinics, support peer specialists?   Amparo Ostojic  22:38 one of the most important parts is understanding and learning to see how we can be used. I think, once you collaborate with a peer specialist, and notice the different perspective that they offer, I think both psychiatrists and peers, and mental health professionals, other mental health professionals can learn from each other. And I really appreciated that with one of the psychiatrist that he like, I could see that he really learned from me, and that gave me a lot of confidence. And I learned a lot from him. And it didn't feel like a top down relationship. And it really felt like he valued my perspective as a professional. And that helped a lot because basically just have faith in in something even if you don't understand how it works. You want to try and see how you can work with this person and encourage them to do actual peer support. If at first you don't know what to do as far as how to work with them. There's really good guides. There's one that I really recommend, that is put out by Castro. And they are basically recovery organization. And they have it's called the meaningful roles for providers in an integrative healthcare. And they really break down the different positions that peer specialists could do the different roles so like a peer navigator peer advocate, wellbeing coach is sometimes what they call it. And it really spells out things that a peer specialists can do. And it helps both the pure and the professional because they will say, you know, they could serve as a bridge between the community based organization, they could help clients in enrolling with health insurance programs, they it really spells out things that a client can do with a pure specialist, and that helps both the pier and the clinic.   Katie Vernoy  24:53 How about letting us know a little bit about if someone's interested in this I think from many different angles I wanting to advocate for better utilization of peer support specialists within mental health programs advocating for swift implementation of SB 803. For California, you know, or even this advocacy for individuals who are navigating mental health concerns themselves or with their family members, and how they can advocate like, it seems like there's a lot of lot of potential calls to action for our listeners here. What resources would you recommend that they look into, and we'll put all of those in our show notes.   Amparo Ostojic  25:33 So definitely the I would guess, I guess, I would say, one of my favorite organizations that I worked with for the past two and a half years is Cal voices. And they have different programs, the advocacy space, is access. So access stands for advancing client and community empowerment through sustainable solutions. So they're kind of a systems change perspective. And they have really great e learning toolkits that give you tools on how you would advocate for yourself and for systems change within your community. One of the great resources that Cal voices has is their Ys program, which stands for workforce integration, support and education. And they have what they call the YZ University. And it's created by peers, it's taught by peers. And this is where I got my training for becoming a peer support specialist. And they basically provide a lot of support in what a peer does. And like they have wise Wednesdays, where they provide information about something related to peer support and learning about how to, you know, either be a peer specialist or work with a peer specialist. And that's everyone's they. And so, it's a great program, because like I said, it's peers that are teaching and creating the curriculum. And I think that's just wonderful because receiving that information for someone with the lived experience is very powerful.   Curt Widhalm  27:21 Switching gears here and talking about the implementation of peer support specialists, here's our interview with Jeff Kashou. We are joined by Jeff Kashou, a licensed Marriage and Family Therapist. He's a former Service chief who oversaw collaborative behavioral health program in Orange County, and had opportunities to oversee the implementations of peer counselors into some of the programs.   Jeff Kashou  27:51 Yeah, well, first off, thank you for having me on. And I'm very much appreciated that you guys have this podcast and give the opportunity for topics like this to be covered.   Katie Vernoy  27:59 The thing that I find very interesting about these roles that I know you and I both have hired these roles, but people have to claim lived experience in order to get these roles. And so it's it's a very interesting line to walk. There's there's very interesting things there. But what do you see as the difficulties that are associated with hiring peer counselors?   Jeff Kashou  28:20 Yeah, so I think, very specifically, what makes the role unique and special also makes it kind of a unique challenge in the interviewing process? How do you ask about one's lived experience as a direct, you know, in theory qualification to have that job is what makes it a unique role to a to an organization or an agency. So I would, you know, really encourage anybody who is looking to start a peer program to bring on a consultant who can really help you think the process all the way through and how to have those conversations without inadvertently walking into equal opportunity ramifications or accidently discriminating against someone while also being very mindful that you're bringing into the room into the interview room and process someone's vulnerabilities. And so being able to manage that very tactfully and professionally, while also ensuring that this person, you know, feels comfortable to share that as well. That's your first introduction to somebody and they're interviewing you in that, that process and they want to ensure that your program has really thought through how they're going to be not just added to their system of care, but how your entire system of care embraces and is made better by having peers on board. Oftentimes peers are looked at as very client facing but really in the best situations for them are those for the entire service model is made better by their presence.   Curt Widhalm  29:48 A lot of the talk that we've had on this show about how programs barely take care of their mental health professionals within the work systems. Is there any management that is actually being put towards looking after peer counselors in this way without infantilizing them. I mean, if we're not doing this with the brunt of the behavioral health health workforce, are there other implementation problems when it comes to ensuring this kind of stuff or incorporating them into treatment teams,   Jeff Kashou  30:19 when I created a practice guidelines of like best practices for the entire Orange County systems, and not just County, but the entire behavioral health system for how to conduct supervision with peers, I leaned very heavily on a toolkit that I found from the city of Philadelphia, that there Department of Behavioral Health and intellectual disability services put together on how to create a peer support system, from the first moment you decide you want to all the way through to supervising them to managing disciplinary things to supporting their growth. And looking at it even from you know, how is the entire system set up to support them, even the interactions that they have within the multidisciplinary team, you know, they face an additional layer of potentially of scrutiny or challenges by constantly having to explain who they are, why they have any authority to work with patients or clients. So there's, there's added stress to the question or the systems in place to actually take care of them. You know, I would really look at that toolkit that the city of Philadelphia put together as sort of a way to evaluate if your system is there, I'd say, it's certainly lacking just to be completely blunt, the county that I worked for, from the children's behavioral health side was not equipped at the time to take them on effectively. And it required a lot of having to build the plane while you fly it, which I think for some roles, it's okay. I think for peers, it can add additional stress. And it means, you know, workplace ambiguity is stressful enough. But when it comes to all the other challenges of integrating them and supporting them and explaining their role, and giving them the right training, and so on, and so on. There's just another level that needs to be thought all the way through.   Curt Widhalm  32:11 How are pure counselors implemented into treatment teams, and how are their voices in actual practice, kind of placed into the role where there's a bunch of other potential licensed professionals across a wide variety of interdisciplinary systems?   Jeff Kashou  32:30 Yeah, so I can speak to my experience, and then also kind of broadly to and the research that I've done on the topic. So it's often implemented as a top down approach, it's, you know, people in leadership, saying, we're gonna add this program to our larger organization, without ever really embracing maybe the full scope of what it means to engage in a recovery service model, which is really antithetical to the principles of the peer program, you know, which is meeting people where they're at. So a system of care, really understanding from the bottom up what's happening on the ground level, that's really where the entire program began with. But the ways that they're being implemented, we have that additive approach that systems of care will take. And from a very top down perspective, oftentimes, systems need a way to recoup revenue by bringing on this workforce and, you know, supporting the work that they do. And so when it comes to Medicaid, for example, it's involving them in the billing system. So it requires choosing a diagnosis for the person from the list that the other providers have diagnosed the individual with, which is sometimes very new and a bit challenging. I think, sometimes for peers who don't want to necessarily see someone as a diagnosis. But you know, our current system of billing practices and documentation practices requires that also, multidisciplinary teams really don't know about peers, and can have a lot of prejudice as they go in. So systems need to really be thoughtful and do a self assessment before they decide to bring on this very important role, you know, on are this system set up? Or what are the prejudices or preconceived notions that other providers on the team have of people that come in with lived experience? Right, you know, oftentimes, we have that sort of gallows humor as providers when we talk about our patients or whatever. But, you know, now you have to be very mindful of that, not just because you don't want to upset somebody, but due to having that internal shift of like, you know, I actually really maybe need to check myself when it comes to that, and why I engaged in something like that in the first place. So really thinking about decreasing the stigma and helping the rest of the team even before peers come on, understand what it is that they do, the value that they add, and how they're going to be just as important of a member of a treatment team. So really leading with the why through this process. They're often brought a board you know without much structure I Which, you know, leads to them being assigned a lot of admin tasks as well. One of the things that I learned a lot when working with pure forums was that peers are often assigned, you know, a lot of filing tasks or, you know, paperwork kind of tasks, because the program wasn't really trained or made to be aware of what appear is going to do. And so managers will get, you know, assigned X amount of peers and hire them on but not really know what to do or may not have the bandwidth to train them and think through that whole job requirement. Similarly, what I experienced was, sadly, even partway through the interview process, we found out that we were actually interviewing for peers, but the program was set up, they had to find a job title or job classification that they could fit these folks within, so that we can hire them in a timely manner. And so when we were hiring mental health workers were actually supposed to be hiring peers. And so we found out midway, that we were hiring peers, which meant as managers, then we had to shift and reevaluate what we were doing which we put a lot of emphasis and fervor and figuring out and making it a smooth process as much as we could. But it was by no means ideal. And the cohort that we hired, certainly struggled with a lot of the ambiguity and sometimes just having to sit around and wait while we figured things out for them.   Katie Vernoy  36:16 You've mentioned a couple of times the the money element of it, that oftentimes these are folks who are hired to do an important service that isn't always reimbursable. And it makes me think about the value. And this speaks to the prejudice as well. But it makes me think of the value that people hold for this role. You know, they're not generating revenue, typically, or not generating a lot of revenue. They're not seen as experts, although they're oftentimes more expert than the folks in the room that are doing the treatment planning. And so what are the ways that you have found whether it's best practices or what you were able to accomplish in your program, of integrating these folks more successfully into, you know, kind of explaining the role? Like, why is it so important? What is the value of this? Because I feel like, and maybe you've already said this, and maybe this isn't needed, but it does feel like there's a case for this role. There's an importance to this role. And I just feel like maybe we need to be more direct and saying it, I don't know.   Jeff Kashou  37:25 So yeah, so there's really two directions to think of when it comes to how do you demonstrate the value, there's two those who would be, you know, deciding to bring on this role, which would be those key stakeholders. And then you also have the provider teams as well. And then I guess, there might even be a third group, which are the patients or clientele that you would be serving. So when it comes to demonstrating the value, I think the message needs to be pretty clear all the way through, which is when you're working with, you know, with individuals with serious mental illness, or those with CO occurring disorders, some of these more serious conditions, we know we preach about prevention and early intervention. And this is the rule that really helps with that. And this is the rule that allows us to make that big shift towards a recovery model, and not just pay lip service to saying that, you know, we meet our patients where they're at, and, you know, we want to, you know, improve the quality of their lives and help them reach their full potential. Now, that's, you know, a bit more idealistic and trying to sell it maybe to those that population level into the stakeholder level, but to the provider team, it's also a matter of, you know, recognizing that they will complement the services that, say, a therapist or psychologist or psychiatrist provides as well. And so it's more of like a meshing of gears versus like, people running off into separate directions, you know, where we know that metod here, it's a very important thing. Medications is a very important aspect of treatment. And if individuals, you know, go to their psychiatrist and they prescribe them an antidepressant, we oftentimes know that adherence drops off very quickly, either because the person has some sort of side effects, or because they start to feel better, and they decide they don't want to take the medication anymore. What you know, for multitude of reasons, here, the peer can actually meet with that person, you know, right after they meet with a psychiatrist, or maybe even be in the room with them when they meet with a psychiatrist. And help them ask the questions that are there might be uncomfortable asking, or ensure that they're asking the questions they didn't think to ask, creating that plan afterwards with them for how they're going to fill the prescription, how they're going to, you know, lay out their medications for the week, how they're going to make sure they maintain their motivation to take it or communicate changes that they need with their medications. When it comes to treatment adherence, you know, we assign individuals journaling to do for example, but I don't know about you guys and how often we assign tasks to to patients to do in between sessions, it's extremely hit or miss. And then you end up spending your next session processing, why they didn't do it when you'd rather be processing what they did. And so it's not to say it's 100%. But a specialist can really help with complementing services in those ways. I think ideally, we know that there's attrition, oftentimes with this population. So here's how we keep people engaged in care. I think the other thing is we think about completing goals or completing treatment plans. But that's not really the case. Again, it's not like that broken leg where your leg gets mended, and you don't have to really do anything afterwards, you have to maintain those gains for the long term to allow you then to get to those next levels of functioning, or satisfaction or fulfillment, whatever they might be. And that's where the period specialists can help somebody in the sort of aftercare discharge planning or even long, long term support through their maintenance of their goals.   Katie Vernoy  40:56 I think another element for the treatment team, and this is something where, you know, we had the conversation with Kemisha about this, but they're also an expert on the lived experience. I mean, obviously, each person's experience is different. But there's so much that I think my treatment teams anyway, we're learning from our peers, because they just hadn't been in the situation themselves. And so I think there's, there's also incorporating in that way, like here is another member of the team who has really valuable and valid feedback that you need provider. Because I think it's I think it's hard, I think it's hard to understand this. And I think that we've hidden behind a hierarchy that clearly doesn't work, we need to have, we need to have a whole bunch of human beings working on this on a level playing field.   Jeff Kashou  41:47 Yeah, I'm really glad you brought that point up, Katie, I remember, and you guys probably had to do this in your grad programs as well, where we were assigned the task of attending a 12 step meeting to understand what the recovery community is like. And we can see what these you know, non therapeutic support systems are like, and it's a way to get that experience. But we were only assigned that at one point in time, and there is so much value that appear can add in terms of to use your your point expertise in these areas, you know, the approach, I think a lot of us take in the recovery systems, you know, I will get asked oftentimes, you know, well, are you in recovery yourself? And I think as a therapist, you make your own call in terms of self disclosure. And I would say the while I can tell you yes or no, it's more important for you to tell me what your experience is like, rather than me telling you all about what your experience is like. But I think there's a way we can sort of fast track that by having peer specialists add that level of detail to us upfront so that we're not always taxing individuals to have to educate us each and every time if that's not something that supports their care in the short term.   Katie Vernoy  42:52 Exactly.   Curt Widhalm  42:54 There seems to be a lot of mixed evidence on the effectiveness of pure counselor type programs, with the United States in particular lagging behind a lot of other countries when it comes to the implementation of this, some of which is highlighted by some of the funding stuff that you're talking about within things like Medicaid, and we even see some of this going on and private insurance type programs where this stuff can't be implemented. What do you see is the difference between a successful incorporation of pure counsellors versus the ones that kind of fizzle out,   Jeff Kashou  43:32 it's going about it with a systematic approach. And that's I'd really emphasize either, you know, utilizing one of those toolkits, like I mentioned, the city of Philadelphia created, which is extremely comprehensive, and very much focused on the existing org and not necessarily on what peers need to be doing. But I think in the absence of that, it's really identifying just like with any big change that you want to make for a business, it's identifying, you know, what, you know, doing your SWOT analysis, and then looking at what is your measure? What's your success metric going to be? And how will you know you got there and then be flexible, to iterate and improve upon things as you move forward? Again, to that authenticity point, it's just like how we work with our, you know, our clientele, it's, you know, we don't expect perfect, but, you know, let's talk about what didn't go well, and let's improve upon it, we need to be able to do that authentically, as well. I think, unfortunately, in healthcare, and especially behavioral health care systems, where we're kind of the afterthought in terms of funding and attention and resources, you know, we just have always learned to make do and stay the course. And then on top of it, you have folks in power, who don't necessarily understand what we do, and they just kind of keep adding more and more stipulations and regulations and so on. And so it's also a matter of like, can you cut through some of that maybe sometimes even through the side door, like in California, we have our mhsaa funding that peer programs are oftentimes Funded there, which is very nice, and that they don't have to be capturing revenue through Medi Cal. This is through funding that has less requirements to it. But it's also pushing back and saying, do they really need to do this level of documentation? You know, so I do think it's a matter of like, thinking things through from bottom to top, like doing that assessment and really assessing yourself like, can we take this on, and being very brutally honest with yourself as a system of care, it's an exciting program, it's an exciting idea. It's one that can bring a lot of benefit. But you have to really understand what it is that you're bringing on. There's other companies that I've worked for that have said, you know, hey, we're, you know, one day down the line, we'll have peers and that way our current clientele can engage and give back, it'll be kind of a lower level service line. I think if you're thinking about it from that perspective, only, and really seeing the dollar signs as part of that image. It's not to say that, you know, money isn't the driver here, but it can't be that upfront. Otherwise, what you're doing is you're commoditizing, a service provider who is designed really to add value simply by them being there and engaging with clientele in that way, without necessarily generating dollars by increasing retention by increasing engagement in services. We know outcomes improve, when systems can demonstrate improve outcomes. Oftentimes, they're the ones that get the next grant are the ones that get the renewed contract, sometimes even a larger contract. So it's really, you know, credenza question in a short way. It's, it's all about approaching it systematically. And not just Yeah, that sounds really exciting. Let's do this.   Katie Vernoy  46:43 I think it has to be baked in, it can't be like, let's add this on to the program. It's almost like you have to build it from the ground up, to have these truly integrated into whatever the treatment program is.   Jeff Kashou  46:56 Yeah, there's kind of three different approaches that that Philadelphia tool toolbox outlines, just like that additive approach that I discussed, there's that selective approach. And then it's really taking on the one that has the greatest level of success is what's called a transformative approach, which a lot of systems are understandably nervous to take on. But to make a program successful, you have to be willing to transform things, sometimes top to bottom to make it work.   Katie Vernoy  47:21 Yeah, it's interesting, because the the program that I had, it was, it was baked in, it was like, my agency decided to do a wraparound program. And at the time, it was called an FSP. Program. And so as, you know, maybe you move clinicians into it, but it was like, here is how you do it. And it was baked in. So it wasn't like, Oh, you're already doing services, let's add this on. Functionally, maybe it looked that way. Because we had clients who then you know, like, followed their therapist, and then got these other services added on. But the program itself was well defined by LA County. And so there was discrete roles, there was training that was required. And like, especially with wraparound, there was like, a week long training where you, everybody went, and there were people from all different roles, and you went when you just first started and all the managers had to go to, so I had to go to it as well. And we would sit there for a full week and interact with other people in our same roles or in the in the peer or the you know, the all the different specialists roles. And so to me, it was, it didn't feel as chaotic because it was like it was completely structured. And it was baked in.   Jeff Kashou  48:31 Yeah, and a wraparound program is oftentimes very much set up for that, you know, they traditionally will have either bachelor's level providers as PSCs, or personal service coordinators, which truthfully appear would be phenomenal at which it sounds like that was the role that you had at your program. And because   Katie Vernoy  48:47 No we had we had bachelor's level folks, we had peers, we had a facilitator, and we had a therapist, so there was four or five people on the team.   Jeff Kashou  48:56 That's a tremendous program. You know, and we're the approach, you know, you've probably experienced this as well, the approach of a wraparound program is like whatever it takes, you know, this is a child, an individual, a family in such a challenging situation that we have to throw everything at this person that they need, and and some to get them to the, you know, to a better place.   Katie Vernoy  49:17 Yeah, yeah. I think it just is a good way to think about it as if you actually create a program from the ground up that includes these roles. I think that is stronger. I'm really glad that we're that we did this episode that we're talking about this related to our fixing mental health care in America. I know that it was mentioned in the RAND report, but I also recognize that one of the elements of this is it has been viewed. I think we did this in one of our more recent advocacy and workforce episodes as a way that we take away work from licensed credentialed mental health professionals and I really see this as an important adjunct a positive step forward. And I think we were able to really see that in the conversations that we had with our three guests today.   Curt Widhalm  50:08 And I mentioned a couple of times in the show, both this episode and recently about how little using supporting roles, like peer support specialists is actually taught as part of therapists education.   Katie Vernoy  50:22 Yeah.   Curt Widhalm  50:23 And there's a lot of emphasis on therapists education that's on what we as individuals can do to help with clients, but don't help us to look at the overall workforce system. And I'm echoing your happiness of this episode. And being able to amplify that really good. Mental, behavioral, emotional health treatments, takes a village. And it does take people from a lot of different viewpoints to really help create healing. And especially those people who have that lived experience and have a really great way of helping to help our clients interact with the system to be able to navigate it in ways that makes sense for them. So continuing to emphasize this will be part of our ongoing role in bringing mental health advocacy to the world. And we encourage you to do so as well.   Katie Vernoy  51:24 And for folks who were really interested in this, there are a lot of links in the shownotes that will help you with some of the some of these concepts, we've got the the guides and those things both onpattro and Jeff sent stuff over that are very helpful for folks who either want to be a peer support specialist or who want to implement those programs. So definitely feel free to reach out to us if can't find it on our show notes. But those things are just the really amazing resources that we were able to put down there.   Curt Widhalm  51:55 You can find those show notes over at MCSG podcast.com. And check out our social media out give us a like or a follow and schrinner Facebook group modern therapist group to further these discussions. And until next time, I'm Kurt Wilhelm with Katie Vernoy.   Katie Vernoy  52:11 Thanks again to our sponsor, trauma therapist network.   Curt Widhalm  52:15 If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There's so many types of trauma and so many different ways to heal. That's why Laura Reagan LCSW WC created trauma therapist network. Trauma therapist network therapist profiles include the types of traumas specialized in population served therapy methods used, making it easier for potential clients to find the right therapist who can help them. Network is more than a directory though its community. All members are invited to attend community meetings to connect consults, and network with colleagues around the country.   Katie Vernoy  52:52 Join the growing community of trauma therapists and get 20% off your first month using the promo code Mt. SG 20 at Trauma therapist network.com Once again that's capital MTS G the number 20 at Trauma therapist network.com   Announcer  53:09 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.

    Is Your Practice Ready for Paid Digital Marketing?

    Play Episode Listen Later Nov 15, 2021 34:02

    Is Your Practice Ready for Paid Digital Marketing? An interview with John Sanders, owner of RevKey, about Google and Social Media Ads. Curt and Katie talk with John about the importance of a solid website, effective sales process, and metrics when considering paid digital advertising. We also explore what to expect when you create Google or Facebook Ads. We also talk about why you may want to outsource this and the financial risks for getting this marketing wrong.    It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with John Sanders, RevKey John is an expert in paid search, specifically, Google Ads (which used to be called Google AdWords). He holds a BBA and MBA, and he has put this education to work in a variety of positions in the marketing field, including inside sales, purchasing, E-Commerce, and marketing management. Once he found Google Ads, John was hooked. He enjoys helping businesses generate leads through Google Ads that will help their companies grow, and he has partnered with businesses in a range of professions, including medical offices, B2B companies, and national product brands. John can help your business achieve its full potential. In this episode we talk about: Google Ads and other digital advertising (social media for example) The mistakes folks make in purchasing digital ads, typical pitfalls Specific to Google Search Ads: why not to use smart or dynamic ads Keywords and negative keywords The importance of tracking your results and what results you're looking for The difference between social media and Google ads What a good ad looks like and what page it goes to What's needed on a website before starting Google Ads (sufficient, relevant content and pages) Service pages and the specificity of the search How social media ads work (e.g., Facebook and Instagram) Building an audience within social media to target with your ads The value of an ideal client or niche when using social media ads Social media is more of a branding exercise than Google Ads Facebook has a lot of specific rules for advertising What return on investment you should expect, the goal of placing ads How to assess what is not working Looking through the full sales cycle to determine where to improve efforts (including answering your phone) The technical savvy that is needed to run and assess these ads The usefulness of Google analytics Determining DIY versus hiring out advertising How to outsource paid digital advertising How to determine the average value of a client Advantage of paid digital advertising versus Search Engine Optimization (SEO) The potential to lose money if this is done wrong The benefit if it is set up properly Setting up a multitier marketing plan including Google Ads and SEO Our Generous Sponsor: Trauma Therapist Network Trauma is highly prevalent in mental health client populations and people are looking for therapists with specialized training and experience in trauma, but they often don't know where to start. If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There are so many types of trauma and so many different ways to heal. That's why Laura Reagan, LCSW-C created Trauma Therapist Network.  Trauma Therapist Network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work and what they specialize in, so potential clients can find them. Trauma Therapist Network therapist profiles include the types of trauma specialized in, populations served and therapy methods used, making it easier for potential clients to find the right therapist who can help them.  The Network is more than a directory, though. It's a community. All members are invited to attend community meetings to connect, consult and network with colleagues around the country. Join our growing community of trauma therapists and get 20% off your first month using the promo code:  MTSG20 at www.traumatherapistnetwork.com.   Resources mentioned: 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! RevKey.com   Relevant Episodes: Bad Marketing Decisions The Brand Called You Creating Relevant Ads Hostage Marketing SEO Guide for Therapists Marketing with Empathy Clinical Marketing Branding for Your Ideal Client Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated)   Curt Widhalm  00:00 This episode is sponsored by Trauma Therapist Network.   Katie Vernoy  00:04 Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit trauma therapist network.com To learn more, listen at the end of the episode for more about the trauma therapist network.   Announcer  00:31 You're listening to the Modern Therapist's Survival Guide, where therapists live, breed and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.   Katie Vernoy  00:47 Welcome back modern therapists This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast about all things that therapists face. Sometimes their business stuff, and today's episode is diving into the world of online digital advertising. Any of us who are working through the pandemic have our small businesses, needing to find ways to potentially reach new clients that we haven't had to in the past. I know for people like me, I've built my practice largely on in person networking and some of those relationships. But it's as I get asked by some of the listeners of like, I'm ready to start a practice now. How do I develop a practice like yours? And I say, I don't know, because we're not allowed to beat people during the pandemic. I don't know, maybe like find some Google ads or some Facebook ads. They're like, Well, what works for you. And I'm like, talk to our guest today. John Sanders from RevKey, this is something that he's going to be able to speak on way better than I am. John, thank you for joining us today.   John Sanders  01:54 Thanks for having me.   Katie Vernoy  01:56 We're excited to have you here I was so I don't know what the right word pleased. I'll just say pleased, I was so pleased when you reached out to connect related to the conference, actually, and I'm so excited that you're one of our conference sponsors. Thank you so much for your support. But just in talking with you and about RevKey and what your mission is, I am really excited to have you to talk with our audience about this area that I think a lot of folks just don't know anything about and can be a real great way for people to market their practices. So we'll dive right in with the question we ask all of our guests, which is who are you and what are you putting out to the world.   John Sanders  02:34 So I'm John Sanders. I'm the owner of RevKey. And I focus on Google ads for mental health professionals, probably 90% of my revenue is generated by therapists and counselors who are looking to increase the size their practice, and get new clients either for themselves or for therapists who are working for them. I started doing this I, I kind of got into this a little bit of a natural way, my wife opened her testing psychology practice. And so I started running Google ads for her while I was also running Google ads during the day doing a day job at a marketing agency. And over time, helping her started helping a couple of her friends. And then 2018, it just became my entire job. And I quit my marketing agency job. And I opened rev key and I haven't looked back since.   Katie Vernoy  03:28 Nice, I like it. There's a lot of mistakes to be made in buying digital ads, rather than going networking to a small community where people might be able to get to your physical office or that kind of stuff. Now you're potentially advertising to the whole world. What kind of mistakes do you see people making when they're first moving into some of these online ads that if we can save them a few dollars here and there to be able to be more effective with them? What kind of mistakes do you see that people could avoid?   John Sanders  04:02 Sure. So with Google ads, some of the most common mistakes are setting up what's called a smart advertising campaign where Google really does most of the work for you. But it really doesn't have a lot of options in terms of customizing different ads, and trying to avoid clicks that you don't necessarily want. So if you're going to use Google ads, and when we're talking about Google ads, we're talking very specifically about Google search ads. And those are the advertisements that appear on Google after somebody searches something, make sure you're using the full version of Google ads and not not a smart ad. I'm not a big fan of their dynamic ads that just scan your website, you can end up with all sorts of weird traffic based off of that. We want to be able to go and specifically say these are the keywords that we want to target and then we want to be able to look at the search terms what people are actually searching to come to your website, a couple of other things that that I commonly see when people come to me who are running their own Google ads is not having any what are called negative keywords. And those are words that you put into Google and say, if this word appears in the search, do not show my ad. And probably the most common one that I see is massage. So I'll see a bunch of people will say therapy near me, and they'll get a bunch of searches for massage therapy near me, which is what we absolutely don't want. And then probably the final thing is not really having a good way of tracking your results, not really knowing how many people are calling you, because your ads not knowing how many people are filling out forms. And so you don't really know if Google ads is working for you if you don't do those things. So all of a sudden, Google ads just becomes you know, a charge on your credit card every month that you're just not sure if you're getting anything out of it. So that measurement piece is super important.   Katie Vernoy  06:00 So there's different types of ads that I know that you work on. I know you do Google ads, but you also do social media ads. And to me, it seems like most of these platforms are cost per click or cost for per view, or the more people are responding to clicking into seeing your ad, the more you're going to pay. And so it seems like there's some nuance there that would be important for people to understand what they should use, which one is better for their practice that kind of stuff. So talk to us a little bit about. And maybe this is way too big of a question. But as far as like, what does a good Google Ad look like? Why should someone think about Google ads? And then also looking at the the social media ads, and when that is potentially the right choice, the better choice a good addition? You know, it's kind of like, what are we talking about here, when we're saying digital marketing, online, paid ads?   John Sanders  06:54 Well, let's start with social media ads. In this case, they are a very different animal from Google search ads in that if somebody searches you on Google, they are at least somewhat through their buying journey already to use a little marketing speak, they have already decided that they need a therapist, and so they type in something like therapist near me or counseling near me. And then you know, we want to show them an ad that really deals with what they're looking at. So for example, if somebody types in anxiety treatment near me, or anxiety treatment in their city, I want to show them an ad that talks very specifically about anxiety, I don't want a generalist ad, I don't want something that includes something about couples counseling, or anything that's not related to anxiety, I want then them to click onto my ad. And I want to take them to a page on a website that talks very specifically about anxiety treatment, I don't want to take them to a page that is a bullet point of services, or a homepage that has a whole bunch of other things that they're not looking for, I want to take them to a page specifically about anxiety. And ultimately, the goal is for them to either call you fill out a form or go to, you know, some sort of scheduling link. And that's really the process when you advertise on Google that you should think about as every time you're putting in a keyword thinking, What page is this going to? And how is this going to be successful. And that's really kind of how you should write your ads. And also be thinking about your website. You know, one of the things that we had talked about previously is that before you start Google ads, really getting a good website going is very key and having what we would call service pages, where you have a page very specifically for all of the specialties that that you do, instead of having that page of just bullet points, because that's not going to engage customers. Also, Google's constantly judging our ads. And they're not going to really see that as a high quality landing page. And so your ads are going to get judged by Google for that. So it's really good to have those pages in place before you start advertising both from a Google standpoint, and also from a potential user standpoint as well.   Katie Vernoy  09:12 Yeach you don't want to pay for something and send them to a website that then talks them out of working with you.   John Sanders  09:18 Right, or just doesn't have any information. And yeah, and I know that it's really easy to fall into that trap is, you know, if you're just starting out, you go on WordPress, and you put together your first website, to not include enough content out there. But really the it's it is very key to make sure that you have that content before you start trying to advertise,   Katie Vernoy  09:41 you know, you talked about kind of being a certain way through the the buying process or the or whatever when they're searching on Google for a therapist, but when we're looking at Facebook ads or Instagram ads or any of the social ads, like how do those work and what are those best use for   John Sanders  09:59 So Facebook and Instagram ads are both run out of the same platform. And the way that you target customers is by creating what's called an audience. And this is a combination of behaviors and demographics and interest that people have. So you can say, show my ads to people who have job titles similar to therapist or something along those lines. And you can put in several different ones. You can also do it based off of behavior have they come to your website before that is what's called remarketing, although that's going to get a little more difficult in the next year as kind of that cookie based remarketing that a lot of people have heard about is going to start to go away. So you can target people based off of their age based off of their location based off of particular interest they might have. And so it's really good to use social media ads, when you have a very specific idea of who your audience is, in terms of those demographics. If you're more of a general therapy practice, you're you're going on a little bit of a fishing expedition, because you're going to write kind of a general ad towards a general audience. And that's not necessarily a bad thing. But we can't measure it in a lot of the same ways as a Google search ad where they're already so far through the buying process, you could end up showing ads to people who don't think they need a therapist, or I've never even thought about getting a therapist. And so then it's much more of a multistage situation where you're trying to get them to come to your website, and then maybe you serve them some remarketing ads, or you send them an email or something along those lines. And so I really kind of warn people that when you're doing social media ads to not necessarily hold them to a the same standard as Google, but also to think about a little more as an exercise in branding than what I would call direct conversion.   Katie Vernoy  11:57 You're saying that direct conversion be more likely if they have a product or a book or or some sort of like an event like something that's very specific, that's going to be a better social media ad than, hey, do you happen to be ready for therapy right in this moment, and I've targeted you appropriately.   John Sanders  12:17 Right, exactly. And also, with social media ads, you have to be very careful about the wording you use. For instance, you know, if you try to use the word, you in a Facebook ad, your ad could get disapproved, because you're trying to talk directly to the customer, which Facebook does not like, and Facebook has a number of rules around, you know, the wording and usage it within within your ads, and probably more rules than Google has on that front.   Katie Vernoy  12:48 What makes a successful campaign, you're talking about getting better results here. How do you interpret whether or not what you're doing is successful?   John Sanders  12:55 You know, when we talk about it within Google ads, if we are getting 100 clicks for a customer, I want to see how many of those actually turned into phone calls, leads scheduled clicks. And look at that in terms of our percentage, generally, I want that percentage to be at least 5%. So if 100 people click on your ads, I want at least five of them to do something. And then we also have to look at how much you're spending for each of those leads. And then ultimately, the most important thing is, are those leads turning into customers and revenue for you. If you get into a situation where you're spending $500 a month on Google ads, you want to make sure that you are getting a good return for for that $500 ad spend. And that's where kind of tracking get with you know, your assistant to make sure that those people that are clicking on your ads are actually turning into clients is super important.   Katie Vernoy  13:54 When you're finding that people are not hitting like that 5% What do you see as often kind of contributing to that? Or what kinds of steps do you look at to evaluate where things aren't converting?   John Sanders  14:06 Sure. I think it depends on the, you know, where people are kind of dropping off in the process. You know, for instance, if you know, somebody comes to me, and shows me their Google Ads account, and they're saying, I'm not really getting anything off of this. And I find that you know, less than 1% of people are actually clicking on their ads, that's usually an indication that you have an ad problem, or your ads are being served on search terms that we don't want to go back to the massage therapy example. If you're advertising anxiety therapy and somebody types in massage therapy near me, your ads never kind of get clicked on. So that's that's one of the first things to to look at. If people are then you know if people are actually clicking on your ads that are relatively recent, right, which I would define as about at least two to 3% of the time. I know they're getting to your website. Are they spending enough time on your website? If you find find that your average time on your website is from people from your ads is 30 seconds, they're not spending very long on your website, and they're not seeing a particular bit of content that that they are looking for, kind of the measure that I have for that is I want to make sure people are spending at least 60 seconds on your website. And to go back to the previous example of the service page that just has bullet points. If you're running ads to that, typically people are going to look at that and go, and then they're going to click off under 30 seconds, and you're not going to end up converting that client.   Katie Vernoy  15:37 There's a lot of stuff you're talking about that sounds pretty technical, which is, you know, kind of monitoring the click rate monitoring, you know, and kind of what percentage are people clicking and what percentage of people are actually getting to the website, and how long they're spending on the website? That seems like a lot to first figure out how you can actually get that information. And then also a lot to try to sort through like for DIY errs Is it obvious if you're able to get a little bit technically savvy, how to get that data, so you can even look at it.   John Sanders  16:14 Google Ads has a lot of different menus in it. And so that can, especially if you don't know what you're looking for, can be a little difficult. In a lot of cases, you're having to pull information from another program called Google Analytics, which even if you're not running Google ads, you should definitely have Google Analytics installed on your website. So you can see how many clicks overall, you're getting, how long people are spending on your website, getting information about about those individual pages,   Katie Vernoy  16:42 it seems like people need to have at least some some knowledge and have installed at least Google Analytics to be able to see some of this data.   John Sanders  16:51 Right. And that's one of the first things that as a common mistake that when people will come to me and they're they've maybe they've been running their own Google ads, that they haven't installed Google Analytics, or they haven't put on those negative keywords that we've talked about. Or you don't really have any of that measurement, which is not necessarily obvious in Google ads. And in a lot of cases, you have to involve things like Google Analytics, or even third party programs, if you're looking to track some calls,   Katie Vernoy  17:18 as far as some of the time investment to figure this kind of stuff out. And I'm guessing the monetary mistakes to try some of these things out, see what's effective or not, is this worth a clinicians time to invest this kind of stuff? Or is this kind of one of those things where the best advice is, have people who are good at this pay for their services and let them do their thing, we don't want them treating suicidal clients, we want them to refer to us therapists is this honestly, just something where it's a better use of clinicians time to hire out these kinds of services,   John Sanders  17:58 I would say for the most part, this is something you want to hire out. Much like I hire out graphics design or accounting, I don't like to do accounting. That's why I have an accountant. And I could spend my time and try to figure all of this out. But I probably wouldn't end up doing that good of a job on it. As somebody who professionally does it day in and day out. That's not to say you can't I've had some very technically minded therapist, especially a couple of them that, you know, maybe used to work in it. And this is their their second job, those guys have been able to understand it fairly well. But for the most part, I would say most of the people who try this themselves, they fall into some of these traps that we've talked about. And they potentially end up wasting a lot of money on Google, that doesn't really lead to any clients.   Katie Vernoy  18:47 Yeah, I think to me, the financial downside of doing this wrong can be pretty high, especially if you set it and forget it. And to me, I feel like this is something that I cannot emphasize enough that if you can get it right. I mean, this is a way to have marketing just happening in the background all the time. And this is kind of what therapists desire, like I don't have to do anything and I get clients. And so it's interesting because I think a lot of people are worried to invest. How would somebody identify a good return on investment for outsourcing Google ads, outsourcing potentially other paid online marketing? And and kind of what that would look like? Like, let's just say a solo practitioner who's wanting to start or grow their caseload like, what should they expect as far as being able to get something like this set up? And then what would that return look like?   John Sanders  19:46 I think to answer that question, you have to start with, what the average value of your client is, what you're charging, how many sessions you're keeping them. And if you can, look at that. data you can figure out, well, I charge, let's say, $100 an hour, people tend to stay with me 20 to 30 sessions. So we have each customer being approximately worth two to $3,000. And then you have to think about how much would you be willing to pay for one of those customers. And so, you know, we go back to what we talked about earlier, where let's say you're spending $500 on Google a month, if you can get one client out of that, who's two to $3,000. In revenue, that's a pretty good when and if you get any more than that, it's enormous. If you can be getting four to $6,000, of revenue off of $500, in advertising spent. And you also do have to kind of keep in mind, especially if you're, if you're doing therapy, you have to kind of think about that long term return on investment of what that client is worth, you know, over their lifetime to you, as opposed to on a month to month basis. I think that that's a mistake that that some people make, they'll say, Well, you know, in month X, I'm only gonna make x on this. But you have to not necessarily think about month one, you have to be thinking about months 2345 and six,   Katie Vernoy  21:11 how long does it take to reasonably expect a return on is that it I hear clinicians who are like, Oh, I'm hitting a slowdown portion of my schedule, you know, summertime slowdown or something like that, now's the time that I should be investing in Google ads, are they going to see the kind of quick turnaround to fill up their practice with this kind of an investment? Or is this something that needs to be planned out even more ahead of time on something like this,   John Sanders  21:37 the advantage that Google ads and digital advertising in general has over I would say search engine optimization is that it is something that you can do, and get on the first page. Like if you're a solo practitioner, who's just gotten started, if you try to organically grow on Google, that can take six months to a year, for you to really start getting some clicks off of that the advantage Google Ads has is you go tell Google can show these ads for these particular keywords. And you can get on to that first page, really, really quickly. And really kind of that first 30 days for me is is the period of where I'm figuring out in a specific market, you know how much I'm going to pay for each of those clicks. And that's gonna vary greatly, depending on the market, and what you are trying to advertise. If you're trying to do couples therapy in New York, be prepared to pay eight to $10 per click. If you're trying to do general therapy out in a suburb, you might, you know, only pay three to $5 that click. And that is very much based off of who else is there who is trying to advertise? To get an idea of that what you need to be bidding on those keywords? And then also looking at those results. Are you are you seeing the results? Are people staying on your pages long enough? Are they calling YOU ARE THEY filling out your forms, and that's where you start to to make adjustments, and then over time, you will figure out, you know, I need to change the content on this page, or I need to not advertise in a specific neighborhood that maybe is too far from your practice. And that's kind of the optimization process. And then also looking at, and I would say that this is probably the most important thing for the DIY audience out there is to look at the search terms that are causing your ads to appear. And if most of them are good, you're probably going to do really well. But if you see a bunch of nonsensical therapies, and I see all sorts of different types of therapies that come up that we want to add to the negative keyword list, if you're spending a lot of money on things that aren't relevant to your business, it's going to be very hard for you to succeed with Google ads.   Katie Vernoy  23:53 One of the things that I'm hearing and correct me if I'm wrong is that there's the initial optimization process of making sure that your ad was reading properly, has the right keywords, has good negative keywords. And then it's driving traffic to a page that actually closes the business, so to speak, and gets people to sign up for consults or call the practice or whatever, and to become clients. So there's, there's a part that truly needs to be the therapist or the therapist with a marketing specialist on making sure the webpage that you're driving traffic to is going to convert and going to be targeting the right people. And then also potentially really looking at what is your intake process look like? What is your call look like? You know, do you have? Like, can you get all the way through the sales cycle, so to speak, but once you get that set up, once you have an optimized ad, you have your page is on fire. You you close the call, and you're getting clients, it almost feels like it could be a spigot that your turn off and on with Google ads, because you'll you know, I assume that there's going to be a job So with algorithms and that kind of stuff, so there's still a little bit of tweaking after that. But to me, it seems like once it's set up, then that process of the summer slowdown that Kurt's talking about would be like, Okay, well, we just need to in about two weeks before we want to get some more clients, we just turn on the Google ads. Am I Am I oversimplifying that too much.   John Sanders  25:19 I think it depends on the practice. I think if you're a solo practitioner, I think that that can definitely be the case, I have larger clients who, if they've got 10 therapists, and all of them get full, they go out and hire two more. And then so those Google Ads kind of continue on going. Or for more of your midsize practice that, you know, is four or five people and they hire a new therapist who is specialized in couples, then it's okay. For these couple of months, let's go ahead and run ads for couples and marriage and relationships and really focus on those pieces. So I think that that really depends on the size of the practice. But I think that you are right, in that for smaller practices, you can do that it's probably the number one reason I lose customers is because they get fault, which is a it's a high class problem to have. But it's still a problem.   Katie Vernoy  26:12 So you need more clients   John Sanders  26:14 Well and one of the things I'm also working on right now is is doing a search engine optimization product, because that is the sort of long term planning, and is also another complicated subject of being able to help build practices over the over the long term, like I said, that can take six to nine months for Google to really start recognizing your website with when they crawl it and saying that this is a high quality website and should appear higher up in the search results.   Katie Vernoy  26:42 I think that ends up being a good plan where you start with Google ads, and in the background, you're building the SEO. So it seems like it's a natural partnership, for sure.   John Sanders  26:50 Right   Katie Vernoy  26:51 What kind of tips do you have, you know, spending the last moments here of the podcast here of how those two things fit together? I mean, you're talking about outsourcing this, but for clinicians who are trying to picture okay, I've got the ads, what needs to go on to the website in order to keep people there who are engaged, do I just like, put a video that takes 45 seconds to load so that way, they're going to stay for a minute,   John Sanders  27:18 Google won't like that at all.   Katie Vernoy  27:21 And if the video doesn't load, I'm off that page in 10 seconds.   John Sanders  27:25 Absolutely. Google. And Google knows that. I mean, one of the things that when Google's judging a landing pages, not only is it judging, you know, the content, but it also like if you have images or videos that roll out really slow, Google is not going to show your ads as high up in terms of you know, some of the other things a writer I regularly work with, you know, recommends that you have, you know, four to 500 words on that page. Not only does that give Google enough keywords to grab a hold of and say okay, that this is high quality for an anxiety search. But also, it allows people who are actually looking at it to go yes, this is this is what I'm feeling this is, you know, this is what's happening with me, and to kind of get them nodding their head, and then you know, hopefully, getting them to take that next step of contacting you somehow.   Katie Vernoy  28:16 I think it's something where the hard truth for folks that want to get clients quickly, because I think I've definitely had consulting clients that are like, should I do Google ads, and I was like, let's look at your website first. And I think the hard truth is, sometimes there is quite a bit of work that needs to happen before you really can take this into, into your marketing strategy. Because if you're spending money to send them to a website, that does not reflect who your ideal clients are, does not connect with your ideal clients, and does not show you in the best light. It's it's just throwing money in a hole, and it's not actually getting you results. And it can be very discouraging. And so there may be some work to do ahead of time to get prepared for the calls to get prepared for the web traffic. But once you actually have that in place, it sounds like Google Ads can be a way that you can really, pretty quickly start building a caseload and the return on investment can be very high, especially if you if you have a fee and a length of treatment, typical length of treatment that makes each client worth 1000s of dollars. And you know, even if you're only getting one client a month, you know, that still ends up being a nice return on investment. And usually I'm hearing people get more than that. Do you have a sense of like, if you've got a really good, optimized ad, like you know, and a reasonable spend, you know, how many people are typically getting, how many clients people are typically getting?   John Sanders  29:48 Well, let's you know, take that 100 Click example. And you know, we talked about 5% Earlier, let's double that. Let's say let's say you're doing really well and you get you get 10 people who contact you, then it gets down to that, that that close process that that we talked about earlier, are you are you answering your phone is a common thing that I'll end up talking to clients about who I'll notice off of my call tracking software, they're not answering their phone, and they're getting a bunch of voicemail messages. But if you can take those 10 leads, and you know, you can turn six of those into clients, you know, all of a sudden, your your return on investment, if you're spending $500, you know, you could be looking at several $1,000, and potential long term revenue. That's huge. And, um, it is very hard to find a way to do that anywhere else. You had mentioned the work that goes up front, very often, when people contact me, they'll say, Hey, I'd like to run Google ads. And you know, I really have to tell them, Okay, go work with a content writer, go work with, you know, web designer, let's let's get your website in a good place before we try to run those ads. Because otherwise, I'm going to start running ads, you're not going to get the results and you're just going to get mad at me. And that's just no fun. I, I'd much rather do all of that upfront and delay working with a client for three months. And this happens on a fairly regular basis where I'll refer people out and then they come back three months later and say, okay, my website's ready. Let's go ahead and run those ads.   Katie Vernoy  31:14 Yeah. And I would add, make sure that you have a conversation with someone if your close rate isn't what you'd like it to be if you get a lot of calls, and nobody becomes clients. There's other folks to talk to about that as well.   John Sanders  31:26 And I think Google ads, especially once you put some of those tracking metrics on there, that makes it very obvious very quickly. For instance, I have some larger practices who will go through those call logs, and they will, you know, really scrutinize those and you know, potentially say, you know, why aren't these these people closing? If you're seeing a closed rate of only 30%? You know, you have to start asking those questions about what's going on with the intake process that's causing that drop off?   Katie Vernoy  31:54 Where can people find out more about you and your services.   John Sanders  31:57 Sure, if you want to know more about me and what I'm about, go to redsky.com, that's revkey.com. And feel free to fill out that form on the website. And I will get back with you really quickly because because this is what I preach to people all day. So you've you've got to follow up on those leads. So and then, you know, typically what I do is, you know, start with a conversation where we talk about their practice and how many people they have and you know what specialties they they want to run for. And then put together a proposal and send it over to him and hopefully start working with them.   Curt Widhalm  32:35 And we'll include links to that in our show notes. You can find those at MTSG podcast.com. And until next time I'm Curt Widhalm with Katie Vernoy and John Sanders.   Katie Vernoy  32:46 Thanks again to our sponsor, trauma therapist network.   Curt Widhalm  32:49   If you've ever looked for a trauma therapist, you can know it can be hard to discern who knows what and whether or not they're the right fit for you. There's so many types of trauma and so many different ways to heal. That's why Laura Reagan LCSW WC created trauma therapist network. Trauma therapist network therapist profiles include the types of traumas specialized in population served therapy methods used, making it easier for potential clients to find the right therapist who can help them. Network is more than a directory though its community. All members are invited to attend community meetings to connect consults, and network with colleagues around the country.   Katie Vernoy  33:26 Join the growing community of trauma therapists and get 20% off your first month using the promo code MTSG20 at Trauma therapist network.com Once again that's capital MTSG the number 20 at Trauma therapist network.com   Announcer  33:43 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.  

    Conspiracy Theories in Your Office

    Play Episode Listen Later Nov 8, 2021 36:00

    Conspiracy Theories in Your Office Curt and Katie chat about clients who bring conspiracy theories into therapy. We talk about differentiating between psychosis and believing in conspiracy theories, the characteristics of folks who may be likely to subscribe to these theories, and the importance of the relationship in working with these folks. We also look at steps we would like professional organizations to take to support clinicians. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: How to handle when clients bring conspiracy theories into your office Distinguishing between delusions, shared psychosis, and conspiracy theories Reality testing, obsessive research, and other factors that may distinguish between psychosis and conspiracy theory The impact of internet research and social media algorithms The characteristics of folks who are more likely to believe in conspiracy theories How fear of uncertainty, lack of trust can play into this dynamic Societal impacts like advertising certainty The different responsibility that therapists have when someone brings in a conspiracy theory Hesitation in addressing these theories both in the room and at the professional org level The continuum of engagement with conspiracy theories (from “entertainment” to going down the rabbit hole) The level of investment in the theory, groups forming around these theories, and cults The risk factors and legal/ethical responsibilities related to harm Allen Lipscomb's BRUH modality (Bonding Recognition Understanding and Healing) The problem with direct challenging The importance of identifying is it a conspiracy theory or is someone actually out to get you, especially with clients who are in traditionally marginalized communities Building trust within the relationship through deep understanding of the client's experiences Societal measures that can help (like deplatforming leaders of the theories) Starting from compassion and curiosity; managing reactions Exploring the nuance of challenging irrational fears versus conspiracy theories Seeking common ground and identifying impacts The call to action to professional organizations for guidance and taking a stance (and the understanding of why they balk at doing so) Our Generous Sponsor: Trauma Therapist Network Trauma is highly prevalent in mental health client populations and people are looking for therapists with specialized training and experience in trauma, but they often don't know where to start. If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There are so many types of trauma and so many different ways to heal. That's why Laura Reagan, LCSW-C created Trauma Therapist Network.  Trauma Therapist Network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work and what they specialize in, so potential clients can find them. Trauma Therapist Network therapist profiles include the types of trauma specialized in, populations served and therapy methods used, making it easier for potential clients to find the right therapist who can help them.  The Network is more than a directory, though. It's a community. All members are invited to attend community meetings to connect, consult and network with colleagues around the country. Join our growing community of trauma therapists and get 20% off your first month using the promo code:  MTSG20 at www.traumatherapistnetwork.com. Resources mentioned: 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 Mind of a Conspiracy Theorist in Psych Today Mashable Article: What happens when people talk to their therapists about conspiracy theories? It's tricky   Relevant Episodes: Political Reactionism and the War on Science (interview with Dr. Tereza Capelos) White Terrorism and Therapy Mass Shooters and Mental Illness   Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated) Curt Widhalm  00:00 This episode is sponsored by trauma therapist network.   Katie Vernoy  00:04 Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit trauma therapist network.com To learn more,   Curt Widhalm  00:27 Listen at the end of the episode for more about the trauma therapist network.   Announcer  00:31 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  00:47 Welcome back modern therapists, this is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast about all things therapy related for therapists the things that we do the things that we face with clients, and literally everything else. Even the things that you don't know that are out there, we are today talking about conspiracy theories. And are we are we actually treading into a conspiracy theory podcast here, like, I'm just now realizing that, but what to do, how to handle when clients are bringing conspiracy theories into the office. Now, as we're looking at this episodes, we don't want to necessarily speak to any particular conspiracy theories that are out there. So we're just going to use a philan conspiracy theory as an example throughout this episode. So the theory that we're working with today is that the company is behind seeded grapes are all just a money laundering front because no one buys seated grapes on purpose.   Katie Vernoy  02:02 I think that's a great one. Okay.   Curt Widhalm  02:04 We're gonna work with that. So do you have clients who were talking conspiracy theories? Bringing in seeded grapes into your sessions?   Katie Vernoy  02:17 Not currently. Actually. I had some folks previously pretty recently, but I think the thing I want to distinguish first, because I think that there are conspiracy theories, and then there's also delusions, shared psychosis and and other types of psych psychotic symptoms. And so because I've had clients that have psychotic symptoms and believe that the world is out to get them, but how do we differentiate conspiracy theory believers from folks who have psychosis? Because for me, I feel like psychosis has other elements to it, that potentially lead to that diagnosis versus someone who doesn't have a mental health condition, but has beliefs that are along the lines of conspiracy theory, how do you make that distinction?   Curt Widhalm  03:08 The profession has not really defined clearly the difference between the two other than we know that they're different. So if you're asking me, there's   Katie Vernoy  03:20 I just did ask you. Yeah, and I was just doing.   Curt Widhalm  03:25 So if you're asking me, it's a focus on ideas, it's more of the approach to the ideas than it is necessarily about the ideas themselves. That when I've worked with clients who have presented with delusions or with psychosis, or something else, there's a certain level of reality testing that we go through that those clients response to, that does not show the obsessiveness into the research of whatever YouTube videos are out there or spending the amount of time going into them. They're not alienating themselves away from friends and family in the way that conspiracy theorists tend to do. And as I see with some of the clients and some of the people who who consults with me, it's more of the actions around what the beliefs are that pushes something into kind of that conspiracy theorist territory. This is evidenced by some of the clients who might be sending me several YouTube links from somebody who got their doctorates off of, you know, some website someplace who's posting 30 minute videos about seeded grape industry and several of them and talking about how their family members will stop talking to them because of their beliefs. So, to me, it's more of the qualitative actions around how they approach it as opposed to necessarily the content of what they're bringing in.   Katie Vernoy  05:10 I agree, I think there's, with the clients that I've had with psychotic symptoms, they seem to just believe and know it to be true. There isn't that research level. I agree with that. I think there's also an element of, in fact, they see proof to the contrary, and fold it in to the delusion or the hallucination that they're experiencing, and it stays in this realm, that's very different. I do think that folks with psychosis can alienate the people around them. And I think, in fact, do they, you know, I've had clients where they believe that you're part of the conspiracy against them, and, and then either decide to meet with you anyway or not, I've had, you know, different folks who argue with, you know, the voices in their head, you know, to try to not do therapy or whatever, or believe family members are part of these larger things and alienate themselves. So I think it's, it's kind of like we know it when we see it. Right. You know, whereas conspiracy theories, sometimes it's perfectly reasonable and rational folks that have kind of gone down this social media rabbit hole, where, you know, basically all of the the algorithms are, are designed to give them more and more information about the seeded grape industry that were as someone with more of a kind of a standalone psychosis or delusion, doesn't have that it's more that they are building things. And this means this, which means this, which means this and it's it's their own logic versus something that they're finding within more established means that that they believe they're doing the correct research, but they've actually gone down these these rabbit holes.   Curt Widhalm  06:53 There's Psychology Today article that is the mind of a conspiracy theorist. This was part of their November 2020. Magazine. We'll link to this in our show notes, you can find those over at MTS g podcast.com. But this article talks about particular personality traits that are more likely to lead to people believing in conspiracy theories. And those things include things like low levels of trust, increase needs for closure, feelings of powerlessness, low self esteem, paranoid thinking, and a need to feel unique. And that these are rather stable personality traits that conspiracy theorists hold across their lifetime. And guides us into probably the crux of this episode, which is, what do we do with this, when these kinds of clients come into our office, when they talk with us about the things going on the coded messages that they might be receiving or spending inordinate amounts of time on the internet with that, it does help to look at the combination of these personality traits as part of how you might want to look at guiding your response.   Katie Vernoy  08:19 And as you were talking about the types of folks I just want to touch on that first, is it when you were talking about the traits it just reminded me of the conversation that we had with Dr. Tereza Capelos on treating political reactionism. And I think that there's there may be some some ties between kind of political extremism and belief in conspiracy theories, if there's some overlap in those those things. So I just wanted to comment on that. I will link to that podcast episode in the show notes as well. But it seems like there could be a perfect storm around this.   Curt Widhalm  08:56 Sure. It makes sense when you've got a low level of trust and the need for closure. Yeah, that if you're not trusting the information that is being presented, and you have that drive for needing things to be in nice, neat little boxes, that that sets up that profile of people who are always going to want just that little bit more, not believing that everything has been quite stated yet. And that leads to the opportunity to start filling in boxes that may not actually be there or partial boxes that kind of exists and haven't. And we've really seen this play out in kind of real time over the last couple of years where people in response to the scientific methods of round the COVID 19 pandemic. Don't follow along the scientific paths. have real time science, which is, oh, we've got an idea. We've tested this, this idea doesn't work, or this idea only partially works. Yeah. And the belief that either that is not factual or that it's absolutely factual and why are they keep looking? They must not be telling us something that is widely prevalent at this point.   Katie Vernoy  10:25 Sure. And I think that there when when we look at a lack of trust, there's societal efforts towards us feeling very decided. Very sure. In what what steps we must take, I mean, the marketing does that this is the answer to your problem purchase this thing. And it's the answer to your problem. And you know, the quick fixes and all those things, the setting with uncertainty, or the setting with, you know, kind of partially conflicting messages or those types of things is not something that we are really encouraged to do by a lot of the content we consume. So it makes sense that there are going to be during times of uncertainty that we want the security of a conspiracy theory, because it feels so definite, and it feels like you know, more than someone else, and it feels like you have the true answers, and so that you're safe, even if all the people around you are not. I think for me, the the part that becomes really hard is that there are if someone brings it into a therapy session, there's this, though, there's a different responsibility that we have, as therapists, let me say it that way, like as a therapist, we have a different responsibility to our clients, then a family member or a family member can just be like, yeah, that's crazy, dude, like, stop it. Whereas with us, as a therapist, there's, there's a responsibility to take care of this client. And there's a responsibility to sustain the therapeutic relationship, there's a responsibility to do and work in service of the client. And so to me, I think the the difficulty becomes, at what point do you push hard back on a conspiracy theory that's very harmful to a client? And at what point do you enter the world of the client and, and help them to kind of process what they're experiencing? I mean, I know we're gonna go into a few different articles that talk about how therapists are managing it. But one of the things and a I think it was a Mashable article that you sent over to be heard that the first paragraph was like, APA doesn't want to actually come on record with how to address conspiracy theories,   Curt Widhalm  12:44 why not? What are they hiding?   Katie Vernoy  12:48 Because they don't want to piss off people that maybe support them, right? And potentially, they don't want to stand up against what a lot of people are saying as conservative rhetoric as conspiracy theory. And we're clearly not saying that we're talking about seeded grapes. But I think that there's that element of, there's some shying away of talking about how do we actually handle this.   Curt Widhalm  13:11 And I think a lot of our tendencies are, this is uncomfortable, we don't want to piss off people. And so therefore, we're just going to smile politely to our clients, and then just return back to whatever's already in their treatment plan. Yeah. But there probably is times to push back on this. Because going back to the Psychology Today article, they point to Timothy McVeigh, the person behind the 1995, Oklahoma City bombing, as having violent fantasies that started out in conspiracy thinking, and, well, those level of things are rare. You did bring up our episode with trees capitalist as far as Yeah, that extremism can form some of the roots in this and it might lead to lower levels of vandalism and harm people destroying seated grapes, because right within this, you probably have a responsibility as a therapist to not just brush things off is his centric sort of hobby thinking. I've seen some literature around that there's kind of three groups of people when it comes to conspiracy theory type stuff is there's those who don't believe in anything that's kind of not scientific at all. There's the people who look at conspiracy theory type stuff with no kind of an entertainment value sort of thing. And then there's the people with the other extreme end who are alienating friends and family. They're staying up late into the night They're missing work because they're not caring for themselves. And it's a continuum. And some of the people who start in some of that entertainment sort of area, start going down the rabbit hole, and potentially do slide into some of this more extreme ideology and rhetoric. And especially with things like the internet, you mentioned the algorithms earlier of ending up in echo chambers, where they're only hearing people from the same viewpoints that end up developing them even further down the rabbit hole.   Katie Vernoy  15:37 And I think when there is that investment, in a conspiracy theory, or a range a, a family of conspiracy theories, and there is a group that forms around it, I think what can happen is that the investment is so high in it being true because of whatever it provides to them. But I think there There can also be an element of others, helping each other to overcome any objections from family members. From other things. I did a little bit of reading around cults and different things like that. And I think once you get a group of conspiracy theorists, I don't know when it becomes a cult, but I think it's something where some of those mechanisms of really getting into someone's head whether it's these algorithms or people and and really creating a space that allows them to disregard everything else in their life and just continue to support this conspiracy theory. I think that becomes more obviously, a mental health issue and a primary mental health issue. I think when we're talking about when do we have to step forward, I think that that knowing how to work with colds and knowing how to help someone, you know, whether it's deprogramming or whatever you want to call it, I think that that's a that's another conversation. That's not what we're talking about today. But when someone is starting to do things that are harmful to themselves to others to property, I mean, at some at certain points, even just as a therapist, we're mandated to take action to make sure that people are not causing harm. But I think the the nuance that that I think you're looking for and I think what we want to talk about today are folks who have these low, low, low level conspiracy theories that they believe in, that could rise to the level of violence or destruction of property, and how we intervene, where we don't alienate our clients. So that they start they keep going down the rabbit hole, but we're not with them, and we can't then take some of those protective action for them and for the people around them.   Curt Widhalm  17:46 One of the biggest signs is people who believe in one conspiracy theory are susceptible to believing in more and part of this is just in social expansion that says you start diving into some ideas that people that you would be conversing with in those areas would also be bringing in other conspiracy ideas. You know, not only is it seeded grapes but now it's seeded watermelons like why did those exist still What didn't we get that figured out? Like   Katie Vernoy  18:23 yeah, I think we've started a whole new conspiracy theory around seeded seeded fruit I'm sure that we can you know if you have the the biological knowledge of why we still have these seated grapes and seeded watermelons, please send us an email at curt@therapyreimagined.com   Curt Widhalm  18:42 only if these are videos by doctors and poorly lit rooms. At least half an hour in length. But in working with these, going to this Mashable article they interviewed Dr. Alan Lipscomb, he is a social worker who has worked a lot with black men grappling with trauma and grief and noticed with many of his clients that conspiracy theories became a reoccurring theme in their sessions really related to things like race related microaggressions that even started with things like the clients talking about, like the Tuskegee experiments, where the government purposely infected black people with syphilis and seeing the effects of these kinds of treatments,   Katie Vernoy  19:43 which is not a conspiracy, which is not - it's true,   Curt Widhalm  19:46 which is true.   Katie Vernoy  19:48 Yes.   Curt Widhalm  19:49 But this helps to push some of the mistrust of the government things   Katie Vernoy  19:55 of course,   Curt Widhalm  19:56 Which not going to blame it Anybody coming from this community with stuff like this in the history of having a healthy mistrust of government? Sure. And even in the response here, I love the acronym for Dr. Lips comms approach to this. It's called the bra approach. Now, I'm cynical enough that this could also be just like, bra, honestly. But this actually is an acronym that stands for bonding, recognition, understanding and healing. And even in the way that we're introducing his work with his particular population, comes with a place of understanding, yeah, I see where these people are coming from I, I agree that some of these interpretations are going to be natural responses. And it takes building trust with these clients, to help them work through some of the mistrust issues. And that includes working on the trust in the therapeutic relationship. Some of my clients who are coming in and talking about the money laundering that goes with CDB grapes right now will continuously kind of still test me with some of the things that they're talking about, Oh, you must not believe in seeded grapes at all that, you know, I hear you, I've, I've seen some seeded grapes before, like, these are things that you're not going to get anywhere with these kinds of clients by directly challenging them with your own beliefs. Otherwise, you're going to be, you know, seen as in on the conspiracy yourself.   Katie Vernoy  21:45 Yeah. Yeah, I guess the thing that I want to point out because I think with the the example, in the Mashable article, I think, the the other element of the conspiracy theories were, you know, kind of based in the reality of the medical harm against the black community, folks were believing that there were other things happening during the COVID 19 pandemic and with vaccines. So, to me, I think, the difficulty in sorting out, is it a conspiracy theory? Or are people actually out to get you -  I think that part is really important, especially in marginalized communities. I think starting from a place of this as a conspiracy theory, can be very harmful. And so and you may not know that it's a conspiracy theory until you actually have a chance to sit with them and understand and so my thought process is, when you actually take the time to understand someone's perspective, understand the oppression that they're feeling, understand the fears that they have, and trying to sort out how is this impacting you? What evidence can you get for and against, and I think there's a there's an issue with going too much into the evidence with someone that's truly in the in thrall to a conspiracy theory, I think that there has to be a space that it may not be a conspiracy theory, it may be that they're actually being oppressed and marginalized and or people are out to get them. And so I guess I just wanted to comment on that. But I think that there's a need I agree a need for trust within the relationship so that you can truly understand the experience and understand where it's, it's going from my reality to a conspiracy theory.   Curt Widhalm  23:30 Part of what the COVID 19 pandemic has done is it's forced people away from being around people with differing viewpoints in their jobs in public. And therefore they are spending more time online with people who are sharing the same beliefs that you know that algorithm stuff that Katie was referring to earlier. Part of getting into the trusting relationship with your clients, also serves a very long term goal of helping to provide a space for them to think critically about different viewpoints and even potentially, opening up to not hearing from some of the heads of some of the theories that are being driven. We've seen this, we've seen evidence of this being successful with things like the D platforming of people like Alex Jones, that when their messages are no longer allowed on places like Twitter or Facebook or this kind of stuff. The people who have followed them, their rhetoric also becomes less extreme when it comes to some of these conspiracy theories. So keeping in mind that this is a slow and deliberate building of trust with clients means that you really have to watch your own reactions and sessions. You can't be rolling your eyes, you can't be necessarily avoiding conversations about these kinds of things. But having compassion for the starting place of where these clients are coming from, so that way, when they are ready or willing to take that next step with you, that you are seen as a trusted figure in their lives,   Katie Vernoy  25:24 how would you differentiate addressing a conspiracy theory with a client versus addressing a a fear that is gone to a slightly irrational place?   Curt Widhalm  25:38 I don't know that I would approach them much differently. That, at least as far as how I'm hearing, what you're saying, with some of the instances that have come up in my practice, is, in my general response, you know, I'll provide some curious space for Oh, I haven't heard about that, that does come from maybe a more neutral place that allows for me to be a curious thinker of Well, I wonder about, fill in the blank, you know, I wonder about, you know, seated oranges. So those things still exist. Or, you know, something that might be a curious challenge to it that does invite looking at things from from different viewpoints as team members that you would also do with clients who do present with irrational fears, irrational beliefs. Yeah. You know, Never have we ever, you know, just confronted a client in session, been, like, hey, that that irrational fear you have? How about just thinking about it differently? Like, if that was the way things worked, our grad school training would be a lot shorter, but it doesn't work that way. So it was   Katie Vernoy  26:57 it, there isn't Rational Emotive therapy? Isn't that kind of like, that's irrational? Like, isn't that isn't that actually a tried and true therapy.   Curt Widhalm  27:07 I love that Aaron Beck can just yell at clients that they're wrong and that, but it, but even even within REBT, there's the trust in this is somebody you know, you're not just yelling, that's your rational in the first session. You're not just there arguing with clients. And part of this is really understanding that you might get 45-50 minutes out of a week with a client, and they're spending eight hours a day online listening to Joe Rogan or   Katie Vernoy  27:43 the seeded grape industry.   Curt Widhalm  27:45 Yeah.   Katie Vernoy  27:47 I think the thing that I'm I'm sensing from the way that you work as well as this is the way that I work is that there is a connection with the client that then allows for some exploration of what's going on. I think this is another distinguisher, between conspiracy theory versus kind of an irrational fear within a normal kind of anxiety presentation is, is that folks who are anxious think that their anxiety is too high for what they're experiencing. And it seems like folks who with a conspiracy theory feel like they're not afraid enough that this is super dangerous. And so I think, really trying to sort through where someone sits there and being able to honor what is occurring, I think is really important. I think the that part that can get very confusing, I think, you know, and this has happened with me with some of my conspiracy focused psychosis that I've seen, but also I think, with folks who are just very intelligent people that believe things that have been put forward as conspiracy theories, I think what ends up happening is, is I try to connect with the pieces that feel like they are, I don't know what the right word is common ground maybe, and trying to understand the impact of of what they believe on how they behave on their relationships, trying to sort through it from that angle. I think it becomes challenging when there's just such an interweaving of reality and conspiracy theory where you can't just you can't yell at them. It's irrational because it's not completely irrational. There's it's so nuanced and there's so many little pieces that the conversation has to be very rich. And so it goes back to that element of it really has to come from a very strong relationship. And and we need to be able to stay in relationship and and the more we push back, the less light someone in our in our office is going to be able to hang with us if they've really invested in the conspiracy theory.   Curt Widhalm  29:55 This Mashable article has interviewed Dr. Ziv Cohen, the founder and medical director of principal psychiatry in New York City. And Dr. Cohen really calls out that the professional organizations do need to be more involved in providing some guidance in this area. And I can understand why the professional organizations are not. That's because many therapists probably also believe in some conspiracy theories.   Katie Vernoy  30:30 Okay, here we go, here's where we're gonna get all of the feedback on the episode.   Curt Widhalm  30:34 Well, and as a professional organization, we know that their first job duty is to make sure that the continuance of the professional organization exists. And if they are alienating their members, that is potentially a drop in membership, and therefore, they don't want to alienate members. So, even being able to wade into this, Dr. Cohen calls for the professional organizations to take more of a stance and guidance, you know, at least use something like, you know, seated grape industry, as an example, we don't need to necessarily go out and address things. But we do need to work on training clinicians on how to recognize when it does progress from seated grapes to harm and potentially identifying those who are most vulnerable to be acting out violently. And it is a continuum and a slippery slope. So call your professional organizations tell them your thoughts on seated grapes. Don't put any context into it, but make seated grapes happen.   Katie Vernoy  31:52 So I want to actually push back on one of the things that you said, as a profession. Is it not important for us to comment on conspiracy theories that are psychologically harmful to the populace?   Curt Widhalm  32:07 Absolutely, we should.   Katie Vernoy  32:09 Okay, so why would you then say that professional organizations shouldn't address that, but should address how therapists   Curt Widhalm  32:16 I'm saying, cuz I'm, I'm picturing the heads of these organizations and what their response is the pearl clutching that they will have in looking at their membership, and giving them an out to be able to walk the line in between what they should be saying and how they can package it nicely to actually start presenting this information.   Katie Vernoy  32:40 So you're trying to get to a place where they would actually do something versus actually commenting on what they really should be doing.   Curt Widhalm  32:47 Exactly, yes. So   Katie Vernoy  32:49 alright, that's fair. Yeah.   Curt Widhalm  32:51 Check out our show notes at MPs G podcast, join our Facebook group, the veteran therapist group, follow us on our social media and continue to drink the modern therapist Kool Aid. And until next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  33:07 Thanks again to our sponsor, trauma therapist network.   Curt Widhalm  33:11 If you've ever looked for a trauma therapist, you can know it can be hard to discern who knows what and whether or not they're the right fit for you. There's so many types of trauma and so many different ways to heal. That's why Laura Reagan LCSW WC created trauma therapist network. Trauma therapist network therapist profiles include the types of traumas specialized in population served therapy methods used, making it easier for potential clients to find the right therapist who can help them. Network is more than a directory though it's community. All members are invited to attend community meetings to connect consults, and network with colleagues around the country.   Katie Vernoy  33:47 Join the growing community of trauma therapists and get 20% off your first month using the promo code Mt. SG 20 at Trauma therapist network.com Once again that's capital MTS G the number 20 at Trauma therapist network.com   Announcer  34:04 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.   Curt Widhalm  35:49 If you're still listening, the code is 62 160 1600  

    Therapists Shaming Therapists

    Play Episode Listen Later Nov 1, 2021 40:36

    Therapists Shaming Therapists An interview with Katie Read about therapists shaming each other when they raise their fees or start playing bigger. Curt and Katie talk with Katie about the puritanical culture within the therapist community that leads to group think, public shaming, and milquetoast messaging to mitigate their fear that anything different will be attacked. We look at reasons behind this (jealousy, guilt, shame, and moralism) as well as what therapists can do to step outside of this culture to create more success.   It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Katie Read, LMFT, Six Figure Flagship Katie takes lessons from her nearly-20 successful years in the field to help clinicians grow...then OUTgrow...their practices. Immediately upon licensure, Katie was made Director of a large Transitional Aged Youth program in Oakland, CA. Later, she was recruited to Direct one of Sacramento's largest Wraparound Programs, and from there she moved into the role of Director of Clinical Supervision, personally supervising 40+ interns towards licensure. Concurrently, Katie had private practices in multiple cities, taught graduate psychology students, and wrote and created therapist training materials. Katie is also a special needs mom and loves helping other moms tune into their own intuition and lead their best-possible lives by taking the sometimes-scary leap into following what's best for them, deep down. She is the creator of: The Clinician to Coach® Academy, The Clini-Coach® Certification, and the Six-Figure Flagship™ Program. She's a little bit obsessed with helping therapists get profitable doing the creative, out-of-the-box, authentic work you're called to do! In this episode we talk about: How therapists are treating each other The concept of trolling, piling on, shame The Article in the Atlantic – New Puritans – and the concept of the illiberal left How identity plays a role and the group dynamics within therapist Facebook groups The shaming related to increasing your fees Katie Read's origin story as an on the street social work The value placed on sacrifice and avoiding guilt for the difference in privilege when working with clients who are impoverished Socially-prescribed perfectionism, self-imposed perfectionism The fine line about what is acceptable to charge or make as a therapist Cancel culture and the lack of allowance for errors Echo chambers, factions, and exclusion The fear of dissenting opinions The low context of the internet paired with the high context nature of a therapist's job Milquetoast messaging to avoid getting attacked Dialing down authenticity to fit into what is acceptable Challenging our financial mindset Cultural and societal factors that frame us as cheap labor The seeming requirement for therapists to suffer in order to understand our clients The reality of therapists as business owners Therapist guilt for “earning money” Feminized professions and the expectation of doing things out the goodness of our hearts Rapidly changing social rules versus entrenchment in what has been How this identity shift is spilling over into real life Jealousy, guilt, and shame, and moralism The best therapists have the worst impostor syndrome How to navigate when you're a therapist going against the grain The importance of every therapist doing their own money mindset work Our Generous Sponsor: Trauma Therapist Network Trauma is highly prevalent in mental health client populations and people are looking for therapists with specialized training and experience in trauma, but they often don't know where to start. If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There are so many types of trauma and so many different ways to heal. That's why Laura Reagan, LCSW-C created Trauma Therapist Network.  Trauma Therapist Network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work and what they specialize in, so potential clients can find them. Trauma Therapist Network therapist profiles include the types of trauma specialized in, populations served and therapy methods used, making it easier for potential clients to find the right therapist who can help them.  The Network is more than a directory, though. It's a community. All members are invited to attend community meetings to connect, consult and network with colleagues around the country. Join our growing community of trauma therapists and get 20% off your first month using the promo code:  MTSG20 at www.traumatherapistnetwork.com.   Resources mentioned: 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 Read's program: Six Figure Flagship Article in the Atlantic – The New Puritans by Anne Applebaum   Relevant Episodes: Therapist Haters and Trolls Advocacy in the Wake of Looming Mental Healthcare Workforce Shortages In it for the Money? Overcoming Your Poverty Mindset (with Tiffany McLain) Not Your Typical Psychotherapist (with Ernesto Segismundo) How to Overcome Impostor Syndrome to leave your Agency Job (with Patrick Casale)   Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated) Curt Widhalm  00:00 This episode is sponsored by Trauma Therapist Network.   Katie Vernoy  00:04 Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit trauma therapist network.com To learn more,   Curt Widhalm  00:27 Listen at the end of the episode for more about the trauma therapist network.   Announcer  00:31 You're listening to the modern therapist Survival Guide, where therapists live, breed and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Kurt Wilhelm and Katie Vernoy.   Curt Widhalm  00:47 Welcome back modern therapists, this is modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. BLEEP you! This is the podcast where we talk about all things therapists, therapy related, therapist communities. And we are talking about the ways that we treat each other and a lot of this happens in the online groups. You know who you are. And   Katie Read  01:20 But do they?   Curt Widhalm  01:22 I think they do. Well, helping us here in this conversation today coming back to the show. Our good friend Katie Read. So before we before we start shaming the shamers.   Katie Vernoy  01:37 For shame!   Curt Widhalm  01:39 Tell us a little bit about yourself and what you're bringing into the world.   Katie Read  01:44 Hi, I'm Katie Read. Thank you for having me back. I missed you guys. We haven't been around here for a while.   Katie Vernoy  01:50 I know!   Katie Read  01:51 Good to be back. Although I did get to see you in person at the conference recently, which was amazing. So anyway, you can find me over at six figure flagship dot com. I do. One of the things that plenty of therapists like to shame, which is encouraging therapists who are creative who had that little spark that maybe someday they want to outgrow the therapist office, I... whispering under my hand here, I help them do that. Lest all the shamers jumped out at us. That's what I do. But I have like you been very active in therapists groups over the last couple years, and been often just shocked by the level of shaming that can happen in these groups. And it's so funny, I don't know about you guys. I've told this to other people, non therapists, like neighbors, friends just being like, Yeah, it's amazing. Those groups, people are astounded to hear that therapists would shame one another like it would never occur to them that therapists would be because they think of us all as being nice and wonderful and accepting and loving and caring and empathic, and all of these things. And I know we all three have had conversations in the background, like why does that fall apart on the internet, and I really do think it's just on the internet. It's not in person. It's just on the internet, but on the internet and therapists group. So not that I have any grand answers for this. But I'm super interested in this conversation today.   Katie Vernoy  03:18 We've talked about this in some ways before, and we'll link to those episodes in the show notes that we've got a therapist, haters and trolls. And there's a couple others, I'll look at them when I'm getting ready to put this together. But to me, I think the biggest thing that I see that that has always been shocking to me is the the piling on, that happens at someone put something out there, it becomes given that that is wrong and bad. And somebody has an opinion that this is wrong and bad. And then there's the defenders, but then there are the piler on-ers, is that is that a word? The people that then cosign on this negative information. And then all of a sudden, it's like the snowball effect. And there's like, hundreds of comments, and you are horrible and all of this stuff. And I think that there is an element of this that I think we do want to call people out when they're doing things that are harmful. I think the the criteria for what is harmful sometimes feels a little bit wiggly to me   Curt Widhalm  04:26 I kind of started looking at this more from just kind of a an academic approach. And what sparked this, for me was an article in The Atlantic called the new Puritans by Anne Applebaum. And it's an incredible article, we'll link to it in the show notes. But it starts to talk about the illiberal left, which many therapists politically identify in kind of this political compass of the left side. And what happens in echo chambers like there pice groups is that it becomes many people coming with a desire for positive social change and social mores are changing that. We've seen this happen not only in society, but in our field over the last 20 years. But what happens seemingly is, we're developing this this collective identity in these groups that becomes part of our own identities and seeing other people acting even slightly different than how we would act ends up becoming almost there's harm to our own self identity that needs to be processed and spoken out against when it comes to things like, hey, I want to raise my fees on my clients by $5 per session.   Katie Read  05:51 I find this one absolutely fascinating because I, I don't think I've ever seen a post go by in a group where a therapist has said, Hey, I'm thinking about raising my fees, and have not gotten at least some very heavy negativity thrown their way. Which is so fascinating to me. Because if you step back and you look at any career on Earth, we assume about every human being in the world, that you will always be on a quest to kind of step up to the next level in your career step up to the next level in your income. This is understood if anyone tells you they've gotten a raise, they've gotten a promotion, you say congrats, that's great. When therapists who are self employed, who have only themselves to answer to they are their own bosses, and when they say it's time for my yearly raise, and I have earned my yearly raise this year, and they attempt to give it to themselves, what do the therapist communities often do? Jump in with really crazy stuff really crazy? Oh, I don't know, I didn't get into this career to make money. I couldn't imagine putting my clients under that kind of strange, just really, really deeply shaming words coming at them. And I find it fascinating. You know, and I'm not exactly sure where it comes from. But it's interesting, because in prepping for this podcast, I was thinking about my early days as an intern and, and I do wonder, probably, at least for me, this was part of it. I spent many years even before I went to grad school, I was doing social work type roles in very, very, very impoverished areas. And then during grad school, I was working with foster kids. And then after grad school, I was an on the street social worker in inner city, Oakland, with teenagers and young adults, most of whom were homeless, or they were sex workers or drug addicts, gang members, like Oh, terrible, really difficult lives, right, like really terrible life situations. And I was dead broke, that job paid next to nothing, it was an internship job. And in a way, coming home to my crappy apartment, where people got mugged right outside in broad daylight and eating my ramen noodles, because that was all I could afford. I didn't have to feel so guilty going into work the next day, because my life was certainly better than my clients lives were at that time. But it was still rough, like things were still rough at my end. And I wonder if I remember at the time, I would say to people, I would say, this is the hardest work you can imagine doing. But if you can do it, you just have to do it. Because these people just need the help. And they need the support. And they need people on the street. And I had this very grand idea of what it was to be an on the street social worker doing that kind of work, and, and staying poor for it. And oh, it took me a long, long time to realize that I had to put the air mask on myself first, you know, like on the plane, like it took me a very long time to come to that change. But I wonder if some part of that for a lot of us does start because I think many of us do start in those types of jobs, those types of internships where you're seeing such poverty, you're seeing such difficult lives and you do feel a guilt around that.   Curt Widhalm  08:57 Even in your story here. Part of what I'm hearing is you lead that off with this is unique to therapists. So you're already framing this as part of therapist identity means that you have to do these certain things. Look at the shame that we put on people who go straight from grad school into private practice, like they are bypassing part of that identity. And, you know, the echoes of the criticisms is, well, that's such a privileged place to come from that you didn't have to go through this with all of these other clients. And a big part of that is in this identity becomes this thing called socially prescribed perfectionism that you must do this because what you're doing reflects on me and in combination with socially prescribed perfectionism comes this self imposed perfectionism that I must act this way. Yeah. And if other people whose identities reflects on the same way as mine And that's not how I see myself doing, I have to deal with that internal conflict, and it's much easier to tear you down than it is for me to wrestle with. All right, you do you and I'll do me and we'll both potentially help out the people that we're best suited to help out with.   Katie Read  10:19 That's so interesting. And it's so true. And I wonder. So like, I'm thinking about the people who I did know from grad school who came from different backgrounds who did go straight into private practice and whatnot. And you do wonder, do they feel any of that guilt? Do they carry any of that with them? Does that bounce off of them that they're like, what I was doing exactly what you just said, Curt, like what I was meant to do, I was helping the people I was meant to help. This is where I'm well suited. It's just interesting.   Katie Vernoy  10:45 And it's, it's something where this idea of perfectionism what what resonated for me was this, it's very thinly defined. And not only have I heard the, the negative backlash around charging a high fee, and and I don't know, necessarily that I've seen a lot of the negative feedback with I'm raising my fee by $5 Next year, but it's anybody that has a premium fee gets roasted. And anyone that talks about charging very little or being on insurance panels, also gets roasted, because you're undervaluing the profession, you're, you're making it harder for me to make money. And so there's this really fine line of what's acceptable,   Katie Read  11:27 Acceptable, huh.   Katie Vernoy  11:28 And so this this perfectionism around, I can't, I can't make too much, but I also can't charge too little. It just it feels very crazy making. And I think this, this notion of we're trying to validate our own identity through making everyone else be like us, or like, what the collective has decided is okay, feels kind of scary.   Curt Widhalm  11:57 And the extension of this goes beyond just, you know, the parent comments in some of these, these groups, that there becomes almost this effort to cancel people across multiple posts, that there seems to be so little room for error, and especially in late, like I said, social mores changing of, you know, a lot of the things that I see is, you know, not doing the emotional work or not doing the education work for other therapists who are potentially asking questions around things like critical race theory and involving, you know, wonderment about communities that they might not have experience with that. While there is validity on both sides is I've seen some of this extension go across, you know, bringing up these kinds of arguments across separate posts across separate days, weeks, even months, that his efforts towards this cancel culture esque type thing that serves to only make this problem even worse, by creating even stronger echo chambers of we're only going to listen to people who think exactly like us. And what ends up happening is we get these factions of, you know, well, here's the group of like minded people who sit over here. And here's the group of like minded people who sit over here, and here's the people who are okay with microwaving fish in the office, and they're okay in their own corner. But then it just makes it to where it's uninviting for anybody to have any kind of a dissenting opinion. Because and this is particular to the internet groups that you brought up. Here at the beginning, Katie, internet culture is very, very low context. And therapists are very, very high context people. This is a sociological phenomenon, that high context is understanding people where they're coming from, you know, we spend years studying how to get the high context of our clients. And we're used to communicating with people in this very, very high context sort of way. And then you get like one paragraph on a Facebook post to be able to try and explain something to somebody else. And it's just this very, really low context like fast moving group of people who kind of opt in and opt out but aren't consistently there. That makes it really enticing to pick on well, you're missing all of these high context things that just it's critical, and it's something that because of internet culture, therapists aren't used to having to receive information in that low context sort of way in embracing how we communicate online. Mind. In other words, we think that we're really smart in some areas of our life, and therefore all areas of our life should be really smart. But the internet is not that place.   Katie Read  15:11 And the internet dumbs us down. Well, it's interesting. And a moment ago, I just lost my train of thought you had said something a moment ago that   Curt Widhalm  15:18 I do that to people.   Katie Vernoy  15:20 Just keep talking, it's   Katie Read  15:22 10 minutes back. There was something I just lost it   Katie Vernoy  15:27 Well, keep thinking because I had something you know, a few minutes back when you were talking about your, your experience as kind of an on the on the streets, social worker and having to overcome that self imposed identity around if I am not so privileged, I don't feel guilty going to work. How did you work to overcome that? Because I think we're looking at being shamed for it. And and you did it within that culture, like I know, that I would imagine you have probably been shamed for for what you do, as you know, a six figure flagship even having that is so money title. So right, having the right so and so actually, how do you how have you gotten through it, I guess.   Katie Read  16:12 Yeah. And I can tell my story, but it's interesting, because you just reminded me of what Curt had said that I had wanted to comment on. Because it's all related. You had to Curt the end. And even Katie had said previously, there's this very narrow band of what kind of therapists are willing to accept as appropriate. And because the echo chambers are loud, and because the pile on culture is intense, within therapists groups, what happens is people are terrified to speak. And so we end up with very very milquetoast messaging. That doesn't challenge that doesn't potentially disagree, we end up with people who only want a message in ways that they will not be attacked for because as we all know, it's very painful and scary. If someone's coming at you online, some stranger online and other people are piling on and everyone would love to avoid ever having that situation. So we dial down what is true, what is authentic, what is important, we dial it down into what we hope will fit this narrow little brass band of appropriateness. And it's interesting like us, for me, it took me years and years. I mean, I eventually went from we eventually moved my husband and I to a different town, I opened up a small private practice. And it's funny, I was one of those therapists, and I was in California, where therapy rates are high. But I was the person where I was charging $90 an hour. And I was the person who set it like this, when a new client came in or called me and said, What's your fee? I went? Well, it's 90. But I can slide I can slide. What do you need, I mean, I can do whatever you need, I can really I get whatever you need, whatever you need, like that was me all the time. Because again, I was still carrying this guilt, about even charging that much and feeling like well, I couldn't even afford to go see me for therapy. So how can I think somebody else's, I was very much in my clients pockets. And what was really interesting was, I had been in this office for a while, you know, I rented my time other people came in and out. And there were several interns in the office, all supervised by this one supervisor. And I was speaking with one of the interns when we were crossing paths one day, and at this point, I had been a licensed therapist. For years, I had worked my way through community mental health up to being a program director, I had taught grad school, I had done all these things. And I was still charging this low rate because of my own internal money issues. And this intern, I don't know how we got on the subject. But she said, Oh, yeah, our supervisor now she was still in grad school. There's a person in her first year of grad school, an intern seeing clients. And she said, Well, our supervisor won't let us start any lower than 125 as our hourly rate, we're not allowed to slide under that they were private pay 125 for the interns. And my mind was blown. That here I was with years of experience behind me years of training behind me. And I it really in that moment hit me I was like I am doing this wrong. I am absolutely doing this wrong. And I need to start working on this. And some of it was working on my money mindset, honestly, for me, doing what I eventually did and wanting to outgrow the office that was motivated by different things like we moved states and then I wasn't licensed for a year while I went through the licensure process in a new state. So my path out of the office and outgrowing the office was sort of organic. It wasn't a pre plan type of thing. It just happened that I moved into coaching and ended up loving it. But within the coaching world, you really really get challenged very quickly on your financial mindset. And you really actually learn very quickly that the norm in the rest of the world is if you bring great value into someone's life, you are well paid for it. And we therapists continually underestimate the great, great, transformative, wildly important value that we bring into people lives. And whether you choose to continue to do it in the context of therapy or to write a book, or to go on a speaking tour to do any of the number of things that therapists can go out in the world, and do, we do by virtue of our passion, our education, all of these things, we bring great value we bring about great transformation in people's lives, and in most of the rest of the world, that would be naturally richly rewarded. But because of sort of the culture, and I honestly think part of it is just the culture of how government even is set up that we need to be able to have cheap labor to go out and work with the people who need help the most. And so many of us, like we said, started off in community mental health in some form, or in schools, which are very underfunded just, we start off as sort of cheap labor. And it's hard to get out of that mindset that we should always remain just cheap labor, or that what we do is not that highly valued in society where, of course, I don't know about you, I remember, every therapist I've had, and I remember them dearly. And they were hugely impactful at those times in my life, and every one of your clients and everybody out there listening. It's the exact same way, you're hugely impactful.   Curt Widhalm  21:14 You know, as I'm listening to this, and going back to that piece by Anne Applebaum, she makes mention of The Scarlet Letter as kind of this this parallel of what's going on with the liberal left. And the thing about this is one of that one of the major themes from the scarlet letter is the the priest who impregnates Hester, I'm forgetting his name right offhand. But he is seen as more virtuous because his sermons have so much empathy, from his own sins that there's almost this parallel what's going on with the groups here that we're seeing of like, we have suffered this injustice. And therefore we're better at what we do in relating to our clients, because we've done this. And especially when it comes to things like privilege and fees in this kind of stuff. It's like, you're, you're not able to relate to your clients as well. Because you haven't done this suffering, and you haven't done this, and therefore, you must suffer in order to be able to be a better therapist.   Katie Read  22:21 Yeah, yeah. Yeah, that's so interesting, isn't it. And so as some of that just coming down, is that just back to that therapist skills, we were talking just today, I had my meeting with my folks in my clinic coach, six figure flagship, and we were talking, there's one therapist, she's putting an unbelievable amount of work into an event that she's producing just probably hundreds of hours of her labor is going into this work. It's a passion project. She's so excited about it. And she came to the group and she said, I'm donating all the proceeds to charity. And I was like,   Katie Vernoy  22:56 Oh, wow.   Katie Read  22:59 And so we really, we took it apart a lot, like we coach through it a lot in the group. And today in our meeting, and I was, like, you know, like part of this here is that we are also business owners. And when you put in hundreds of hours of unpaid labor on something, you actually need to retain at least the majority of your profits, so that you can reinvest them into your own business, so that you can stay afloat, have savings of money for like all the things that we need to do. But really, to me, what I was hearing was therapist skill was I don't want it to look to anyone, like I'm trying to actually make any money. I want it to look like out of the goodness of my heart, I'm putting on this big event for all my fellow therapists to learn and grow. But God forbid someone think I might earn money from doing this. Yeah. And so it's just it was fascinating, because I don't think there's any other profession, where they would even consider for a minute giving every single bit of all this labor, all this unpaid labor straight to charity, without a second thought, maybe with many second thoughts, but feeling like this is what I should do.   Katie Vernoy  24:05 Yeah, yeah, I just I think about teachers, I think about oftentimes nurses, part of it is kind of feminized professions do have this this impact where the majority of the folks in those professions are non male. And so there is an expectation, this is something we should be doing out of the goodness of our hearts. And it seems very mercenary if we would ask for money for it. You know, there are, you know, during the pandemic, these poor teachers, were finally getting recognition for what they actually do for folks' kids. But as soon as you know, even even well into the pandemic I started to get because I work with some teachers. I was started hearing that people were complaining that the teachers weren't doing enough and we're paying their salaries and why aren't they doing enough? And it's like, whoa, you know, or if they go on strike that is just heartless. So it's heartless. And it's kind of like would you work for the salary that they work for? And then we've seen the same with the Kaiser therapists. That was one of the things that happened. We see the same with nurses.   Curt Widhalm  25:11 I mean, our episode, recently where we talked about, you know, let's just throw more Subway sandwiches at therapists,   Katie Vernoy  25:19 workforce shortage at episode that we just put up.   Curt Widhalm  25:21 Yeah, it's just it's throwing more Subway sandwiches at therapists because, you know, how dare you ask for money. And part of this is as a field that our median age is higher than many other fields. And that anytime that we have a field that has rapidly changing social rules to it, it makes it to where, especially with fields that are older, like ours, the entrenchment becomes a lot more rigid. And so I think that that's contributing to part of this, too, is that there's, there's this almost cultural battle that we're facing within our field that is leading to a new identity. And if we're honest about it, we contribute to that a lot here in the podcast, we do call out things that we don't like, including calling out other therapists calling out other therapists. So we do encourage you to let us know your thoughts and feelings on this publicly in any of the therapist groups. But this happens, systemically it happens individually as well. And, you know, I do see this happening outside of the therapist groups, and actually it is spilling over into in real life as well. To hearing this, you know, from some of the practices, hiring people, where I think rightfully, employees entering into the workforce are asking for living wages. And it is a power balance shifts that is leading to things like some of the workforce shortages that we talked about in the other episode.   Katie Read  27:14 Let me ask you, Curt, because as you were talking about sort of the field being a little bit older, in terms of median age and whatnot, I wonder, and I'm curious, just either of your thoughts on this. Do you feel like so let's say you are out there, whatever age you are, really, but you're a therapist, you've kind of become acclimated to the 50k a year therapist average median income, you've kind of surrendered yourself to the fact that you have a very hard job that you can't talk to anyone about, that you are bound by ethics and confidentiality, that you don't get to come home and vent about your day, you have to keep a lot of things bottled up. And at the same time, you know, you're probably worried every month, if you have a $400 car bill this month, it's gonna throw you over the edge, you're not going to have a cushion for that. And then you go into a therapist group, and you see somebody who says, I charge 200 an hour in my area, and I'm doing great and everything's fine. Do you think part of this backlash is just that feeling of threat, that you can't do that or that you haven't chosen that or that you haven't gone to do whatever it is you need to do internally, whatever that sort of money work is that you need to do to actually start charging closer to your worth as an experienced person in the field?   Curt Widhalm  28:30 Absolutely. 100% think that a lot of where we socially prescribe other therapists to be comes from our own anecdotal histories. And our inability is to deal with our own crap when it comes to our relationships to money, our relationships to our professional identities, that and, you know, this even happens in things that I see like in law ethics workshops, that I teach that it's not even just about money thing, but just how much we distance ourselves from other people who make mistakes. You know, if somebody's name shows up in the spider pages, the disciplinary actions, how quickly are to just like, unfriend them or take them off of our LinkedIn connections? Even if it's something that might points closer to us, you know, you see this and things like people who admit to not being caught up on their notes and just kind of the furthering away, you know, these are ethical and legal responsibilities that we have in our profession. And as compassionate people we tend to have very little compassion for the other people in our profession. When they don't do the same kinds of steps that we think that we should be doing or have been doing all along ourselves.   Katie Vernoy  29:52 You're really saying jealousy, guilt and shame.   Curt Widhalm  29:54 Yes!   Katie Vernoy  29:56 Because I think of like the especially I think with the environment around you, Katie, which is like the six figure flagship, it's people outgrowing the office, it's that kind of notion of very successful, you know, I'm going to make a lot of money, I'm going to, I'm going to live a life. And and you don't argue that that comes easily. I saw your post on kind of hustle seasons. And so I appreciate that. But I think that there's this notion that you can work really hard, create something that's more sustainable and make a lot of money. And I think there's a jealousy there, either of the energy that you personally have. I know I'm jealous of your energy. And then there's also the success that people have, I think there's a jealousy there. And so then it's that kind of like, well, I didn't want it anyway, like that. That's wrong, because I don't think I can get it. I'm jealous that you have it. And so I don't really want it. And this, there's all of these moral reasons and moralizing around why I don't want it. I think what you're talking about Curt is kind of this guilt and shame over, I've been doing things wrong. I can't do that, because it goes against these self imposed values and morals that I've put around being a hard worker, that is one of the people and I am not going to I'm not in this for the money. And I'm doing this because it's so valuable. And even thinking about money is so mercenary and wrong. And so there's that guilt and shame of wanting more, but feeling like it goes against either the collective morals or the personal morals. And so to me, it's like if we think about guilt, shame, and jealousy, I mean, the fact that there is so many of those emotions that come out in these public shreddings, in these social media groups or on pages or whatever, like it just it seems strange to me, that therapist would would have those in such huge, huge, impactful ways.   Katie Read  31:54 It's interesting, too, because I was just putting together a workshop where we talked about how typically the best therapists tend to have the worst imposter syndrome. And I think imposter syndrome falls into what you're talking about, and the fact that because we all tend to be pretty intellectual, pretty academic, you know, even those of us who are super heart led, we all still have like our little academic streak. And I think that we all walk around with this belief that if I am not the top researcher in a particular field, I have nothing to say it's very black and white. If I am not the absolute most published person in this particular theory, I should just sit down and shut up, I know nothing, as opposed to being able to see all the gradients, being able to see all of the expertise that everyone has and that you can bring in that could benefit so many more people. If you were brave enough to kind of fight your own imposter syndrome. Stand up, talk about what you know, help even more people that way.   Katie Vernoy  32:55 Yeah.   Katie Read  32:56 But we get very caught in that. Because this will not win a Pulitzer, I might as well not even write it. I might as well not even try it. And I just want what's the point? What's   Katie Vernoy  33:06 and and how dare you, other person that is doing this? How dare you do that? Because I've decided, even though I may have more knowledge than you   Katie Read  33:17 Yes,   Katie Vernoy  33:17 that I'm not good enough to speak on it. So how dare you!   Katie Read  33:20 How dare you? Exactly. Oh, isn't that so true. And I do think this is what we see play out in therapists groups. And I do think it's terribly sad, because at the end of the day, to me, I always think the lay public are the only losers here. Because when you choose to not speak out, when you choose to not share what you know, when you choose to not be open and vulnerable, and who you are, and say, I know I might not be the world renowned expert on XYZ. But let me tell you a little bit about what I do know, because you might think it's interesting. And I think the thing a lot of therapists don't realize because we're sort of taught to write dissertation style for everything is that the average person doesn't want that. They do want the little tidbit. They do want the little micro snippet that you pulled from an interesting article you read that you couldn't get out of your mind yesterday, share that that's what they want to because it'll get into their head too and it'll help them in their life just like it helps you they don't need your full scope dissertation on anything.   Katie Vernoy  34:19 Yeah.   Curt Widhalm  34:20 So is the answer and stop hanging out with other therapists?   Katie Read  34:29 I don't know let's vote should we go around and vote? I you know it's interesting though, you I definitely think it's something that we talk about in our group is that we talked about how when you even when I when I first started doing the most basic stuff, offering like copywriting for therapists offering basic marketing for therapists in this tiny little way like putting a post on Facebook Hey, need help with your copywriting? You know, these tiny little ways? I had rude people I had predicted people I know going well that's never gonna go anywhere. What are you even doing? Why are you doing that? And so I just want all my students like any time, you are going against the grain a little bit breaking the mold a little bit of what it means to be a helping professional, because what I believe at the end of the day is what you call it doesn't matter as much as what you're actually doing. Are you out there helping people in some form? Is your internal calling to be out there helping people in some form? Great, are you doing it? If you are, and if you feel good and authentic, and you know that you are living out your calling that you are truly helping people in some form? Does it matter if you call it therapy today, and maybe tomorrow, it's consulting, and you have consulting clients, and maybe the next day you build an online course where you help people and maybe you go speak at a school the next day, doesn't matter what form it's in, that you're helping people as long as you are authentically helping people what you were called to do, does the name matter? So you can hang out with a therapist like that. Kurt,   Katie Vernoy  36:00 I hear you saying that hanging out with therapists who have that broader perspective that aren't so tied into the Puritan culture is probably helpful for folks that are really coming, that are pushing against the grain in some way. And and I really resonate with that, because I think that's, that's why we found each other and   Katie Read  36:18 That's what you've done   Katie Vernoy  36:22 We've been trying, you know, we don't we don't avoid the purity culture, we just try to push back against it. But I think it's, it's something where when you're really trying to step out and help people in a bigger way, it is, it is important that you find the right people to spend time with because you can get tamped down by purity culture,   Katie Read  36:40 You can. Well, and I should say this, like for a lot of us, I know for me, when I was I think it is important for therapists to do money work on ourselves, go read the self help books, go, you know, sign up with Tiffany...   Curt Widhalm  36:53 GO DO YOUR OWN RESEARCH!   Katie Read  36:58 I think it's important to do that. And I think it's important to hang out with people who get it and have done it. And I think for all of us to, there is a way that you can feel good about what you charge and feel good about what you give back. And that that is going to be different for everyone, whether it's that you do a couple free or cheap sessions every single week, or you give a certain amount to charity every year, like whatever that looks like for you. You can still set this up in a way where you're not going to feel like a greedy bastard, for earning a good living where you still know that you are I mean, for me, when I started outgrowing the office, honestly, my entire motivation was security. My husband worked at a large multinational corporation that was doing layoffs, rolling layoffs every single month. And every single month, it felt like we were going to be any minute we were going to be homeless because he was going to get laid off. And that was the bread and butter of the family. And what then and all I really wanted was some security. And so that drove me and I was like I said we had moved states. And so I didn't have a license in my new state. I couldn't just go open a therapy office, it drove me to get creative and do something else. But I think when your motivation comes from that, like there's, I don't know, a lot of therapists who are like, I'm gonna go get rich so that I can have seven maaser body it's like, it's just not who we are, you know, like, that's just not what we're doing here.   Katie Vernoy  38:16 Well, we do have to end here, but but I think we also if there is a therapist that wants to get ready to get seven Montserrado for months, seven months. Go for it do. So before we close up, where can people find you?   Katie Read  38:30 Six Figure flagship.com is the main program that we run right now it's an application only program for mental health therapists who do want to outgrow the office, that is the best place to find me. And otherwise, I'll just be kind of hanging out with you guys.   Katie Vernoy  38:44 I love it. Always again, it   Curt Widhalm  38:47 We will include a link to Katie's websites in our show notes. You can find those over at MTS g podcast.com. And follow us on our social media join our Facebook groups modern therapists group and   Katie Read  39:01 Or we will shame you.    Curt Widhalm  39:03 we actually have a really good group that seems to   Katie Read  39:08 No I said we will shame them for not joining it, we find them.   Curt Widhalm  39:14 Some we will post those links and until next time, I'm Curt Widhalm with Katie Vernoy And Katie Read.   Katie Vernoy  39:20 Thanks again to our sponsor, Trauma Therapist Network.   Curt Widhalm  39:24 If you've ever looked for a trauma therapist, you can know it can be hard to discern who knows what and whether or not they're the right fit for you. There's so many types of trauma and so many different ways to heal. That's why Laura Reagan LCSW WC created trauma therapist network. Trauma therapist network therapist profiles include the types of trauma specialized in population served therapy methods used, making it easier for potential clients to find the right therapist who can help them. Network is more than a directory though it's a community. All members are invited to attend community meetings to connect consults and network with colleagues around the country.   Katie Vernoy  40:01 Join the growing community of trauma therapists and get 20% off your first month using the promo code MTSG20. At trauma therapist network.com Once again that's capital MTSG, the number 20 at Trauma therapist network.com   Announcer  40:17 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.

    Advocacy in the Wake of Looming Mental Healthcare Workforce Shortages

    Play Episode Listen Later Oct 25, 2021 33:11

    Advocacy in the Wake of Looming Mental Healthcare Workforce Shortages Curt and Katie chat about the looming (and current) mental health workforce shortages. We talk about the exodus of mental health providers, legislation and proposed bills that seek to address these shortages, and what modern therapists can do to advocate for the needed changes. We also talk about inadequate or harmful strategies (like cheering, scholarships, and subway sandwiches) that are often implemented by agencies and legislatures. We provide individual and collective calls to action.   It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: Recent data that shows that there will be huge workforce shortages in coming years The difficulty for folks in accessing mental health services in all sectors The reasons that mental health workers are leaving the profession High caseloads, higher acuity Systemic burnout, jaded supervisors The inadequate “support” of mental health workers with subway sandwiches, cheering heroes Legislation that has gone through to support healthcare workers in receiving mental health Legislation that funds hiring more workers Bills addressing scholarships to increase folks going to school for mental health The problem with scholarship bills versus loan forgiveness bills Bills working to decrease wait times for those seeking services Creating and filling in mental health treatment needs with paraprofessionals, peer counselors Navigating funding and worker shortages with new treatment planning The challenge in “steeling our hearts” to make choices in how we work and who we work for Both individual and systemic action that we can take to address these issues A request for the National Guard to come in and staff residential treatment centers The importance of taking action now to get involved in legislative advocacy   Our Generous Sponsor: Turning Point Turning Point is a financial planning firm that's focused exclusively on serving mental health professionals. They'll help you navigate all the important elements of your personal finances, like budgeting, investing, selecting retirement plans, managing student loan debt and evaluating big purchases, like your first home. And because they specialize in serving therapists in private practice, they'll help you navigate the finances of your practice, as well. They'll help you navigate bookkeeping, analyze the financial implications of changes like hiring clinicians or diversifying your income sources. They'll even help you consider strategies like the S-Corp tax election. Visit turningpointHQ.com to learn more and enter the promo code Modern Therapist for 30% off their Quick Start Coaching package. Resources mentioned: 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! Mercer Report on Major Shortages of Healthcare Workers Senate Passes Legislation on Mental Health for Health Care Professionals Rand Report on Transforming the US Mental Healthcare System CA Bill would decrease wait times for mental health services Opinion: Exodus of mental health workers needs state response Send legislative bills to curt@therapyreimagined.com to get ideas on advocacy and responses.   Relevant Episodes: Why Therapists Quit Why Therapists Quit Part 2 The Return of Why Therapists Quit Bilingual Supervision The Burnout System Gaslighting Therapists Waiving Goodbye to Telehealth Progress Kaiser Permanente Strikes Episodes: Modern Therapists Strike Back Special Episode: Striking for the Future of Mental Healthcare   Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated)   Curt Widhalm  00:00 This episode of modern therapist Survival Guide is brought to you by turning point   Katie Vernoy  00:03 Turning Point financial life planning helps therapists confidently navigate every aspect of their financial life from practice financials and personal budgeting to investing Tax Management and student loans. Visit Turning Point hq.com. To learn more and enter the promo code modern therapist for 30% off their quickstart coaching package.   Curt Widhalm  00:24 Listen at the end of the episode for more information.   Announcer  00:27 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  00:43 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 that looks at uncomfortable things in our profession. And this is another one of those episodes that does that. And we are talking about the already developed but looming and worsening mental health workforce shortage across America. And this actually, some of the stuff that we're going to talk about today also has impact worldwide. So for our international listeners as well, we're gonna talk about YouTube. But there's been this little thing called COVID-19 pandemic. And those of us in the know, before the pandemic knew that Mental Health Access was not great in pretty much all parts of the world. And we follow along workforce issues and work with our legislature and the US government on some access issues in our advocacy efforts, and continue to have an interest in continue to provide advocacy on this. And as we're looking at the next few years, it's going to get worse, that we are seeing a exodus of workers from the mental health workforce, we are seeing a lot of reports from research organizations, we can talk about some things out of research group called Mercer and their reports that things are looking bad in the next five years as far as mental health workers that there is a exodus of workers here, Katie and I have talked before about how hard it is to become even eligible for some of these positions. And it's going to get a whole lot worse,   Katie Vernoy  02:54 paired with what people were, colloquially calling a mental health pandemic. You know, the second, the second wave of pandemic is a mental health pandemic. And I think, for me, I'm actually seeing this in my own practice, I open for new clients, and I'm getting calls from folks who can't find someone who takes their insurance, who are not getting calls back. I mean, there are already issues with folks being able to access mental health treatment when they want it. And we've also got this worker Exodus. And I think the the broad strokes of this, I think, are that there are, at least locally, you know, for me, I don't know that many people that take insurance, you know, many people have gotten off insurance panels, I'm getting off insurance panels because of the, what they pay. And I think it's something where people want to use their insurance, people also, at times need higher levels of care. And those beds are not there. I was reading an article out of Colorado where there there are folks who are staying in I think solitary confinement because they can't get into mental health facilities when they've been determined that that's the appropriate type of incarceration. Not that that's kind of what we're talking about today. But but there are so few mental health workers across the breadth and depth of our field, that people are not getting the services that they need. And there are big impacts on our community. So this is already happening. But it's it's something where we are also leaving the profession, and that's pretty terrifying.   Curt Widhalm  04:34 And we've been talking about this for a while we had a episode earlier this year on why therapists quit. We had several follow up episodes to it. But in looking at the trends, and I'm looking at the Mercer report here, we are looking at some major mental health shortage of workers. The Mercer report talks About that they're expecting 400,000 mental health workers will leave the occupation entirely over the next five years. And that's going to be leaving mostly public mental health employers with a shortage of 510,000 spots us nationwide. Getting into the reasons why we've covered in a number of other episodes, super high case loads, you know, large case loads, the very quick return to business as normal in a lot of situations. And this is echoed, really largely at the time of this recording I'm seeing early reports of this is really impacting places like college counseling centers that are a month into the new year to two months into the new academic year by the time that this episode drops, and are seeing increases from last year's already increased rates of seeking services by over 20% year over year. So they are facing increased calls for services with a drop in available workers to come in and provide services. The experience of these workers is also that the crises that are coming in are bigger and more severe than they have been in the past. So we're getting this perfect storm of more need higher need and fewer people to do it. And most people in our profession, as caregivers tends to want to help out but it does lead to just this really systemic burnout problem. That is easier for a lot of people to go and not work in this profession. Because it is just so taxing at this point.   Katie Vernoy  06:57 Yeah, I think it's something where, when I've had in the past, short staffing, you know, whether I was a mental health provider or, or a supervisor or manager, what we by and large do is take more cases, do more work, just try to keep going, you know, everybody needs us. We can't say no, it's it's really hard. It's all of those things. I was thinking I was picturing Adriana, you know, when she came and talked on our episode around the same thing happening for bilingual clinicians. But just this idea of I can't say no, they need us and so that this these gigantic case loads that are both systemically problematic, but also personally problematic because there's just no way to keep that pace up. And so folks burn out and leave really early. But even if they make it through I mean, we've we've had this this conversation and the burnout machine and you know, so we won't go too far into this but it's just it's such a bad situation where not only are the clinicians, overworked burned out, usually not getting paid much more because oftentimes the cuts happen there. And their supervisors and managers have broken away from the day to day grind of seeing huge case loads, but are jaded and not necessarily the support that those clinicians need. And so they might as well have left the profession.   Curt Widhalm  08:24 And we specifically talked about this in our gaslighting therapists episode did at the beginning of the pandemic and there's a part of me that really likes having been right but there's also a part of me that is like, we knew this was coming and and so frustrated just in this was so predictable that yeah, this is just Ah,   Katie Vernoy  09:00 yeah,   Curt Widhalm  09:02 Calm down.   Katie Vernoy  09:06 Oh, go ahead.   Curt Widhalm  09:07 But this is where we haven't changed the way that we take care of the workers. I mean, maybe what we've changed is given them a second subway sandwich party each month and   Katie Vernoy  09:19 Or like cheering WOO HOOO! way to go thank you heroes   Curt Widhalm  09:23 some sort of banner that that promotes You are a hero. But But I mean, it's it's stuff like this and it's stuff like, okay, we are seeing some of this response in legislation. There's a bill was passed by both houses of the US government. Moving on, will link to it in the show notes, but as a bill written by Senator Tim Kaine to promote and look into interventions for preventing burnout. in mental health and healthcare workers, and this is widely celebrated is Alright, we're going to be getting to the problem of why so many people are leaving the profession, how can we address this to keep people in. And these funding bills are continuing to miss the point in looking at this bill, my first response was, oh, we're gonna blame the individual mental health practitioners and the healthcare workers. The bill is literally about promoting mental health care and looking for ways to promote resiliency. And I know that the $30 million that is being spent to investigate this is going to result in do more yoga and have thought about therapy. As mental health workers, we know that we need to go to therapy, it's not dealing with all of the access issues, it's not dealing with all of the giant caseload issues. It's not being able to have good workplace practices. It's no set Principal Skinner meme of like, is it that's the problem? No, it's the workers. They're misinformed, that is just going to continue to reinforce this as a problem. And my big bold prediction is that in a couple of years, they're gonna say, well, we spent $30 million on it, and it didn't fix anything. So we probably don't need to invest in mental health workforce issues for a while. Hmm.   Katie Vernoy  11:33 Yeah, I think one of my I'm going to put this on my to do list right now is figuring out if that does go through, is there a way for mental health providers to actually get on task forces and those types of things? Because I think there's, there are possibilities, if there's money going toward it, it has not been decided current, let me be a little Pollyanna for a second and then decided that's not been decided. And maybe if our modern therapists across the country, go and try to get into these committees and at these tables and talk about what you were just saying, as well as different payment structures, and just like, just drop the RAND report right in front of them and say,   Curt Widhalm  12:11 That's just it! They're paying for more investigations to end up with things that are already in existence?   Katie Vernoy  12:20 Yeah, well, alright,   Curt Widhalm  12:23 we'll have a call to action about what we can do with that next step with the way that grant money is going with Health and Human Services. Maybe not today, follow us on our social media, and we'll figure it out, we'll figure out exactly who needs to be called on that. Now, some of these other bills that I'm seeing, they do provide for money for hiring more workers, General Manager, those are good.   Katie Vernoy  12:49 Yeah, let's hire more workers, give them some money, give them give them money and and autonomy, that's probably not happening, but give them give them money.   Curt Widhalm  12:58 Now, there's other bills to address behavioral healthcare work shortages. This also goes to other health care workers. They have their own podcast. We're talking about behavioral healthcare workers here. There are other bills that are addressed towards scholarships for improving access in particularly like rural areas. But with telehealth, I'm seeing a lot of these just in general, like let's get more people into school to be licensed for these positions. And these, in my opinion, are generally misguided and bad bills.   Katie Vernoy  13:33 And scholarships are bad   Curt Widhalm  13:35 Scholarships don't address the problem and actually may end up increasing the problem.   Katie Vernoy  13:43 Because why did they increase the problems? My friend this is, it seems like a lot of a lot of people I know they got these scholarships, and to help them get through.   Curt Widhalm  13:53 scholarship money tends to increase the overall cost of tuition and expenses that universities charge free money that's available for universities to take in, the more that it raises the cost for all students who don't get the scholarships. Because if the tuition can go up, because it's being covered by somebody else, this actually then ends up creating barriers for people who maybe, you know, not qualifying for the scholarships, still not able to pay for school, they end up taking out large loans. Now, what I'm saying is, this scholarship bills should be directed towards loan forgiveness, as opposed to paying for tuition, same dollar amounts. But if you are aware of anything, start talking with your legislators about how this money actually can impact the workforce as opposed to just filling some University's endowment fund a little bit more or being able to get three Subway sandwiches in student appreciation. We're just going to have an economy of Subway sandwiches. That's that's the way we're talking about this.   Katie Vernoy  15:10 So so we can try to increase the workforce by either hiring people somehow making education cost less. There's there's another bill that I saw, and I think there's one in California right now. But there's a lot of them, I think, across the country that I'm sure are happening, but it's working to decrease wait times for clients, patients seeking services. And on the face of it, this is potentially bad, because then there's a legislative, potentially legal responsibility for mental health providers to take more clients more quickly. However, this is the part that I think is really interesting. And this is where I think there's a challenge for us. If insurance panels cannot keep clinicians in their in their roles, and cannot keep up with these wait times. I'm wondering what happens if we don't jump to this action here? Am I getting into cartel territory?   Curt Widhalm  16:14 No, I don't think you are, because on one   Katie Vernoy  16:17 The Cardigan Cartel is taking this on!   Curt Widhalm  16:21 On one hand, the history of a lot of these insurance companies is whatever fines that they end up paying, are going to be probably cheaper than what they would have paid out in services anyway. And we've talked about this and things like the the episodes on the Kaiser Permanente strikes in the past, but these are billion dollar companies. fines to them are just, you know, shifting some numbers over from profit margins. It doesn't. These things, these bills like this are really well intended, but they don't address workforce shortages either. Yeah, and potentially even gives some of these insurance companies the opportunities for having a defense of, there's no workers for us to actually hire to shorten these labor times. which then leads to what has also traditionally happened in the workforce, which is that, well, this seems like a great time for mental health professionals too heavy, really good impact on legislation. Traditionally, worker shortages have been addressed by creating or filling in with more paraprofessionals. Now that if the really high barrier to entry positions are going to need a longer pipeline, it's being able to provide things like peer counseling services, peer support specialists, and, well, those are good, it's not something that addresses the specific problems that we're facing as licensees or for our pre licensed listeners on the pathway to being licensed. All the more reason for you to be involved with advocacy to address the specific issues. But my, you know, not Pollyanna, like, Debbie Downer piece of this hair is in unless you really take action right now, in all of the free time. And with all of that not burnt out energy that you have. History suggests that without really good action on this, we're not going to get the very needed changes that we've identified 1015 years ago, that have all come to a head here and will likely come to a head at some other position again, in the future. We need the action now to continue to call legislators to be involved in the bill writing process. So that way, it can be better. Otherwise, it's going to be filled in by paraprofessionals. And continuing to just replicate the same problems that we're seeing in our workforce system.   Katie Vernoy  19:10 There's there's a few things that you're saying that i i agree with, but I also think that they don't have all the pieces to it. And so speaking to my experience with some of these public mental health contracts and those types of things, when there is a financial shortage, so they're the funding goes away, because you know, and around near and around 2008, when, you know, the great recession began, there was a lot of funding that went away for mental health services. And so there were really creative ways that folks added some of these positions. So there was paraprofessionals case managers, there was different types of codes that could be used at or slightly lower rates. And there was also this huge push for evidence based practices to you know, kind of create these different funding streams and kind of pull money from here and There. And what I really saw is that there was this combination of how do we make this cost less? And how do we take care of people with a lower cost. And with, you know, there wasn't a workforce shortage at that time, I don't think I feel like there's always a little bit of a workforce shortage and public mental health. But that's a whole other conversation. But it's one of those things where there was, there wasn't money to pay people. And so they did create these positions. But since that time, and I think this, this is accounted for in the RAND report, as well, there's been a real efficacy seen with these multidisciplinary teams. So I don't want to say like, hey, let's get out and make sure that we get to keep all the work, because I don't know that that's necessarily what we need to do, I think we need to make sure that the work that we're doing, suits our expertise and suits, what is needed. But I think, at that time, there was creativity that was both kind of mercenary, as well as actually improving mental health care. So I don't think it's black or white, like, Hey, this is just because of a workforce shortage that we need to bring in people who have different qualifications. I also think, and this is very much aligned in what you were saying that there is a tendency to make do because it's not a nameless, faceless mental health problem. It's this client and that client and this group in that group. And I think, when we are looking to make a difference right now, I think there's looking at how do I steal my heart against wanting to solve this systemic problem myself. And that is both in how we how we run our practices, but it also can be in where we get employment, when a when an agency gets a contract. So they get let's say, they get a $500,000 contract, to provide services, if they cannot fulfill it, they they lose the money. And so for public mental health providers, they actually need to say stay staffed. And we can actually make a difference in who gets to keep their money by making sure we're very diligent in where we go to get employed, and where we stay employed and where we do the work. And so there there's there is I feel like there is an element of us choosing whether or not large app companies gets our employment, whether there's, you know, public mental health organizations that don't that do shady work, whether they get our employment, you know, like, we do have a value there beyond like insurance companies and their gigantic war chests being able to fight against some of these things. So maybe that was all over the place. But I think it's something where I don't want to say like, Hey, we can only do legislation, because unless we have power in and how we choose to do our work. I think there's not going to be change anyway.   Curt Widhalm  23:19 You're talking about individual issues here. While there's also such big systemic issues that do need the focus, and well, I think that there's a lot of individual efforts that we can make in our own practices, that it almost just kind of ignores the problem. I'm looking at an opinion piece in the Oregonian from September. And this was penned by Heather Jeffries, Executive Director of the Oregon Council on behavioral health. Cheryl Ramirez, Executive Director of the Association of Oregon mental health programs, and rice bowl and director of the Oregon Alliance. And their public call includes some things that very much speak to this kind of stuff, increasing funding to recruit and retain staff, reducing administrative burden. Those things are great, providing cash supports for organizations struggling with the financial impacts of increased costs and insufficient revenue. Fantastic. Publicly recognize and appreciate the workforce, throw more Subway sandwiches at them, maybe misses the point. Yeah, but the one that stands out to me is that they are asking the National Guard to be deployed to staff residential facilities. Hmm. We are in such a crisis, that the heads of behavioral workforce associations are coming together and saying we need people who Have nothing as far as training to be called in by the government to come and provide staffing here. And I point all of this out because we feel an individual responsibility to take some of these steps ourselves. There is only so much that each one of us can do that really needs to be able to address this, especially as a lot of these legislative waivers are ending and not, you know, being progressed things like, you know, telehealth supervision waivers that are, you know, going to be gone at the end of October in California where Katie and I practice but in this lurch where we talked about this in our in our most recent episode with Ben Caldwell is due to the legislative process, there is going to be systemic barriers, that rather than expanding some of this energy more for us to help the one or two or five more people on our caseload that we can take on to have a greater impact, spend those one or two or five hours where this can actually impact 1000s of people in a much better way. Even if it means looking more for long term changes in short term changes right now,   Katie Vernoy  26:32 I want to do a yes, and because I think it is hard, and we'll do some of the legwork here. This is what we've been talking about with not focusing in on a conference this year, we will do some legwork. And we will try to help have some specific guidance on how we make some impacts here on legislation, policy, that kind of stuff. But I think we also need to be very conscious about the choices we make collectively and individually on where we get hired where we do our work, what we charge, because if there is a path to status quo, the legislative efforts won't go through. Right. And so we have to push back against the status quo of poor insurance reimbursements ridiculous, or bureaucratic burdens on organizations, like we need to push back on those things, individually and collectively, or it doesn't matter how many of us go in, there's, you know, we're a small workforce, kind of an in comparison to some of these gigantic, you know, other types of organ, you know, profession. So, all of us just saying, like, I'm going to take two or three fewer clients and going and fighting on the hill is not going to necessarily be sufficient, I think we need to do both.   Curt Widhalm  27:56 We do need to do both, right? It's, it's like the gaslighting episode where it's like, this is stuff that is predictable that legislative changes are gonna be five, six years from now, where it's like we, we told you, so stop, stop complaining about stuff five or six years from now, because the call for action is right now. Legislators know that mental health needs to be addressed. What they don't know is what needs to be addressed in mental health. And that's where that call to action is. And I know in some of my early online conversations, when I point these things out, the response is, well, this is at least addressing the short term thing that's good enough. And right now, having been involved in advocacy for as long as we have addressing good enough for right now does not change the problems that are going to be way bigger five years from now. And I agree. And this is really where it's giving up some of our short term action that, you know, still may not be kind of our perfect sort of answers to everything. I mean, we do have several more decades of podcasts that we need to make. But we do need to actually address some of our problems in in our systemic part of our profession, and get this stuff off the ground. We have been doing some of the legwork on we will organize some of this stuff. We encourage you to start looking at what bills are going to be written in your respective jurisdictions. Send them to us send them to me, curt@therapyreimagined.com, c u r t at therapy reimagined.com. I'll give you at least you know some ideas of things to start talking with your legislators about and if your legislators aren't reading Mental Health stuff be calling their offices and saying, what are you doing to address mental health stuff in our profession, in our state in our in our country? Because the stuff that is being written is really what   Katie Vernoy  30:15 Subway Sandwiches   Curt Widhalm  30:16 it's Subway sandwiches. So thank you for giving me something so we don't have it explicit on this episode.   Katie Vernoy  30:25 I think we're in agreement, I think both of us just have a different take on it and and what can be done more readily. You are very adept at the advocacy at the legislative level. And I think that is something where we need to, we all need to get better at it. And we need to be at some of these tables, we need to be talking to our legislators. I 100% agree. I think if we are working for places who are exploiting us, at the same time, we are undermining our efforts. So that's all I'm saying.   Curt Widhalm  30:55 Okay, I agree with that.   Katie Vernoy  30:58 Overall, you know, kind of summarize in the call to action is really assess where you are in this in this time, in this really pivotal time. For our profession, are you working in a way that supports you and the work that you want to do? Have you created bandwidth so at the same time, you can advocate and make changes at the larger scale so that you're both supporting yourself standing by your principles and how you are going to work and pushing for larger systemic change.   Curt Widhalm  31:42 Be in touch with us, follow our social media. Take those Subway sandwiches and tell your supervisors where to put them. And until next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  31:55 Thanks again to our sponsor Turning Point   Curt Widhalm  31:58 we wanted to tell you a little bit more about our sponsor turning points. Turning Points is a financial planning firm that's focused exclusively on serving mental health professionals to help you navigate all the important elements of your personal finances like budgeting, investing, selecting retirement plans, managing student loan debts and evaluating big purchases, like your first home. And because they specialize in serving therapists and private practice, so help you navigate the finances of your practice as well. They'll help you navigate bookkeeping, analyze the financial implications of changes like hiring clinicians or diversifying your income sources. They'll even help you consider strategies like S corp tax collection,   Katie Vernoy  32:35 And for listeners of MTSG you'll receive 30% off the price of their quickstart coaching intensive just enter promo code modern therapist when signing up. And don't forget to visit TurningPointhq.com to download your free finance quickstart guide for therapists.   Announcer  32:52 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.    

    Waiving Goodbye to Telehealth Progress

    Play Episode Listen Later Oct 18, 2021 37:38

    Waiving Goodbye to Telehealth Progress An interview with Dr. Ben Caldwell, LMFT about the impacts of rolling back the covid telehealth waivers. Curt and Katie talk with Ben about how the expiration of emergency orders will impact the profession. As a case study, we talk through how the California professional boards and associations are navigating these challenges, including looking at disciplinary action that has caused alarm (although we don't think it should). We also talk about calls to action to get involved now, so you can shape future policy on telehealth, tele-supervision, and remote work. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Dr. Ben Caldwell, LMFT Dr. Benjamin Caldwell, PsyD is a California Licensed Marriage and Family Therapist (#42723) and the Continuing Education Director for SimplePractice Learning. He currently serves as adjunct faculty for California State University Northridge in Los Angeles. He has taught at the graduate level for more than 15 years, primarily in Law and Ethics, and has written and trained extensively on ethical applications in mental health care. In addition to serving a three-year term on the AAMFT Ethics Committee, Dr. Caldwell served as the Chair of the Legislative and Advocacy Committee for AAMFT-California for 10 years. He served as Editor for the User's Guide to the 2015 AAMFT Code of Ethics and is the author for several books, including Saving Psychotherapy and Basics of California Law for LMFTS, LPCCs, and LCSWs. In this episode we talk about: As a case study: the California Board of Behavioral Sciences rolling back covid waivers and losing the progress made during the pandemic The emergency orders - covid waivers - that are expiring related to telehealth, tele-supervision The specifics of remote supervision when emergency orders are rescinded. Looking at permanent legislation concerns as well as the best-case timeline for when remote supervision can come back The concerns about moving backward and losing all progress made during the pandemic related to electronic and telehealth efforts The short-sightedness of requiring an in-person meeting when starting telehealth or tele-supervision Disciplinary action case regarding remote supervision and a prelicensed individual working from home – but there's so much more nuance than that Current legislation related to where mental health employees can work (which is actually quite flexible in CA) Equity and access issues related to not allowing clinicians to provide mental health from home On-going responsibilities for supervisors to ensure confidentiality and data security The requirements that supervisors have regardless of where supervisees are working Calls to Action to attend Board meetings for your licensing board, so you can be informed and help to shape future policy.   Our Generous Sponsor: Turning Point Turning Point is a financial planning firm that's focused exclusively on serving mental health professionals. They'll help you navigate all the important elements of your personal finances, like budgeting, investing, selecting retirement plans, managing student loan debt and evaluating big purchases, like your first home. And because they specialize in serving therapists in private practice, they'll help you navigate the finances of your practice, as well. They'll help you navigate bookkeeping, analyze the financial implications of changes like hiring clinicians or diversifying your income sources. They'll even help you consider strategies like the S-Corp tax election. Visit turningpointHQ.com to learn more and enter the promo code Modern Therapist for 30% off their Quick Start Coaching package. Resources mentioned: 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! SimplePractice Learning Motivo's tool regarding rules for tele-supervision in all 50 states CA Board of Behavioral Sciences Covid Information   Relevant Episodes: Covid-19 Legal and Ethical Updates Post Pandemic Practice Noteworthy Documentation Connect with us! Our Facebook Group – The Modern Therapists Group  Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated)   Curt Widhalm  00:00 This episode of Modern Therapist's Survival Guide is brought to you by Turning Point   Katie Vernoy  00:03 Turning Point Financial Life Planning helps therapists confidently navigate every aspect of their financial life from practice financials and personal budgeting to investing Tax Management and student loans. Visit Turning Point hq.com. To learn more and enter the promo code modern therapist for 30% off their quickstart coaching package.   Curt Widhalm  00:24 Listen at the end of the episode for more information.   Announcer  00:27 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, Kurt Wilhelm and Katie Vernoy.   Curt Widhalm  00:43 Welcome back modern therapists. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast about all things therapy therapists for therapists. by - I pause here because I don't know if we can call today's guest still a therapist he's but he is not.   Dr. Ben Caldwell  01:04 How dare you Curt!   Curt Widhalm  01:06 We are once again joined by Dr. Ben Caldwell, a longtime friend of the show and returning for like somewhere around his fourth appearance. But talking to us today about some stuff going on in the California Board of behavioral sciences and their attempts to go back to the Dark Ages, in some some legislation that they're crafting. This is important for all of our listeners, because in preparing for this episodes, I asked them is this just where licensing boards are creating solutions to problems that don't exist? But let's allow Ben to introduce himself.   Dr. Ben Caldwell  01:50 It's always good to be with you both. I'm Ben Caldwell, I'm the Education Director for simple practice learning and I am in point of fact a California licensed MFT.   Katie Vernoy  02:02 Yeah ....you two.   Curt Widhalm  02:06 So at the core of this is a subcommittee meeting which these are fantastic meetings, if you've ever seen TV shows like Parks and Rec, where they're open meetings for the government discusses things and people are allowed to show up. And many of these meetings are kind of lackluster as far as entertainment value. But important stuff happens at them. And recent telehealth subcommittee meeting of the California BBs happened here a couple of weeks ago. And Dr. Caldwell was there and relayed some information of some discussions as far as with COVID restrictions changing and some stories that we're going to share in this episode today that are going to illustrate why this is important enough for us to dedicate an episode to what should hopefully have been a rather boring meeting.   Dr. Ben Caldwell  03:06 Yeah, those those meetings are they are not compelling television. I'll put it that way. But it is important for us to be involved and aware of what's happening there. Because that that is how the proverbial sausage gets made when it comes to the policies that ultimately impact our work and can move us forward, backward or sideways kind of depending on what gets done. licensing boards generally around the country. They have open meetings and their their public meetings, anybody can show up anybody can be heard. And in general, I think boards are actually pretty responsive to the questions needs and desires of those people who do show up. It's just that very, very few people do. You know the BBS governs now more than 100,000, licensees and registrants across it's different license and registration types in California. And most of these meetings, there's five or 10, licensees are registered to actually show up, even if it means that the meetings are going to take longer, and there's going to be a little more argument on both sides. It's probably better for more people to be at those meetings and be heard and have some influence on the process.   Katie Vernoy  04:17 So I think this is a point of advocacy. And so I think one of the calls to action I'll just put it out right now is if you are a registrant or a licensee in a state, but especially California, since that's where we're talking about, like, go to some of these meetings or at least understand what's happening at these meetings so that if you want to make a statement you can but to frame this a little bit, I guess I am hearing that in this meeting that there are COVID waivers that were coming to a close that people have a response to There was also some ideas around telehealth and tele supervision. So So what is it actually that we're talking about? What should people be paying attention to right now as covered waivers are coming to a close.   Dr. Ben Caldwell  05:04 So, across the country, there have been emergency orders that were put into place around the beginning of the pandemic. That allowed for things like the increased use of Interstate practice, that allowed for increased use of telehealth with with less restriction. And that allowed for some other kinds of intended to be temporary changes that made it easier for us to engage in continuity of care, as everybody was stuck at home. Where we are now is that a lot of those emergency orders either have expired, or are going to be expiring in the relatively near term. Now California has hung on to a lot of those emergency orders and waivers longer than some other states have. But even in California, the waivers that have been issued by the Department of Consumer Affairs throughout the pandemic. Those are it sounds like it kind of in the process of winding down. And one of those waivers that has been really attention getting in California is the waiver that allows associates in private practice settings, to engage in online video supervision. If you go pre pandemic, can you look at sort of the the normal California law, video based supervision is only allowed for associates in nonprofit and other what the law calls exempt settings. Private Practice doesn't typically allow it. There was this waiver put into place at the beginning of COVID to allow for video based supervision in private practice. That waiver has been extended 60 days at a time throughout the pandemic. And the current extension of that waiver is set to expire at the end of October. I know that camped and others are continuing to advocate for additional extensions to that waiver. But the Department of Consumer Affairs ultimately makes the decision and they it sounds like had a meeting with some of their boards and bureaus. And what the BBs said in the most recent telehealth committee meeting was that it is and I wrote this down because it the language struck me quote, very highly unlikely, unquote, that there will be a further extension of that waiver.   Curt Widhalm  07:28 So I am aware of some efforts towards legislation to make that piece more permanent. And assuming that there's no substantial opposition to it. Like that would go into effect in 2023, based on at the earliest based on the way that California's legislative system works.   Dr. Ben Caldwell  07:50 Correct. That was one of the things that was actively discussed in that telehealth committee meeting. And they talked about kind of what the policy should be on an ongoing basis for allowing remote supervision across all work settings. I think there's general consensus that remote supervision should be allowed across all work settings. But there is this anxiety. And I keep asking folks for hard evidence to back it up. But I have yet to see any not say it doesn't exist. But I haven't seen any where some board members, some practitioners, some people are just weirdly nervous about allowing remote supervision across all work settings. And to the point where one of the proposals that the BBs was was weighing out in this committee meeting was a 5050 model, where remote supervision would be allowed across all work settings, but you'd have to do no more than 50% of supervision remotely. And the other half would have to be in person, which eliminates a lot of the prospective benefit of telehealth supervision or tele supervision. And thankfully of those people who did show up to the committee meeting, to a person almost universally, they all dragged the committee for even considering this concept because it doesn't make sense. It just wouldn't work. And where they landed, I think their proposal that they're going to carry forward is to allow tele supervision across all work settings, including private practice, conditioned upon there being at least one in person meeting between supervisor and supervisee within 60 days of the beginning of the supervision relationship, and that's kind of a parallel to the the current requirement for the supervisor to get SSI related to supervision you have to do that within 60 days at the beginning of supervision and that allows for people who are kind of pulled in in agency or hospital or other settings at the last minute so that you don't have to do a whole bunch of other stuff before you can supervise if you're needing to take over quickly. But there is a bunch of stuff you have to do within 60 days. I don't really know why that in person meeting is necessary. But I will take that long before a 5050 kind of approach.   Curt Widhalm  10:11 Now and in hearing this, this sounds like we've been through one pandemic, we've seen the world transformed. Have we learned nothing about the way that commerce and healthcare has transformed and that many consumers are expecting us to continue to be available?   Dr. Ben Caldwell  10:33 I don't know that we've learned nothing. I also don't know that we have taken all of the lessons that we potentially could have taken the BBs to their credit, they went out and they did a bunch of surveys about kind of how people felt about tele supervision specifically. And there is clearly not only demand but expectation that that the current telehealth status of our work is largely here to stay. And that the policies we have that govern our work should accommodate that, rather than moving us backward to how things were pre pandemic. And there is some, I guess there's conflicted opinion about that. But the hope among the majority of practitioners is that we're not going to have this weird back and forth of, you know, tele supervision was okay for a long time, and then it's going to be not okay for a little while, and that's going to be okay. Again, I don't know if there's a way to avoid that at this point, it seems kind of inevitable that the the waiver is not going to go all the way through 2023. But I don't know how we then avoid that kind of forward and back and forward again, kind of process.   Katie Vernoy  11:47 What, what are we seeing across the country? Because I actually right before we started recording, I saw something from motivo. And they had, you know, kind of all the tele supervision laws across 50 states. And I'll put that that tool in the show notes. But I was noticing that it's very variable across all 50 states and even across licensure types. I mean, yeah, maybe though. So maybe the question isn't what is everybody else doing? But but kind of digging more into this anxiety? I mean, to me the in the in person meeting, what is it supposed to accomplish, that you can accomplish? According to this theory, that maybe you don't agree with? But like, what is it supposed to accomplish? And how is it supposed to improve the supervision relationship?   Dr. Ben Caldwell  12:38 The theory goes, that if you meet with the supervisee, in person that provides an opportunity to most effectively gauge whether they are in fact appropriate for tele supervision. That's the theory. Again, I've seen no hard evidence to back that up. And I would even argue that that's kind of the same anxiety that we saw and heard at the beginning of the the use of telehealth in therapy, where you had a lot of practitioners saying, Well, you know, it's just not the same as face to face, there's this thing about the energy in the room, and I need to assess somebody in person to see their little micro expressions and, and pick up on their vibe, and et cetera, et cetera. And that just has not held up to research scrutiny. That telehealth provision of services seems to be every bit as effective as in person services, from the overwhelming majority of studies conducted to date. And I don't see any reason why supervision would be different in that regard that there's somehow something magical in an in person supervision meeting, that would require that process for supervision. But we don't need to do that in standard telehealth care. These are in many ways, parallel but not identical processes. It's just that in both of them, it seems like we can do our jobs effectively, remotely. And we have been doing that for a year and a half now. And so sometimes in these committee meetings, people will say things like, well, I don't want to open the floodgates. Well, that ship has sailed, the floodgates have been open for a year and a half. Yeah, and it's been fine. I've seen no evidence that this has created some kind of a massive problem in terms of supervisee misbehavior or treatment failure in therapy. You know, we've all been doing the best we can under really, really difficult circumstances. And it's been an interesting natural experiment. And the results of that experiment are that telehealth and tele supervision can be tremendously tremendously effective and don't appear to increase risks at least from the best information we have available. Now.   Curt Widhalm  15:00 Now, he brought up CAMFT. And CAMFT has a little bit different opinion in this or at least based on a disciplinary action case that has a lot of nuances to it, but seems to oversimplify it to be like, but there was this one discipline action. Actually two because both the supervisor and the supervisee were disciplined. This case largely was it This was actually all before the pandemic even happened when when these infractions occurred. But can you walk us through what happened and why this is pertinent in this discussion?   Dr. Ben Caldwell  15:45 Yeah, so the the disciplinary action that you're talking about, I'm familiar with it, it was finalized in 2020. And you're right that it was based on behavior that had occurred prior to the pandemic. But there is kind of separate from the rest of the the supervision rules in California, there is this one very specific section of the California Business and Professions Code that says, and I'm going to quoted here, because I knew we were going to be talking about it. A trainee associate or applicant for licensure, shall only perform mental health and related services at the places where their employer permits business to be conducted. That section of law is not further limited. There's no like clause after that, that says, except for x y&z so if you read that, if you take that language at face value, then as long as the employer allows, and as long as the services are otherwise legally and ethically compliant, so you're still maintaining data security, you're still protecting confidentiality, you're still doing all the stuff that you are normally required to do, then it appears to be fine under the law, for a supervisee to work from home. And that's in statute. That's not an emergency waiver, that that is the sort of normal case of the law as it exists right now. The disciplinary action that you're talking about, there were a lot of things going on in that case, beyond just the supervisor, you're working from home, that is one thing that was happening, but there were a lot of other shenanigans that were happening there. And when you look at the disciplinary action, it reflects this kind of kitchen sink approach to discipline that a lot of boards take where they unearth as many possible violations as they can find, because that gives them some leverage in negotiating what the ultimate discipline against the licensee is going to be. So they document all these different violations. They put them in front of the administrative law judge, if it gets that far if it gets to a hearing, and that becomes the basis for disciplinary action. In this particular case, the administrative law judge looked at the history of the law, the history of that clause that I just quoted, and basically came to the conclusion that well, the legislature didn't intend to say that you can work from just anywhere. that's problematic. Yeah, it is. Right? I mean, the the historical record lines up with this, that neither the BBs and in running that legislation, nor the legislature and making the change, really intended to allow for full time work from home. But you and I, and other people were not expected to be psychic about what the laws intent was, we're supposed to be able to read the law, make sense of it with kind of a plain language, good faith reading, and act accordingly. And the language here quite plainly reads as though it allows work from home, including full time work from home, if the employer allows it and if it is otherwise legally, and ethically compliant. So to your question, Kurt.   Curt Widhalm  19:17 Okay, and even even before you get to the question,   Dr. Ben Caldwell  19:20 yeah   Curt Widhalm  19:20 even before you get to the question. This would also be inconsistent with many licensing boards, definition of therapy taking place where the client is located, and would be completely irrelevant to where those services are being provided, as far as where the practitioner is located.   Dr. Ben Caldwell  19:43 Yeah, that's right. The licensing boards and ethics codes generally take the stance that therapy happens, where the client is physically located at the time of service, and that's reflected in our California telehealth laws that's reflected in professional ethics codes that quite often use that word located very intentionally and specifically. Now, that doesn't mean that boards can't restrict where the therapist is providing services from they have that authority if they choose to take it on. But the California standard right now is just what I read to you, if the employer allows it, it's permitted.   Katie Vernoy  20:20 What was the intent,   Dr. Ben Caldwell  20:23 The intent was to allow for supervisees to leave their agency settings to go do like home visits at client homes, to work in homeless outreach to go provide services at schools and other kind of third party locations, where the the super actually the employer allowed it and where they could again, take those steps to protect and preserve confidentiality, data, security, etc. There's nothing in the record of that law change that really contemplates full time work from home. Although there's a whole bunch of laws, where we could say that the current environment, the COVID, environment was not contemplated at the time that that law was created. We we didn't anticipate being in the middle of a pandemic. Yeah. And so the BBs has said, Well, we probably ought to go back and take a look at this language. Now in light of what we've seen since the pandemic of people working from home full time, but it's weird to me that they are looking at it with the potential impact of kind of walking back this allowance, when again, work from home seems to have largely been fine for a year and a half.   Katie Vernoy  21:38 What's interesting, because I remember when field based services was coming about, you know, I was working in community mental health at that time, and and there was a huge pushback from providers on how it wouldn't be as good as someone coming into the clinic. And so that has that same feel to it of, well, maybe it's not good enough. But I think honestly, you know, the pendulums keep swinging on what's the best and all of that stuff. But uh, but what I'm really hearing is that the law in itself, as is currently written provides the flexibility and creativity for employers to be adaptive and responsive to the clients they serve. And that also means they can be adaptive and responsive to the workforce, and allow for clinicians to live where they can afford to live and do services in areas that potentially have a different lineup. You know, it, to me, it just seems like walking it back would be hugely detrimental to quality of life and quality of work for clinicians, but also for access for meeting clients where they are I mean, it just it seems, it seems to me that there's a lot to be worried about if this gets walked back.   Dr. Ben Caldwell  22:57 I agree. And a couple of people brought up very eloquently the the point about access and equity in that recent telehealth committee meeting. You know, one of the great advantages of allowing work from home is that it allows clinicians to provide services, even if the clinician is working from a rural location. And if the clinician has some kind of medical or mental health issue that makes it difficult for them to leave their home. You know, are we just telling those folks well, tough, then you can't work in the mental health field? I don't think any of us intends that. And so the question then becomes really how much flexibility and accommodation are we supposed to? Or do we want to put into the law, and I like this statute as it is right now, I recognize that it does not line up with the historical intent. But I think the outcome is fantastic.   Katie Vernoy  23:53 My understanding of the best laws and policies are ones that are specific to what's most important, but don't get caught in the details of, you know, kind of current affairs, right, like so if we're, whether it's working in the field, whether it's working telehealth like this, the law itself provides enough guidance around it. And so to specify it becomes more time limited, it would it would date it, and it would make it so it would have to change again soon. Whereas as it's written, it actually does what it needs to do. At least that's what I'm hearing that you're saying.   Dr. Ben Caldwell  24:30 Yeah, I mean, the law is intended to be revised over time. It's a it's a living set of documents, right? And so we're always responding to what's happening in the larger world around us and hopefully learning more about how professionals work how we can best provide services. From the BBs perspective. They are fundamentally a Public Protection Agency. So they're most interested in developing laws and regulations that keep clients safe. And to that end, I think we've got Now a year and a half worth of data that suggests that when the therapist is working from home that does not seem to impede client safety. Now there is still a supervisor responsibility there in terms of making sure that that supervisee really can provide a confidential and data secure environment. But to your point, Katie, I think that the best laws are ones that both allow and enforce a level of appropriate professional responsibility and judgment. And so do we want to be really prescriptive in terms of how supervisors are supposed to ensure that? Or do we just want to say that supervisors have that responsibility of ensuring that their supervisors are providing data security, confidentiality, etc, and let supervisors kind of do their jobs?   Curt Widhalm  25:50 So I want to talk in generalities, that almost sounded like a real word. I want to talk generally about some of the disciplinary stuff that this seems to be based on because you talked about the administrative law judge, looking at the intention behind the law. But at face value, some of the concerns about oversight seems to be really the foundations of a lot of these anxieties, the the, some of the cardigan cartel pearl clutching seems to be based on here. Now, my understanding is this disciplinary action is already written into law as far as the kinds of oversights that a supervisor should be having over their supervisees. Anyway, am I correct in that?   Dr. Ben Caldwell  26:49 Yeah, so with the, the disciplinary action I was talking about earlier, there, there were so many problematic things happening in terms of the supervisee sort of acting independently, with the blessing of the supervisor, as best as can be read, they're to go out and get office space and set things up, like it was a supervisees own business, do independent billing, etc, etc, there's a there's a lot of stuff there in terms of the oversight that the supervisor was supposed to be providing that they were not providing, apparently.   Curt Widhalm  27:26 And that is already in the law as far as this kind of stuff. And so if I'm hearing and making up what I have not attended this meeting, making up what I imagined that the conversation is, well, if there's even less oversights by not having met them physically, one time that this is going to prevent all sorts of future bad supervisee behavior. When you know, I have a practice, I have supervisees, in my practice, they can do stuff off the clock anyway, that would do any of these things anyway, that are already against the law.   Dr. Ben Caldwell  28:08 Yeah, and that's one of the challenges, I think, from a from a regulatory framework, but also for for you and me and everybody else, as supervisors, you know, we do the best we can and ensuring that the behavior of our supervisees is legally and ethically compliant. And there are those situations where, you know, there may be a disciplinary action against a supervisee, but not their supervisor, because the supervisee did go off kind of on their own didn't tell the supervisor about stuff they were doing. And the supervisor was providing the kind of expected and intended level of supervision. I don't think there's any amount of in person requirement or any level of regulation that is going to effectively prevent every supervisee, who has sort of ill intent from going out and doing what they decide on their own to do. I think the question becomes this balance of how much regulation do you do? How prescriptive Do you get in telling supervisors how to do their jobs? And what what levers Do you want to pull to try to ensure that supervision happens in the way that you would like for it to happen, you know, one of the levers you can pull is requiring a certain level of in person supervision. But does that actually impact anything in terms of legal and ethical compliance beyond that? I don't know.   Curt Widhalm  29:35 It would seem with a lot of the waivers and stuff that have been in place across the country that we would not want to become overly restrictive for when and if there is a next pandemic or worldwide event. In your opinion here does the direction that these discussions are going at the at the licensing board and Possibly, and other licensing boards across the country seem to be ignoring some of that flexibility that would allow for a profession to need to respond in an event, like a pandemic, if it were to happen again.   Dr. Ben Caldwell  30:17 Yeah, I mean, as Katie said, the, the way that boards are moving and the sort of default states for boards across the country, it's all over the map. There are some that that really had flexible policies in place before the pandemic. There are some who I think I've taken lessons from the pandemic and are wanting to move in a direction of flexibility. And there are others who might say, once the pandemic is and take this with a giant grain of salt, more or less over, that they just want to go back to what the default state had been before that. It's, it's a reasonable thing to ask what should be sort of the the normal state of regulation for mental health work. And then what should be the exception, where we do things a little bit differently because an emergency demands it. I think that at least the preponderance of what I've seen in Policymaking around the country, boards are kind of moving in the direction of more allowance of telehealth more allowance of even temporary practice across state lines. Of course, all the professions are working hard on trying to improve license portability. And those are good changes. policy does appropriately, move slowly. You know, we don't want the law to be so reactive to current events, that you're getting constant whiplash, you're being pushed and pulled in different directions based on the events of the past few weeks or past few months. But I think we are going to see some lasting change, especially around telehealth regulation. What's going to be weird, not just in California, but in a bunch of places around the country, is that with putting into policy, what we've learned from the pandemic, we've got sort of this exceptional state right now, where where lots of places are still under some form of emergency authorizations, we're going to go back to the prior default state, at least for a little while, as new policies are being crafted run through state legislatures and implemented, and then we're going to step forward again, to a new normal, that better accounts for the flexibility that has been shown to be really effective during the pandemic. It's, it is a weird forward than back then forward again. And I don't think every state board is going to land in the same place in terms of the adaptations they want to make on an ongoing basis. But I do think the, the overall path is a good one. It's a path toward increased use of telehealth increased authorization for telehealth. It's a path toward better license portability. It's a path toward flexibility in the supervision process. But it's not a straight line to get there.   Curt Widhalm  33:18 If you've hung with us this late in the episode, the call to action here really is keep an eye on your licensing boards. And to know that there is a lot of stuff that you might have to sit through, but could drastically impact the way that you go about your business or the way that you go about your practice. And these are the kinds of mundane things that those of us who've been in the advocacy world for a while. We hear complaints 5678 years later of like, Well, why didn't anybody say anything. And that could have steered a direction, you know, that prevented some of this stuff from happening. And as Dr. Caldwell was pointing out here that for many states, this might be a forced return back to pre pandemic ways while the legislative process catches up with some of the actions that we've been able to do during this pandemic. But go and be a part of those conversations as that legislation is being crafted so that way, you can actually talk with licensing boards, law makers about how this has played out in the real world. And that is something that is tremendously impactful when talking with people like politicians who have no idea about what we do. So thank you for spending some time with us today. And where can people find out more about you and the stuff that you're working on?   Dr. Ben Caldwell  35:01 They can find out more about me and my stuff at simple practice learning.com. And just I want to thank you both as always, for having me on, these are really important conversations to have. And I couldn't have said that better for it. if folks want to know what policy changes are coming down the pike show up, come to these meetings. It's it's not unusual that we will hear from people to change takes effect saying, what How did this happen? I didn't know about this. Well, if you go to your board meetings, you can know about those changes a year or more ahead of time. And in fact, you can have real influence on what those changes are going to look like. I love it. When more folks come to these board meetings, it makes for better conversation and informed decision making for everybody.   Katie Vernoy  35:48 And it's probably a little less boring for you,   35:50 It is a lot less boring. Listen, like in parks and rec people sometimes will show up with the most off the wall. Wild comments that have nothing to do with anything. And if there is I'll admit this certain part of my heart that is it warmed when that happens.   Katie Vernoy  36:13 I've got my marching orders. I'll be there next time.   Curt Widhalm  36:17 Until next time, I'm Curt Widhalm with Katie Vernoy and Dr. Ben Caldwell.   Katie Vernoy  36:22 Thanks again to our sponsor Turning Point   Curt Widhalm  36:25 we wanted to tell you a little bit more about our sponsor turning points. Turning Points is a financial planning firm that's focused exclusively on serving mental health professionals to help you navigate all the important elements of your personal finances like budgeting, investing, selecting retirement plans, managing student loan debt and evaluating big purchases, like your first home. And because they specialize in serving therapists and private practice, so help you navigate the finances of your practice as well. They'll help you navigate bookkeeping, analyze the financial implications of changes like hiring clinicians or diversifying your income sources. They'll even help you consider strategies like S corp tax collection,   Katie Vernoy  37:02 and for listeners of MTSG you'll receive 30% off the price of their quickstart coaching intensive just enter promo code modern therapist when signing up. And don't forget to visit Turning Point hq.com to download your free finance quickstart guide for therapists.   Announcer  37:19 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.    

    Reimagining Therapy Reimagined

    Play Episode Listen Later Oct 11, 2021 25:59

    Reimagining Therapy Reimagined Curt and Katie chat about their decision to step back from the Therapy Reimagined Conference and what they will be focusing their energy on moving forward. We explore how we came to this decision and the importance of examining what is working in your business practice. We also talk about how other Modern Therapists can get involved in the Therapy Reimagined movement. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: Taking a step back and looking at what the mission for Therapy Reimagined is. Why we decided to take a step back from the Therapy Reimagined Conference. What we will be focusing our energy on in place of the conference. How and what you can begin advocating for to help improve the field. Factors that get in the way of advocacy. Ways to get involved with Therapy Reimagined. Our Generous Sponsors: Turning Point Turning Point is a financial planning firm that's focused exclusively on serving mental health professionals. They'll help you navigate all the important elements of your personal finances, like budgeting, investing, selecting retirement plans, managing student loan debt and evaluating big purchases, like your first home. And because they specialize in serving therapists in private practice, they'll help you navigate the finances of your practice, as well. They'll help you navigate bookkeeping, analyze the financial implications of changes like hiring clinicians or diversifying your income sources. They'll even help you consider strategies like the S-Corp tax election. Visit turningpointHQ.com to learn more and enter the promo code Modern Therapist for 30% off their Quick Start Coaching package. Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might 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! Therapy Reimagined (4 Tenets) Relevant Episodes: Therapy Reimagined Defining the Therapy Movement Therapy of Tomorrow The Fight to Save Psychotherapy Why YOU Shouldn't Sell Out to Betterhelp   Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2021  Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, 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 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. 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Full Transcript (autogenerated):   Curt Widhalm  00:00 This episode of Modern Therapist Survival Guide is brought to you by Turning Point   Katie Vernoy  00:00 Turning Point financial life planning helps therapists confidently navigate every aspect of their financial life from practice financials and personal budgeting to investing Tax Management and student loans. Visit TurningPointhq.com. To learn more and enter the promo code Modern Therapist for 30% off their quickstart coaching package.   Curt Widhalm  00:24 Listen at the end of the episode for more information.   Announcer  00:27 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  00:43 Welcome back monitor therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm, with Katie Vernoy. And this is the podcast that is all things therapists, things that we do things we look at our profession about the struggles that we face coming into this fields, and about this time of year is when we're always coming out of our therapy reimagined conference. And some years we've recorded a live podcast at the conference. But this is the time of year when we reflect on what our mission is, and how we're going about that evaluating if we're being effective or not. And one of the things that we announced at this year's therapy reimagined conference is that we're not doing a therapy reimagined conference in 2022, that we have decided that our conference is going to go and live on a farm upstate, where it can have plenty of room to roam around and play with other conferences. But we are looking at, and part of the decision to not who is is the tremendous amount of time that it takes for our very small team to put together an event that is a snapshot in time of a lot of work that we do, it's hundreds, if not 1000s, of man hours to put on an event that Katie and I feel that some of that time can be actually better done to further admission in some other ways. And taking a step back as far as 2022 goes, does allow for us to refocus on our mission.   Katie Vernoy  02:31 Yes, and I think some of it came into stark relief, because we were putting on a conference two years in a row during a pandemic, with planning the conference numerous times, interacting around, you know, the COVID and the other stuff, but also zoom fatigue, and it just kind of the general malaise that I think has set in on all of us. And so, to me, I found that when we were getting ready for this year's conference, there was a lot I was really excited about. But there was a lot where I felt like, if I had more time I could do x if I had more time right now that wasn't dedicated to this conference, I could really do more for the mission that we've set for ourselves. And so and I know Kurt, you were feeling the same way. So I use is cuz I don't want to speak for you. But um, the things that I really see, being really important for us is looking at reevaluating how we're using our resources, time, team money, all of those things, because there's a lot that's happening in the field of mental health right now. I'm sure we'll do another workforce podcast around people leaving the field. And there's also a lot of initiatives that are starting to come forward that may help therapists but certainly are designed to try to make therapy more accessible. And so there's just a lot where I think we need boots on the ground, to be able to make sure that our profession is actually going in the right direction that we're using this time to make a difference versus being so stuck in the grind of whether it's our practices or a big annual conference or whatever. When Kurt and I were talking, I thought it was important that we actually for folks who haven't been with us that long, we've got a lot of new listeners lately, to really let people know what our mission is. We have a website that is dedicated to the podcast and to the therapy reimagined mission and so I'm I'll read kind of the main four tenants that we put up on this website, but we'll also link to it in the show notes. The four things that we're really looking at is create sustainable careers supporting sound business practices, the incorporation of technology and adequate pay for all therapists. The second one is improved education to reflect modern practices support, support high quality clinical work, trained therapists to care for themselves and address the diversity in our communities. Increased representation across the field, in supporting inclusion on our stages in our classrooms and in our offices. And, you know, kind of the one of the moment improve access to mental health care without requiring sacrifice, financial instability and burnout from therapists. So there's a lot there. It's a very broad mission. It's more just like, how do we make our profession better? But I think there's a lot that we could be doing here and, and so to me, I think for this episode, we kind of turn to what are we looking at? How do we do this? How do we help our fellow Modern Therapists to make our profession better?   Curt Widhalm  05:50 And but we have a number of projects that we're working on that we'll be announcing it has they come up, because one of the things that we have learned is get things kind of figured out before we   Katie Vernoy  06:05 very true, very true, we get so excited, and then we get to many projects. So yes, we will, we will wait to announce the ones till we're really ready.   Curt Widhalm  06:14 The podcast isn't going to change. And in fact, it's probably might allow us to become a lot better and a lot more focused and being able to bring messages that especially leading up to conference time, some of our podcasts, we have to record out quite a bit of head of time. So that way you can put on a conference. But   Katie Vernoy  06:36 yeah, we that little logistical thing of Hey, for the next two months, most of our focus will be the conference, that we have freedom to not do that this year.   Curt Widhalm  06:44 We're we're not going anywhere. As far as the podcast goes, we're going to be adding out some other things, we started a little online place for some continuing education, if that is something that we'll probably continue on with our conference that will allow us to bring some content to you and some new and other ways. Yes. And that takes off a couple of some of these mission points as far as providing still a good place for improving education for therapists and being able to bring what I think a lot of other conferences have shied away from, which is content about running business practices better.   Katie Vernoy  07:27 But also topics that push the envelope. It's interesting, because for me, I feel like we've been so immersed in our conference segment, which is misfits, outliers pushing against the status quo, like that just feels so endemic that I'm like, Oh, well, everybody has topics like this. And I think that's not actually true. Right. So continuing to bring new perspective to the clinical work to how people show up in the room, so that that's still going to be happening. And I like to think about that as like a learning community where we find different new and different ways to learn together through the podcast through this learning platform that we built out for the conference. I think that's all going to be really fun, regardless of exactly what it looks like, which we still don't know. So we're not going to promise.   Curt Widhalm  08:11 One of the things that I'm really looking forward to re establishing in our work is piece of the advocacy of really getting boots on the ground. And Katie mentioned that we're working on another workforce issue. We'll we'll get into some of these details here in a little bit. But I'm seeing across the country, a lot more bills going through legislators about dealing with mental health workforce shortages. And knowing that we can't rely solely on the professional organizations to be able to voice what it is that we actually need as workers that beyond getting like an extra Subway sandwich, you know, in an appreciation lunch once a month, that there are really structural problems with the way that our field is funded, and working with legislators outside of legislative season, when they're busy focusing on hundreds of bills. Yes, this is where some of the free time that we have not in planning a next year's conference right now is we're going to come up with some bullet points for you to actually start talking with your legislative representatives about in order to deal with this. You know, I can't wait to record this next episode. But it is going to be something where there is a call to action that's necessary because just as a little preview, some states are looking at having the National Guard come in to staff, residential facilities. Yeah, that's not good. So these are the kinds of things that allow for our focus to take some time into actually start making some impact to leave this as a better profession for those going forward.   Katie Vernoy  10:05 I think advocacy and activism can feel daunting. And I think it can also feel exhausting to be an activist or an advocate for your own profession. It's like, Hey, I gave it the office, so to speak. And I think for Kurt, and for me, I think this is clearly a huge passion of ours, we've been involved at the state level with our professional association with our board. And I think it's something where we can do some of the legwork, and I'm sure there's others like us out there that maybe can do the legwork in other states. And we could potentially put together a repository of information so people could activate on a local level on a national level on an international level and recognize we've got listeners from all over the place. And so I think it's, it's something where sharing information and doing the part that you can, maybe it's not always sufficient, but it's certainly good enough.   Curt Widhalm  11:06 And this comes across not just in legislative bills, right? Sure. One of the episodes that not one of the episodes, the absolute most popular episode that we've done, is about not selling out to companies like betterhelp. Yes. And some of the advocacy and stuff that we need to do is going beyond just complaining about companies Yes. And being able to turn that energy into something productive, based on the download numbers on this episode. This is something that really resonates with our community, we crafted our therapy, reimagined conference, talk around surviving and thriving in your own practices in a world where these apps are coming out. There's more steps that we can do. And it's well beyond the reaches of licensing boards, it's well beyond the reaches, which professional organizations are even starting to focus on. Yeah, that really does take more than the two of us clicking on every betterhelp ad that we see trying to take them down $1 at a time and advertising money.   Katie Vernoy  12:24 Oh, dear. There we go. Again, I think the thing that I'm hearing you say current and I think this is what's what's really important is that yes, there are things that need to happen at a legislative level at a policy level. And then there's kind of how we spend our dollars, so to speak, or how we spend our energy. And so one of the things that I'm really looking at, and I've been talking to some fellow modern therapists, and I'm going to be doing some more research. And I know Kurt, you're you're involved in this as well is really looking at how do we make a decision on where we work, who we work with, where we spend our money, because those things are actually hugely impactful on on what flies, better help and other organizations, conglomerates, you know, whatever, would not survive if we didn't work there. And so I think it's something where being able to get more information to everyone so that we can make those decisions, I think is something that's important to us. But we also are just two people, with a few people helping us out. And so we can't look everywhere at once. And so as always, we're always saying like, hey, if there's something that we need to be looking at, if there's something you're looking at that you want to talk with us about on the podcast, please send us a message podcast at therapy, reimagined, calm, but I think it's something where sharing information so that we're making more informed decisions is something that we can do much better when we have more time. And I think if you're listening and taking action based on that information, it has a ripple effect that I think is really impactful for our profession.   Curt Widhalm  14:07 And one of the things we hear at the conference from our attendees year after year, especially people who are attending the first time as Where were you earlier in my career.   Katie Vernoy  14:19 And that will say we've been here.   Curt Widhalm  14:22 And you know, the more the longer that we do the stuff that we do, that is becoming part of my answers. And that not having other people entering in our profession feeling the same way. And this is the call to action of being able to help us being able to take some of the steps that we do. And being able to do that in your own community is your own professional organizations, your own licensing boards, your own even therapists, culture and community around you does make it to where It's not the same complaints over and over. Part of what Katie and I thought, when we were originally launching the podcast back in 2017, was, if we just start talking about some of the issues that we hear in the same conversations over and over again, and we record them, then maybe this can serve as a resource for people to not have to ask the same questions over and over again. And it's worked a little bit, it helps to be able to post an old podcast up and say, here's our take on this from when we talked about this before. And in some areas, it has really served to shift some of the conversations that some of this deals with, like our work on developing a statement about paying pre licensees that, really being able to see our profession, in some respects, be able to stand up and be like, we have master's degrees or doctorate degrees, we should get paid for the work that we do. And part of this is how much I recognize that, for a profession like ours, where the median age is a lot higher than it is in a lot of other professions, we hold on to a lot of old ways. And a lot of the things that is frustrating that we have had the same conversations over and over again, is that the more vocal modern therapists are, the more that we can start to sway what the attitudes about our profession really are. I'm sensing that we are getting this tipping point. And the reason that I know this is the more that I hear from more established seasoned therapists about how we're making it harder for people to get hired at low rates. Yeah, that people are asking for things like, oh, living wage, rather than working for free. But I know that this tide is changing. A lot of this is beyond what we do. But sure, it's giving the permission to be able to make this a sustainable career. And that is very much part of our mission. And we see this in a number of ways. But hopefully, it's those people who are listening to us those people who are coming to our conference for the first time, we're able to take away some of those other complaints from future therapists to be able to say, there was a time when you guys didn't get paid.   Katie Vernoy  17:38 Yeah, that would be cool. Yeah, I don't know what to expect as far as what's reasonable, or not even reasonable. Maybe that's not the right word. But what, what's realistic to expect as far as the amount of changes we can make, and I know we've talked about how to approach change at different times, whether it's working within the system, or burning it all down and starting fresh, or whatever it is. And I think, to me have been one of those therapists that has been around for quite some time, it's just blows my mind that I've been a therapist for 20 years. And it's something where I've burned it down, I've quit things and a half. And I've also worked within the system. And I don't know that either of those things can work without the other completely. I think there needs to be people working in both, both arenas making these differences. And I'm not sure how much can be done it within within the remainder of my career, I've got you know, I've been a therapist for 20 years, I'll probably be a therapist for another 20 years. So I'm right smack dab in the middle. I don't know what's reasonable to expect. And maybe this is just me feeling reflective and a little bit sentimental after the conference is finished. But I'm excited about the work we can do. And I also am trying to stay more cautiously optimistic about what's actually possible.   Curt Widhalm  19:11 And I'm looking at it as fast not doing conference. That way we can focus on is more sustained effort, you know, avoiding the Tony Robbins effect, you know, where people go to the, you know, great motivational speakers, and they walk out and they're like, I'm gonna change everything about my life.   Katie Vernoy  19:33 Everything is gonna be amazing now because I was at a three day conference.   Curt Widhalm  19:38 And people have done research on people who attend Tony Robbins events. It's why it's named after him. Yeah. That effect wears off after about 72 hours.   Katie Vernoy  19:49 Oh, geez. The length of that of the conference maybe is the length of time that you remain, you keep that sustain that that effort and so   Curt Widhalm  19:59 what We want is for us to be able to not just focus on creating kind of this groundswell of energy that everyone returns back to their normal lives, but is able to kind of throughout the year, hold some consistent pressure on the community around them, you know, they   Katie Vernoy  20:20 can't escape us, they will always have us all the time, and we will constantly be working.   Curt Widhalm  20:26 Well, I mean, it's, it's the things like, you know, you're talking about having left agencies in a house before. And yes, but it's also taking a hard look at ourselves and the culture that we bring, because I look at some of the Facebook groups where somebody, you know, announces that they're leaving a group, because they're not satisfied with the way that the community support is. And looking at the atrocious way that the Facebook communities respond in those situations, tells me that there's a lot of therapists that are just fine, being part of that toxicity.   Katie Vernoy  21:09 And the status quo. Yeah, and I think there are times when the people leaving and a half are actually part of the toxic culture, too. So we're not commenting on specific people who have left in a half. But I think it's it's something where the response, I guess, regardless of whether someone leaving is part of the toxicity, or whether the environment is toxic, or both, the response is to sustain the status   Curt Widhalm  21:36 quo, the same status quo that everyone complains about.   Katie Vernoy  21:40 Yes. So I think consistent effort, it building a consistent culture of learning and growing and challenging the status quo and working to combat complacency. I think I like that idea. I also am just acknowledging that people may need to opt out at times, because it is a lot of work to sustain this type of effort to keep pushing forward. Especially if there are other things that people are interested in advocating for and activating for. So we recognize that but we're gonna maintain consistency are gonna be there. Week after week, with the podcast month after month, with whatever else we're doing, we're going to be pushing forward these concepts to make all of our careers better.   Curt Widhalm  22:28 And a final note from me on this is, this is also permission for you that we believe in the things that we talked about on this podcast, we do them in our practices, and part of what you're witnessing is reevaluating what's working for your business and what's not. And Katie, and I came to the conclusion that conferences, not helping us in the way that we want to spread our mission. It's something where it's okay to take a step back. And really what we're giving ourselves permission on, is we come out of therapy, reimagined, 2021, Hayes is you don't have to have everything figured out at every step along the way. Part of redeveloping your business plan is looking at what's working and what's not, we're in that phase of, we know what's not working for us, and gonna be sitting down and clarifying and continuing to bring you great content.   Katie Vernoy  23:30 And a final note from me, because I think part of our assessment and evaluation is that it's the two of us and a few other people that have been doing a lot of this work. And we've had opportunities and I hope, have taken advantage of opportunities to collaborate with a number of people, with our speakers with our sponsors and partners. We've collaborated with a lot of people. But the word that kept resonating for me as I was thinking about how we move forward is co creation. And so my call to action is stay involved. But let us know if you actually want to take a step forward with us and help us with creating content or researching something or spotlighting an area of our profession that needs a closer look. You know, definitely reach out to us but Kurt and I have each have our own experiences and perspectives and and we need to broaden that in the work that we do. And so if you want to be part of this co creation of the next steps, please reach out and let us know.   Curt Widhalm  24:39 Until next time, I'm Kurt, Katie Vernoy.   Katie Vernoy  24:43 Thanks again to our sponsor turning point,   Curt Widhalm  24:46 we wanted to tell you a little bit more about our sponsor turning points. Turning Points is a financial planning firm that's focused exclusively on serving mental health professionals to help you navigate all the important elements of your personal finances like budgeting investing Selecting retirement plans, managing student loan debts and evaluating big purchases, like your first home, and because they specialize in serving therapists and private practice, so help you navigate the finances of your practice as well. They'll help you navigate bookkeeping, analyze the financial implications of changes, like hiring clinicians or diversifying your income sources will even help you consider strategies like S corp tax election,   Katie Vernoy  25:24 And for listeners of MTSG you'll receive 30% off the price of their quickstart coaching intensive just enter promo code modern therapist when signing up. And don't forget to visit TurningPointhq.com to download your free finance quickstart guide for therapists. Thank you   Announcer  25:41 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.

    Why You Shouldn't Just Do it All Yourself

    Play Episode Listen Later Oct 4, 2021 36:55

    Why You Shouldn't Just Do it All Yourself An interview with Bibi Goldstein, on how clinicians can grow their business by assessing what they can automate, delegate, or eliminate. We explore the importance of getting rid of the tasks you don't enjoy doing and benefit of creating more time for things you do enjoy (including getting some rest!). We also talk about how to balance spending money to outsource responsibilities in order to make revenue.  It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.   Interview with Bibi Goldstein, Founder of Buying Time, LLC Buying Time, LLC founder, Bibi Goldstein is a time management and systems expert, speaker, co-author of Get Organized Today, Navigating Entrepreneurship and Business Success with Ease, where she provides information on establishing systems in every size business. She is an Infusionsoft Certified Partner and works with many entrepreneurs to automate and systemize their businesses in order to maximize their time. Her team proudly launched www.virtualassistantsuniversity.com in 2021 to provide an opportunity for the millions of people finding themselves needing alternatives to a traditional work environment due to the pandemic. She is an active member of her business community in the South Bay. Bibi is current chair for the South Bay Women's Conference, Board Member at the Manhattan Beach Chamber of Commerce, Community Chair/Board Member at the Redondo Beach Chamber of Commerce, Advisory Board Member for Walk With Sally, a mentoring program and Past President and current Vice President of the South Bay Business Women's Association, she served as a committee member and past chair for the Manhattan Beach Women In Business, past President of the Kiwanis Club of Manhattan Beach, and a member of the 2011 class of Leadership Redondo. Bibi has strong lifelong ties to the South Bay community, she lives in Redondo Beach with her husband Mark and has a daughter Julie who is a hairstylist and a local entrepreneur.   In this episode we talk about: Who Bibi Goldstein is and what she puts out in the world. What people, specifically healers, get wrong in scaling their businesses. How clinicians can figure out what to outsource for their business and what to manage themselves. Understanding how to balance what outsourcing will cost you and how much it will make you. Important things new clinicians should know about scaling their business and action steps they can take now. The things clinicians should not outsource. How clinicians can do a quick assessment of what they need to automate, delegate, or eliminate. Understanding the importance of rest and doing the things you enjoy to help grow your practice. Getting over not wanting to outsource because of anxiety about how “bad” you've been doing it thus far. What Buying Time and Virtual Assistant University are all about. Our Generous Sponsor: Turning Point Turning Point is a financial planning firm that's focused exclusively on serving mental health professionals. They'll help you navigate all the important elements of your personal finances, like budgeting, investing, selecting retirement plans, managing student loan debt and evaluating big purchases, like your first home. And because they specialize in serving therapists in private practice, they'll help you navigate the finances of your practice, as well. They'll help you navigate bookkeeping, analyze the financial implications of changes like hiring clinicians or diversifying your income sources. They'll even help you consider strategies like the S-Corp tax election. Visit turningpointHQ.com to learn more and enter the promo code Modern Therapist for 30% off their Quick Start Coaching package. Resources mentioned: 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! Buying Time LLC Virtual Assistant University Bibi Demonstrating Delegation To Technology Social Media: @buyingtimellc, @virtualassistantuniversity, @bibigoldstein Relevant Episodes: Post Pandemic Practice Mental Health Entrepreneurship Don't Take Tax Advice from Therapists Creating Opportunities Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined Conferences   Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated)   Curt Widhalm  00:00 This episode of Modern Therapist Survival Guide is brought to you by Turning Point.   Katie Vernoy  00:04 Turning Point financial life planning helps therapists confidently navigate every aspect of their financial life from practice financials and personal budgeting to investing Tax Management and student loans. Visit Turning Point hq.com. To learn more and enter the promo code modern therapist for 30% off their quickstart coaching package.   Curt Widhalm  00:24 Listen at the end of the episode for more information.   Announcer  00:27 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  00:43 Welcome back Modern Therapists This is The Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. This is the podcast for therapists and all the things we do the ways that we see clients the ways that we run our business. Our guest today is Bibi Goldstein, she has helped us put on the therapy reimagined conference last few years really helped us to up our game with that. And she is the owner and founder of Buying Time LLC, a lot of really good virtual assistant type stuff and helping us and helping you our audience to figure out some ways, the advantages of having to have a team to help expand the things that you do for your clients and improve your clinical practice. So thank you very much for spending some time with us.   Bibi Goldstein  01:33 I'm so excited to spend time with two of my favorite people.   Katie Vernoy  01:36 Oh, we're really excited to have you too. And I have to admit, I am really excited about this conversation because I think everything, maybe not every single thing. But the foundational things that I've learned about delegating, automating running my business more simply, all of those things have been in conversation with you. And you've been your team has been my team since almost I began my business. And so I'm excited that we're finally taking this opportunity to talk about this because the depth of your experience and knowledge, I think it's gonna be a big source of relief for our audience, because I think this is something that's really scary for them. So the first question we ask everyone is, who are you? And what are you putting out into the world?   Bibi Goldstein  02:23 Well, in the broad sense of who I am, I'm going off of the general titles. I'm a mother and a wife, and I'm somebody who enjoys supporting people. And that's what I'm putting out in the world. I love the idea that what I do for a living, almost feels the same as what I like to do in my volunteer work and things like that in where you can support people through using your skill set and your knowledge to do something bigger and better with their talents.   Katie Vernoy  02:58 I love that I know, you could probably answer the next question with a very long answer. Because this is part of how you assess what what people need, but what to therapists and other small business owners because I know you work with a lot of different types of business owners, but helpers are one of the one of your hearts one of the people of your heart are their helpers. What do they do? What do they often get wrong when building or scaling their businesses? Well, first, I   Bibi Goldstein  03:25 could probably answer every question with a really, really long answer. You know, I, I'm sure that everybody who knows me would say that I have lots of answers for everything. But I think that the whole idea of what you went to school to become a therapist, you didn't go to school to become a business person. And I think that one of the areas that many people get get wrong is that this idea that they can run everything by themselves, or that they can outsource everything, instead of finding that middle ground and the bridge that says how do I be a really great practitioner and a really great therapist, a really great coach, whatever it is, and at the same time, be able to build my business and grow my business, and have not have any knowledge of that, you know, everything from marketing, to accounting to scheduling all of those pieces, you go into that as a therapist thinking, I'm going to go help people. That's what my world is going to be I want to go help people. And if that's what you want to do, and help people then how do you do that and still make sure that the rent got paid and the lights got paid and all of these other things because you're focused on helping people.   Curt Widhalm  04:51 How should people have that honest assessment about themselves, what they should outsource what they should continue to be doing for themselves. Have you work with people to help them find like, here's where you're wasting a lot of time or a lot of money or like, here's where you're just really not good at this and you should spend money to get somebody who's better at doing this.   Bibi Goldstein  05:14 I think that there's a couple of different things that people that we look at when we talk with many of our clients for the first time, the area that we focus on primarily is what is that thing that you hate doing? That is first place that we go. Because what we don't like we procrastinate, all of us do in everything in our lives, right? If it wasn't for my husband, laundry, laundry would never get done in this house, as I hate it. Same with cooking. But you know what, give me a sink full of dishes and I'm happy. And I can do do that, you know, you find those things that make you happy that you love doing but you outsource those things that you hate doing. So you start there, find those things that you hate doing. The second place would be find the things that you're really not that good at. So you may not hate it, but you may not be so great at it, right? If you find yourself consistently making mistakes in balancing your bank register, then maybe it's time to hire a bookkeeper.   Katie Vernoy  06:24 Yeah, that was the first one for me, right? Like I was like, baby, I have a whole drawer full of receipts. And I have not balanced my checkbook, basically, or my books for most of the year. So I hated it. And I was bad at it. So okay, sorry, back to your list.   Bibi Goldstein  06:46 So what you hate what you're bad at? And then I always try to get folks to look at those things that are not value generating, revenue generating. And when I say value, is it something that brings value to your client? For you to do those things? Does it matter to your client? If you're the person who's posting on your social media? Is that a value based thing, even though you love it, and you love being on social media, and you like being out there and doing these? Maybe that's not the thing that brings value in traditional businesses, the the idea of revenue generating is the first place that we think that right? If, and this is always a tough conversation in the world of professionals, whether it's therapists, attorneys, doctors, whatever you name it, we, you know, we support clients in all of those areas. I would say that you have to think about, can I make more money in this hour that I'm spending doing this? versus handing it to somebody else? Who would charge less than what I charge an hour? Yeah, it still kind of come away ahead of the game. And it's it's it's a phrase that I heard a long time ago, and I continue to use, and that is not not, what is it going to cost me? But what is it going to make me say more about that? You know, that concept around if you charge $150 an hour, and that work that you're spending an hour or two doing? You could be seeing somebody for that $150? Yeah, and you can pay somebody between 40 and $70, for an expertise at something, you're still making money. And that's the part that I think that we get stuck on as business owners, myself included, it's constantly this Well, can we really do that? Can we is is that really in our budget? And well, wait a second, what is that going to free up? Yeah. What is that going to free up for me? And so when we think about those things, I think it's super important for us to constantly look at what are our financial goals? And within those financial goals? Can we add some more hours where we can take away some of the administrative part of running our business   Katie Vernoy  09:17 in the tasks that I initially delegated to your team, which was my bookkeeping, I would spend a day, every couple of months trying to sort through it. And I recognize not only was it the hours that I could be either seeing clients and so getting that, you know, fictional $150 an hour or I could be marketing or I could be networking, or I could be resting. But when I was sitting there with the emotional load of this bookkeeping that wasn't getting done or wasn't getting done right, then I was less effective. And I also was spending way more time than the bookkeeper on your team was spending. And so for me, it's It's what is it going to make me? But also what is it going to free up for me and I love that concept. Because that concept I think is revolutionary. I think a lot of people won't invest in their business, because they're worried about the cost. And they don't really picture what the final result is. And I think being able to think past, well, this cost this much, and this cost this much. And this cost this much, I think is a big step up for business owners.   Bibi Goldstein  10:25 Yeah, it's so true. It's amazing how, if you could stop for even a moment and recognize that, and I want to go to your comment about rest, okay, because you guys are in the, and I'm a strong believer in energy, right? So you're in this, this field of space, where you're taking on someone's at someone else's energy, in order to be fully there for them, and support them in their time of needing you. Yeah, how do you do that? It's that idea of, you know, if your cup is empty, you can't give to other people. And if that rest creates an opportunity for you to become better at what you do, I'm more efficient at what you do love what you do again, enjoy that, then that's part of it as well. So yeah, it's it's that piece of just figuring out, yes, I can, this is the one thing that I can get off of my plate, that's that, if everyone started with that thing that they hated. And the bookkeeping thing is a huge piece of that, Katie, we hear that all the time, it's, well, I tried to recreate everything, and then I can't remember because it was two months ago, and I can't, you know, I'm trying to, like, decipher what I did with this. And I can't find this receipt and these kinds of things. But our bookkeeper, the person on our team who does that she's in the system all day. So she's not having to shift gears. So that's the last thing I'll say about it, because that's one of the areas too, that we find in productivity and efficiency is that when you have to shift gears from one type of work to another type of work, so you go from something that's heart centered, where you're with a client, and then you have to turn around and do something that's more cerebral and more outside of your realm, the time that it takes us to switch, that's why they tell us to turn off diggings and all of these other things, because those interruptions, those interruptions cost you seconds that turn into minutes that turn into hours that turn into days,   Curt Widhalm  12:36 I want to jump in here, because you're talking about people who were really busy already, and you know, have maybe dug themselves into this time hole that you know, they need to free up a bunch of time. There's also people who are starting out their practices or might have some of their time that allows for them to get sucked into all of these various projects that they don't know yet that they don't like or they do know that they don't like, Can you speak a little bit more to people who are starting out their businesses too, as far as getting these systems in place, and why it's a worthwhile investment, even if they don't have those revenue generating hours ready upfront,   Bibi Goldstein  13:18 it's actually like the best time to to start with getting that support, you can hire a VA for even a couple of hours a month for a little over $100 and, and be able to take even just a few things that you know going in, it's not what you enjoy doing. But it's all about creating a plan, right? When you go to, you know, hang your proverbial shingle and go into business, there's some things that you still have to do, right, you still have to set yourself up as a business, you still have to set yourself up as as an entity, you have to go to the bank and open a bank account, you have to do all of these things. And if people just made that idea of how can I start off with these things as part of that setup, when you are also new, one of the things that I always encourage people to do is when you're small, it's very, very easy for you to start to document your processes. document, how you want your phone answered, document how you want your client intake to go, document how you want to how you want your scheduling to happen, start documenting those things, because then that documentation makes it so much easier as you grow, to be able to either bring on Team bring on a VA and hand that to somebody. And with all of these great technology things that we have. Now. You can do your process documentation right on the computer, you don't even have to write it anymore. You can do a video of it. And guess what That then means that if you start getting to a place where you are opening up a large practice, and you have multiple therapists, and you're going to need multiple folks doing the same thing, you then have video training. So now they're all hearing the same exact training, they're all seeing the same exact thing. And there's no differentiating, oh, well, when Kirk trained me on how to do this. And then when he trained Katie, on how to do this, he did fail to mention this part. And yeah, it's all the same message, all the same content. Those are the two things I would say.   Katie Vernoy  15:37 Yeah, I think the piece that I took from what you just said, and in my in my experience is that people are worried to invest before they start making money. But I think sometimes when you do that, you're able to actually create something that's more sustainable, especially if you're not over investing, I think there was a period of time I was like, I'm doing nothing. And you had mentioned, like delegating everything is probably the wrong idea, too. So maybe you can speak into that different, you know, kind of that differential of delegating what you need to but also recognizing what you don't need to delegate or when when not to delegate.   Bibi Goldstein  16:13 Yeah, you know, I always think of things as sensitivity, right. So if there's something that is sensitive information, like in, in, in some of the cases of some therapists, if you're doing transcription of notes from a session with the client, it's probably something that I would be careful in how and who you delegate that to. Sure, right? If it's something that requires someone to have personal information, like social security numbers, or bank account information, or things like that, you know, I'm going to use the example again, with bookkeeping, because we don't actually have access to that information. It's all connected to the system, but we don't have actual access to it, we can never, we don't go into the bank account and, and are able to transfer money or anything. So that's, it's those are the kinds of things that I want people to think about is that those are things that I would hold on to, you know, a little bit longer in my business until there was like, enough growth that required that, hey, I need to hand this off to somebody now. And it's time to hand that off to somebody doing payroll, having those kinds of just sensitivity information. But yeah, I think that also one of the things that you can look at, when, when you're scaling, when you're growing, and building your business, that you can actually be still in that, that role of being your the business owner and do some of the administrative tasks, if that's what makes you happy, I'm going to go back to that over and over again, is that don't take away something just because you think you should delegate it. And I can't speak for the people outside of who I know that I've experienced this, myself included is that sometimes when we get into this, like what you just mentioned, Katie of, of delegating everything, you kind of lose touch with what's happening. And you don't want that. If you want to be connected, you need to have still some connection and still continue to do these things. You know, one of my greatest joys is depositing checks. Go Go pick up the deposit. Right? Makes me happy?   Katie Vernoy  18:32 Yeah, yeah. I think the thing that we're talking kind of a little bit and around. And so let's get specific to it is this idea of automating what you can automate delegating what you can delegate and eliminating what you can eliminate. And I think being able to distinguish between those three, and then also the things that you keep, I think that becomes the assessment that becomes really hard for folks. And what you probably don't see because you're not in these Facebook groups with all these therapists is that there's a lot of shoulds, you should be doing this yourself, or you should be delegating it. And so not shelling the automating delegating and eliminating, like, how does someone do a quick assessment of that when they're when they're looking at their tasks.   Bibi Goldstein  19:16 So there's a ton of automation out there. And I just want to kind of touch on on that. Because there's, I think that there is also this myth that everybody thinks you have to hire a person, you have to hire labor to take something on. And that's not the case. I mean, there's so much technology, there's so many apps out there, there's so many things that can take on some of the things that you're looking to do, but I'm going to go super, super simple for you. Perfect, perfect game. I developed a program long time ago called 15 minutes from overwhelmed to organized, okay. And one of the things that we did in that was we created a document that simply had a happy face and a sad face and a line down the middle of it. Okay, and when Encouraged in that program for people to, to sit down and on a weekly basis, have that and start to document those things, those specific tasks on whether it's the happy face or the sad face of those of what they're doing. Because then obviously everything that's under the sad face, we can start to figure out, can we automate it? Can we delegate it? Can we simplify it? Or can we eliminate it? Okay. And those were always our four buckets. And once we, once you have it actually written down, it's easier to figure out that, wait, why am I doing this? I don't necessarily need to do this, because I can skip this step, and go directly to this to this other step. And so then that can be eliminated from one of the tasks but because, you know, we're creatures of habit. Yeah, I've been doing it that way forever. You know, it always reminds me of the story of the pot roast, I don't know.   Curt Widhalm  21:01 Now you got to go into that story.   Bibi Goldstein  21:05 The pot roast of, of why they would cut or the ham where, where they would cut off the ends of it, and put it into the pan. And they would say, Oh, my mom used to do it that way. So then they would go and ask the mom and then they they go down the line, they figure out that it was because grandma didn't have pan big enough. And that's why she cut off the ends for no other reason. But everybody   Katie Vernoy  21:27 was wasting a whole bunch of meat. Because that's how it's always been done. Okay?   Bibi Goldstein  21:34 So, because that's how it's always been done. And that's the thing that we continue to do in our businesses, we do it in our lives, we do it everywhere. But we but finding those places that you're just doing them because you've done it forever that way, doesn't mean that that's what that that's that it has to continue that way, right. So finding those automation pieces. One of my greatest greatest automation success stories was a client who was a therapist who used to schedule all of her appointments via text message.   Katie Vernoy  22:11 There's many who still do this, this is a really good example baby.   Bibi Goldstein  22:16 So we it took it took about a good 60 days and a lot of pushing and pulling with her to really start to see the benefit of it. And we put in an automated scheduling link. And we created it so that it went via text message. And it had a link for them to reschedule. It didn't allow them to reschedule within a certain amount of time. It it when they scheduled. One of the other things that she absolutely loved that when they scheduled, they also paid. So she didn't have to worry about sending them an invoice. She didn't have to worry about any of that stuff. And I will tell you, she's an example for me that I use often with testimonials, because she sent me one of the most beautiful notes, she had ultimately ended up moving out of the area. And she said, I don't know what I would have done. And how I would have been able to grow my business the way that I did. She was able to add, I think 11 new patients to her practice within the first 90 days, by doing those simple things, just making it easier to schedule, just making it easier to schedule, taking herself out of the equation of scheduling and allowing for her to be fully present, instead of having to worry about payment and collecting payment at the time of the session. Wow.   Curt Widhalm  23:45 What you're talking to here is also added benefits for the clients of not having to wait for somebody to get out of session to be able to return phone calls or worrying about the time of days. If I get out of session at eight o'clock at night, is it appropriate to be calling people back after that and being able to, like you said at the beginning of the episode, do the things that make you money, do the things that you enjoy and to have this not just as benefit for yourself but also for the clients that you serve?   Bibi Goldstein  24:16 Yeah, yeah. I mean, I applaud what you guys do for for a living, it's to me not something that I could do. But I also know that there are people in the world who can't do what I do. Right and that's why it's important that if you can stay in that place of being the support for them without having to worry about all the other stuff. It's it's so true Crt, you know, being there and being present for them in that capacity is probably easier than trying to think about I was supposed to return that while you're you know with somebody or you come out to from a session. If you are somebody who can stay fully present with someone, you come out from a session and all of a sudden you've got, you know, 1520 text messages and messages that you've got to answer.   Katie Vernoy  25:09 Yeah, I think the the level of overwhelm that a lot of therapists will put up with for a long time. And whether it's bookkeeping, or scheduling or billing or any of these other things that have to be done, but don't necessarily have to be done by you. It blows me away, because there's this hesitancy to spend some money on it. But I've also had folks say, well, it's such a mass, I would hate to have someone else do it. I would hate to put that on someone else. And what you just said about what you do well, and what we do well, like, can you convince folks that you actually want to clean their stuff up?   Curt Widhalm  25:48 And that they should get over the embarrassment of like, here's how far behind I am? And I don't want to admit this to everybody. Well,   Bibi Goldstein  25:55 it's kind of like when the the cleaning people come, right, everybody, everybody picks up before the cleaning people come, but there's not the whole reason why you hired them. Yep. Right now, they're good at what they do. So let's let them do what they're good at. And the fact is, is that more and more for me, it's become easier just and that's just because of experience and time and being able to get people to understand that it's not about judgment, it's about creating space, right? So when we create space, we create space for ourselves, to do the things that we need to do in our life. I do the same thing in my business. Now, I don't do client facing work on Fridays, I have blocked off my entire day on Friday, so that I could create space in order to continue to work on my business, or you know what, go get my hair done, go get my nails done, do whatever the whatever I want to do in that moment, right? So the The fact of the matter is, is taking getting people to take that first step and not thinking about what it looks like. We love it. I love what what Katie said about you know that, that, that I we do enjoy cleaning up messes. That's just Unfortunately, the case, but it's super satisfying. Yeah, I was just reading a statistic about the pimple doctor, right? Like how people love those videos. And I'm like, it's so gross to me. And I could never do that. But people are so focused on those things, right? You like, it's this feeling of satisfaction for somebody, for, for me, and for my team, when we can take something from what was considered tangled and a mess, and create something from it, that gives somebody that I'm going to sit back in my seat and take a deep breath and go, Wow, I didn't think that was possible. It's huge, especially automation. You know, client intake is a big part of what you guys do, you know, processing that whole. I will tell you one of my biggest pet peeves of going to a new doctor or going someplace is that when the first thing when you sit down, you got to spend the first 10 minutes filling out those forms. Yeah. Right. And it's like, well, wait a second, why can't you make the process so much easier by having those forms, be online forms, have them fill them out, they can print them, sign them, and bring them in with them so that they aren't spending that first few minutes doing that. There's little things like that, and how my team's brains work that they can see that sometimes people can't see in their own business.   Katie Vernoy  28:52 And I think it really speaks to just a very different level of expertise and not even knowing what they don't know, you know, simplifying within your business, automating delegating, eliminating hiring folks to do things like that's just so out of the realm. And so I think it's something where people really understanding how a VA company works can be very helpful because I think oftentimes they're like, Hey, I'm going to have my friend like, do something and they need a couple extra bucks. And then you've got you don't have the expertise behind it, or you have to train them and you're training them on the inefficient system that you had created. So you want to you want that expertise. But I guess this is just a very long way around to asking, why did you create a VA company? What does your company look like for getting to that point of are going to ask where people can find you, but like, tell us a little bit more about what that actually looks like for Buying Time.   Bibi Goldstein  29:45 So Buying Time has been around since 2007. There was a lot of different types of conversation but we started as a like a personal assistant service, I will say it was more in the realm of we used to walk dogs, buy groceries. You know, do Those kinds of things. And over the years, and the main reason why we started it even was we start I started to do some research I was working for in the transportation and logistics business. That was my career for 20 plus years, I worked as a regional manager, and I traveled a lot. And when I traveled, I have four siblings. But we all kind of took our own sense of responsibilities with my mom, when when my dad passed away, and my mom, being an immigrant, didn't deal with a lot of the financial stuff. And so she had written checks that were too large utility companies and things like that. And we were just trying to find somebody to help her because she, we had had to take her license away, and she couldn't do some of these things on our own. And that started me on this trajectory of Wait a second. There's nobody out here that does stuff like this. So that's how this company started. Fast forward, we ended up with a client who is an attorney, who was like, Can you help me with PowerPoints? And I'm like, Yeah, I used to do that all the time. And then I, but I found all of these things, you know that, and I did not know that the virtual assistant universe existed. And that's how I found it. So I we fast forward to transitioning to 100%, virtual wi today, which used to just consist of a couple of us, and a cell phone is now a team of we're up to 12 of us now. Wow. And we have every type of support from customer service, email management, bookkeeping, automation specialists. We have a web developer, we have a graphic designer, we have project managers, we have people who specialize in what they specialize in. And then myself, who I love doing strategy with clients, I love helping them figure out, you know, what, Curt was asking, Where do I start? How do I get something out there? So that's really how this kind of became born. And today, this business looks so different than I had ever imagined it could be, right? Yeah, I wanted something that allowed for me to continue to support people. Because Katie, as you know, giving back to my community and being a part of some of our local nonprofits, my husband Oh, is a part of a nonprofit, like, there's so many organizations for me that are huge here in the South Bay that I love to support. But I like to support them with my time and my expertise as much as I support them with my dollars. That's important to me. So I really created that and I'm, I'm a very vocal person when it comes to women's issues in general. I so disheartened with what's happening right now in the world, with so many women unable to work. It's there's just there's a lot of things I think that we can do as, as an organization, my company donates a ton of my team's time to these nonprofits. So the company itself is has really kind of evolved into exactly what I want it to be now, in that place of being able to support people who have the means to be able to have that support in order to support the people who don't,   Curt Widhalm  33:33 Where can people find out more about you and the services you provide.   Bibi Goldstein  33:37 They can go to our website buyingtimellc.com or there they can actually email into our team as well service at buyingtimeLLC.com or they can check out our new passion project, virtualassistantsuniversity.com.   Katie Vernoy  33:56 Tell us just a tiny bit about Virtual Assistants University.   Bibi Goldstein  34:01 So Virtual Assistants University is this thing that came from the whole idea of what's happened right now with women being out of work, we wanted to create an opportunity for people to take an embrace their own destiny, not rely on someone else. And the virtual assistant world continues to grow in a lot of ways. And I think that we're going to see a huge shift with many people. And so we created this university that allows for people to have support curriculum, and, and the ability to have a resource to build their own virtual assistant company. And that was something for me that was hugely important in that creating opportunities for people to take their skill sets. Because not everybody who comes to us is our cup of tea and we're not everybody else's cup of tea, right? So that's why there's so many beers out there. And there Are people who really want that one on one, they don't want a full team. Like, like what I've built, they want a one on one VA and we want to build as many of those as we can and help to support them. They have Lifetime support with us in our Facebook group so that they can build that business the way they want to. So that's it's very, very new, very new. We're, we're, it's a passion project for me right now.   Curt Widhalm  35:28 We will include links to all of the stuff in our show notes. You can find those over at MTSGpodcast.com. And until next time, I'm Curt Widhalm with Katie Vernoy and Bibi Goldstein.   Katie Vernoy  35:39 Thanks again to our sponsor Turning Point,   Curt Widhalm  35:42 We wanted to tell you a little bit more about our sponsor Turning Point. Turning Point is a financial planning firm that's focused exclusively on serving mental health professionals to help you navigate all the important elements of your personal finances like budgeting, investing, selecting retirement plans, managing student loan debts and evaluating big purchases, like your first home. And because they specialize in serving therapists and private practice, so help you navigate the finances of your practice as well. To help you navigate bookkeeping, analyze the financial implications of changes, like hiring clinicians or diversifying your income sources will even help you consider strategies like S corp tax election,   Katie Vernoy  36:20 And for listeners of MTSG you'll receive 30% off the price of their quickstart coaching intensive just enter promo code modern therapist when signing up. And don't forget to visit TurningPointhq.com to download your free finance quickstart guide for therapists. Thank   Announcer  36:37 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.

    The Return of Why Therapists Quit

    Play Episode Listen Later Sep 27, 2021 30:10

    The Return of Why Therapists Quit Curt and Katie chat about how therapists can maintain joy in their practice when they begin to feel burned out. We explore different ways to incorporate self-care into your life and practice, including making future plans and developing your whole identity. We also talk about how privilege impacts therapists' ability to engage in self-care and career opportunities. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: Discussion of why Katie has not quit the field. Fighting burnout by focusing on what brings you joy in your practice (the Marie Kondo approach). The importance of self-care and incorporating new hobbies/interests into your life. Assessing the distinction between “not great days” and a “not great workplace”. Considering privilege in the ability for therapists to engage in self-care as well as career opportunities. The impact COVID has had on therapist's being able to participate in self-care. Learning how to incorporate time to make plans for future career goals. How to notice burnout and sacrificial helping. The importance of fostering all aspects of your identity (because you are not your job). Our Generous Sponsors: SimplePractice Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what's most important—your clients—by simplifying the business side of private practice like billing, scheduling, and even marketing. More than 100,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform. Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Go to simplepractice.com/therapyreimagined to learn more. *Please note that Therapy Reimagined is a paid affiliate of SimplePractice and will receive a little bit of money in our pockets if you sign up using the above link.   RevKey RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener.   Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might 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! Marie Kondo Steven Covey's Big Rocks Relevant Episodes: Why Therapists Quit Why Therapists Quit Part 2 Burnout or Depression We Can't Help Ourselves Quarantine Self-Care for Therapists The Danger of Poor Self-Care for Therapists Negotiating Sliding Scale Overcoming Your Poverty Mindset Career Trekking with MTSG Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2021   Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, 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 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. 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Full Transcript (autogenerated):   Curt Widhalm  00:00 This episode is sponsored by SimplePractice.   Katie Vernoy  00:02 Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what's most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing.   Curt Widhalm  00:18 Stick around for a special offer at the end of this episode.   Katie Vernoy  00:23 This podcast is also sponsored by RevKey.   Curt Widhalm  00:26 RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists digital advertising is all they do, and they know their stuff. When you work with RevKey they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts. Katie Vernoy  00:48 Listen at the end of the episode for more information on RevKey. Announcer  00:53 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  01:09 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 sorts of stuff things that we do things that we don't do, things that our profession does for us. Katie's giving me the work that I'm still not back into good episode intros. We're starting today with a little bit of feedback from one of our listeners, we got a message on our Facebook account from Jennifer. I'm gonna paraphrase a little bit of this. Jennifer writes, hi, Katie. And Curt, this love letter is well overdue. I earned my Master's in 2018. I was a relative newbie therapist when the pandemic hit. And I've been providing telehealth to a lot of my clients and been struggling with some stuff. I'm paraphrasing here. And one day I found your podcast, appreciate a lot of the things that we talked about. And just as things were starting to feel good, like the world was opening back up, again, the Delta variant hit. And especially in response to some of our episodes, looking for a little bit of a hope here of how do we keep going? How do we not just fall into those traps and things like our episode around why therapists quit? How do we survive in our careers and not just wanting to give up and go and be in any other profession? Katie, why haven't you quit yet?   Katie Vernoy  02:57 I think I have several times. I think that the the definition of quitting can be very different for folks, I've not left the profession. So maybe that's the accurate thing. But I left community mental health, I've switched my private practice a number of times I've worked in the profession and more of an advocacy framework. And so the first thing that I would say is I've not seen it as a single career that has one particular path, but instead a an evolution of how I work and how I interact with the work and where I find my place in it. So I think the short answer is I keep assessing myself and the work and trying to realign it pretty frequently. Actually,   Curt Widhalm  03:50 I would describe my approach is kind of the Marie Kondo approach, does this part of my job bring me joy. And what I've found and this does come with some experience in the fields, some longevity, some being in some positions where I can cut out or throw away some of the aspects that just no longer feel like they are bringing joy to me bringing me back into the profession. But a lot of that permission for me, comes with community. It comes with being around a lot of like minded therapists that give the permission and the support, to be able to take some of those leaps to be able to recognize that the safety of something being done just because I've always been doing it that way. And it can be let go. It can be something where if it doesn't emotionally pay off, it doesn't monetarily pay off for me that it's something that I don't have to be beholden to forever. And I say this as somebody who is very much Are you a completionist? Somebody who likes to finish video games to 100% to not give up on things in the middle that, for me, a lot of it does come from having the permission given to myself to not stay stuck in things just because it's, it's there. And it's what has been.   Katie Vernoy  05:25 I like that because it provides this ongoing assessment of what brings me joy, like Marie Kondo, but it also is not sticking to something, you know, this is the sunk cost fallacy, like, just because I've started it just because I've invested invested time or money in it doesn't mean that I need to go down this direct path. And I think that can be really hard. Because if you've invested in a lot of time and energy into a specific niche, for example, you've you've networked and created relationships. And I think for you this was around autism, right? You did a lot of networking, and there was a lot there, and you still work with with autistic clients. But I think there's that, that element of once that was not your area of focus, she moved back. I've done that with trauma work. I've done that with, you know, trauma survivors and different things in that way. But I think that being able to identify what doesn't bring me joy anymore, what doesn't seem this sounds a little bit mercenary, I guess. But what isn't bringing the return on investment that you would like whether it's an emotional return on investment or a financial one, I think being able to drop those things can be really good. I actually, when I talk to consulting clients about this, because this is one of the things that is a big conversation, especially for mid career therapists is if you started from scratch, you know, what would you put back in? And I guess this is Marie Kondo. So maybe this isn't that earth shattering. But even just taking away your whole schedule, like everything is off the table, and you start from scratch, and you only put the things back in that really energize you bring you revenue, which may not energize you do the things that you're required to do. And whether it's Stephen Covey's big rocks, or or some of these other concepts of really sticking to the highest priorities, and only allowing them back in can be very helpful. And oftentimes, we can't do it like, next week, oftentimes, it's like, okay, let's look at next year. So three months from now, your schedule is now fresh, you might put clients back in the same time slots, but you may not you may put them at different times of day, you may not have all the same clients, because some of those clients are emotionally draining you in a way that you recognize that you're probably not doing your best work with them. But I think being able to take away those things that aren't working, no matter how much time and effort you put into them, no matter how much you feel like that's what you should do, I think can be very helpful. I mean, there's practical things to think about, you know, income and all of those things. So this is more of a high level philosophical conversation than a practical one, in this moment, but I think, actually starting from scratch, in your mind, you don't have to burn everything down. But like, doing the thought experiment of starting from scratch, I think can be very helpful.   Curt Widhalm  08:24 On one hand, the need for mental health and mental health related services seems to be at an all time high, as far as coming out of the pandemic fingers crossed that we're coming out of it. But the the need for mental health and mental health related services is quite high. And with that, at least at this point in the foreseeable future, and comes a little bit more freedom to be able to take some risks, because the need for mental health service providers is going to remain strong for quite a while here. And so it's not like we're in a situation where if we were to leave, you know, an agency stop a practice or something like that, to go and explore something new. That it would necessarily be something where you can't go back, that there is some overall professional job security here. And we're seeing this expand just beyond the traditional, providing direct services to clients and a number of different ways, whether that's entrepreneurial yourself and maybe moving into more coaching program type things or courses, courses or any of those kinds of reaching stuff. Yeah, I've never seen more positions in corporate environments that are requiring people to have a mental health background to come in. And so there is a lot of options out there that you can take advantage of and think gets our fear of losing what we have that often keeps us subjected to staying into the same positions over and over again. And to Katie's point, this also does require some thoughtfulness and some planning, this can't just be like an impulsive, like, I had a bad day at work on Thursday and Friday, I'm going to accept a job wherever offers next. So one of the things that I occasionally get a question from clients is, you know, would you care for me if I wasn't paying for your time. And my answer to that is usually, the some version of my care exists, because I care for you, as a human being, a lot of what you're paying for is, for my experience, any wisdom that I'm able to bring, and most of all, that you're ensuring that I'm prepared, that I'm taking care of my life enough that I am ready for the sessions to be able to take on what you're bringing in, what you're paying for is the thoughtfulness in the preparation for our time together for that character come out. And it's with that same kind of intention that I'm looking at this kind of a question of, its being able to put that kind of thoughtfulness in place for yourself, to be able to be in a position where you're able to make a shift to continue to take care of yourself. And if you can see beyond, you know, a bad experience with a couple of clients, you can see beyond a bad experience with a supervisor or toxic co worker or a mountain of paperwork, whatever it is, and say, you know, overall, this was a bad day. But this is still an environment where I can continue to show up and have that care, as I define it for myself, does help to answer some of that question when it comes to how do we stick with some of these things? I'm not great days.   Katie Vernoy  12:09 I like the distinction between not great days, and not great work environments. I think, if the not great days stack up, it could be that it's not great work environment, or it could be that you've chosen something that aligns when you're fully resourced and doesn't align when you're not. And so some of this and we have a lot of different episodes on systems of self care or addressing burnout, or is it burnout or depression, like we have a lot of different episodes that can talk about addressing burnout specifically. And, and some of that is being in the wrong place. But some of it really is working without that thoughtfulness, and the deliberateness that Curt's talking about with taking care of yourself so that you can continue to show up. I want to extend that even further. Because I think, folks, and maybe this is a very Western idea or something that's, that's very present in the United States. But I think folks have this notion around, I have to be growing and expanding and getting better and creating the next big thing. And I have to keep increasing my revenue, or you know, those types of things. And I think when, when we see it rather as seasonal, or seasons of our career, I think that can be helpful. I was talking to a dear colleague recently, and she was talking about coming out of a toxic work environment and basically, not cruising, and I wouldn't say it was that but like, creating something that was very doable. There wasn't challenged, there wasn't growth, and I'm overstating it to make the point. But it was something where there was restfulness, in how she chose to do her work, you know, the client, she chose to work with the time she spent on the work, she was very, very deliberate in charging premium fee. So there was fewer clients and creating that space. And then after that timeframe, when she felt rejuvenated and ready to tackle the next big thing, she found another job and then was able to take on another piece of things in our profession. And so I really like that concept. Because there are a lot of folks who will be burnt out or they'll be ready to quit. And instead of taking care of themselves, they'll jump into programs that are designed to be a lot of work to get to some place in the in the future. You know, like, do all this work and make a lot of money. And when someone's burned out or when someone's ready to quit, they may not have those reserves. And so you have to assess that for yourself. But if you don't have reserves, you don't necessarily have to make drastic changes. You may just have to back off a little bit and refocus on your life for a while rather than your career. If you can do the work, you can set your set your career in a doable space. Does that make sense?   Curt Widhalm  15:07 Does. I wonder how much of this is really just coming from a place of privilege, though. But absolutely for those of us who have survived, as long as we have, we talked about this in our state of the profession episode this summer that a lot of the younger therapists as compared to other age, demographic, tripling, maybe I don't want to stay in this profession. And that's going to come at a time when you don't have a lifetime of savings built up. But you are more sensitive to having to work unpaid or underpaid jobs, that you might not be in a position to make some of these decisions where your responsibilities to family might be a lot bigger proportion of your life, especially if you have young children. So creating the space in here also for those, and remembering back to the time in our lives where we weren't quite so privileged to be making some of these decisions. I know in leaving the agencies that I did at the times that I did, and being unhappy in some of the work environments, I don't think I ever felt that I was in the wrong field completely. It was very much recognizing that there are good places and good opportunities that I was doing what I wanted to do in creating healing in the world. It was just not in that particular environment. And it was recognizing that one agency is not representative of all agencies. And part of that perspective, once again, comes back to community, it comes back to the ability to have trusted peers have, you know, your own therapy to not think about therapy all day long to have other hobbies and interests that go and make you you. And I recognize particularly for this, you know, last year and a half during the pandemic, that a lot of people's abilities to go and do things that aren't therapy have been shut down. And a lot of us filled in that extra time with more work. And so, you know, we've been talking about this, the faculty level at the university that I teach in that one of the issues that we're anticipating with students is how much that they're used to working now, and being able to accrue their hours towards graduation and licensure by being able to fit in more, because everything's over telehealth. And when we inevitably returned to more of a program wide face to face role in things that students are going to have a shift in and struggle with house, how much slower things are going to be accruing for them. I say all this to say that it's really being able to take that step outside of yourself, which requires downtime, which requires an ability to get a different viewpoint on what you're doing, not in the sense of making what is happening around you. Okay. But doing it in a sense of Are you okay with what's happening around you?   Katie Vernoy  18:36 when we're looking at self assessment, I agree, we need to have downtime, we need to have space. And as you were talking, I was really resonating with this concept around privilege, and how at different stages of your career at different places in your life are different socioeconomic status, different societal pressures and levels of oppression, like I think that this challenge is going to be different for different folks. And so in looking at that, and looking at having some downtime to make an assessment, or looking at finding ways to make your agency job better, or finding ways to make your career more sustainable, I think we have to really honor that when you're feeling stuck. When you see no other way to do what you're doing. It's very hard to do any of this. And so, if we can't get any space at all, I think it's going to be very hard for people to not quit. And when I've been in those situations, whether it was when I was in an agency job or just other periods of my life. I think the way that I didn't quit when I didn't quit was finding the smallest space that I could preserve from my own. Or maybe maybe It's better said a small space, but the biggest space that I could preserve for my own to plan for what I did next, whether it's doing that assessment and finding out whether you're able to do what you want to do and the place that you're at, but also to have your exit plan, because I worked in community mental health, and I did not feel like I could just quit and start a private practice and do all the things like I wasn't able to do that I wasn't able to take that on that financial risk on. So for me, it was carving out a little tiny piece of time, where I started figuring out what I needed to do to start a private practice. And I started figuring out what I needed to do to get on insurance panels, or whatever it was, at certain points, it was carving a little bit of time to look for jobs, when I was still wanting to move from place to place and having people around me hold me accountable to finding a new job, I think people get really caught in well, another agency might be just as bad, it doesn't make a difference. And I really argue that that's not necessarily the case. And that you need to talk to your colleagues and your cohorts and that kind of stuff to see what what the experience is because sometimes just taking that little bit of a little bit of time to put in an application or to make a plan for your exit, or whatever it is, can be the way that you stay. Because it gives you a breath of fresh air, like, I'm gonna have my escape hatch. And I think I even called it that when I started my private practice, or when I started applying for other jobs, like I have my escape hatch, and adjustment that I wasn't stuck, there was an endpoint, it was a nebulous endpoint, but it was an endpoint. And I think that does help.   Curt Widhalm  21:44 I have found that, you know, emotionally taking vacations is appropriate. Getting away from work, is as much as our profession as a calling, as much as we're deeply emotionally invested in the work that we do with our clients. And whether we get a return on that emotional investment or not. The end of the day, it's still a job. that it takes a certain kind of ability to show up for that job, as compared to many others takes a certain level of awareness, it takes a lot of ability to care and recharge for yourself. And in a number of our episodes before we've talked about that self care is not an option. Self Care is a discipline. And I can speak for myself on this third, when I go on vacation, I like to completely not deal with work as much as I can to really be separated from it. Even if it's just like one day on a on a weekend of like, here's my day to go spend in the kitchen doing things where there's a beginning, middle and an end. And it's practical and delicious. These are the kinds of things that at least recharged me for the next day of work. It's and this has been particularly hard during COVID of, Oh, well, I got nothing else to do. So I might as well throw another couple clients on my schedule, or I might as well dive into this thing. And then just like anything else we can become so enveloped in whatever our work or what our interests are that it just consumes us and leaves us not wanting to look at it at all. And that's not unique to our profession. It's not even unique to jobs, it can be done with hobbies, it can be done with side hustles. That the key is balance. And it's finding what your right balance is Katie was describing as I'm describing of like taking some intentional rest time away from it.   Katie Vernoy  24:02 I've I've talked to a number of clinicians who had not taken vacations for years. And I would call a day off a day off not necessarily a vacation day, Curt. So I think you also need to take a real vacation, your plate. But I think that there are there are many different reasons people don't take time off work. One is potentially they don't get paid and that that income is needed. And and that's that's relevant. And I think there are different conversations that we've had and we'll link to him in the show notes about money and trying to make sure that you're earning more money and that kind of stuff, and planning your money based around taking vacations. But the other thing that I've really seen is there are folks who either just don't even think about it, they don't plan ahead and they just don't schedule the time away. And I'm not talking like a Caribbean cruise I'm talking about even just staying home and watching Netflix and chilling for a week and not answering your phone, whatever it is, whatever you can afford, actually vacating your work, I think is important. But people won't do it because my clients need me, subconsciously, maybe it's I don't deserve it. And I think and this speaks to and we probably have an episode early on where I talk about sacrificial helping, but it's it's this relationship that we have to ourselves and our work that I think can get in the way. And really being able to address that I think is, you know, what I'm thinking is kind of our last points that we'll make on this is if you're constantly sacrificing yourself, if you're constantly putting yourself in this place where you're doing, doing for your clients, for others in your life, more so than you're doing for yourself. Self Care doesn't necessarily land on your list. And it also doesn't, it's not necessarily sufficient, because you're constantly in this place of less than and of service, and you're not necessarily feeding yourself. And I'm not talking about folks who find great joy and meaning and helping people that is exactly why I'm in the profession. It's that that is who I am, that is all that I am. And I will sacrifice everything else in my life to that purpose. I think that becomes really hard. So when we're in this place, and I think this can happen, when we have clients that are in high crisis, it can happen when especially early in our careers when we're feeling like our clients are very dependent on us and and we think we have to rescue them all. Or maybe that was just that, that that sacrificial piece can come in, and that that's not sustainable by any stretch. And so I think it's important to also I guess, to say, looking at the relationship you have with yourself and the work, and maybe go into back what Curt said like it's a job. It's an awesome job. It's a job that is very meaningful and can be very powerful and make a big difference in the world. But it's your job. It's not who you are. Yeah, it's   Curt Widhalm  27:10 not an identity and your only identity.   Katie Vernoy  27:13 Because we are saying that everybody's modern therapist, so we've given them we've given them an identity point. Okay,   Curt Widhalm  27:21 fair, fair. And since it's not your only identity, it's not the only identity that you should be shaping. It's not the only one that you should be subscribing to. And it's dealing with that imposter syndrome of people who've honed that part of their identities, especially in your early career when you're looking at people who've been in the field 1020 3040 5060 years, that part of how they got there is going through what you're going through now. So form all of your identities,   Katie Vernoy  27:54 spend time with all of them. So   Curt Widhalm  27:59 if you have questions for us or would like to suggest an episode, as you can tell from several of our last episodes, we are responding to our listeners. And you can reach out to us on our social media or through our websites. MTSGpodcast.com. And until next time, I'm Curt Widhalm with Katie Vernoy   Katie Vernoy  28:19 thanks again to our sponsor SimplePractice.   Curt Widhalm  28:21 SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform.   Katie Vernoy  28:39 Get your first two months of SimplePractice for the price of one when you sign up for an account today. This is collusive offer is valid for new customers only. Please note that we are a paid affiliate for a SimplePractice so we'll have a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapy reimagined. And that's where you can learn more.   Curt Widhalm  29:00 This episode is also sponsored by RevKey.   Katie Vernoy  29:04 RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services. RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs.   Curt Widhalm  29:28 You'll never receive a data dump report that means nothing to you. Instead, red key provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners.   Katie Vernoy  29:44 You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener   Announcer  29:51 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.

    How to Fire Your Clients (Ethically) Part 1.5

    Play Episode Listen Later Sep 20, 2021 39:07

    Episode 226: How to Fire Your Clients (Ethically) Part 1.5 Curt and Katie chat about different therapist-client mismatches and how to manage them. We explore how to balance dealing with discomfort in therapy and seeking consultation with knowing when and how to refer out clients. We also talk about how to incorporate ideas of redefining and decolonizing therapy. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: How to manage situations when the client having a clinical need that the therapist does not feel capable to treat. Different kinds of therapist-client mismatches. Cultural considerations in therapist-client matching and incorporating ideas of redefining and decolonizing therapy. How to refer out clients when there is a mismatch and what to do if the client doesn't want to be referred out. What to do when you have different ideologies than your clients. The benefit of sitting with discomfort when you disagree with your client and knowing when to seek consultation. How to support clients when they aren't aware that a different therapeutic style (e.g., direct vs. indirect) may be beneficial to them. The importance of reviewing treatment plans with client (even when not required). Revisiting how to address therapy interfering behaviors and how to appropriately terminate with clients when necessary. Barriers in referring clients out. Our Generous Sponsors: SimplePractice Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what's most important—your clients—by simplifying the business side of private practice like billing, scheduling, and even marketing. More than 100,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform. Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Go to simplepractice.com/therapyreimagined to learn more. *Please note that Therapy Reimagined is a paid affiliate of SimplePractice and will receive a little bit of money in our pockets if you sign up using the above link.   RevKey RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener.   Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might 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: How to Fire Your Clients (Ethically) Make Your Paperwork Meaningful Therapy is a Political Act The Balance Between Boundaries and Humanity Is Therapy an Opiate of the Masses? Ending Therapy Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2021  Our consultation services: The Fifty-Minute Hour   Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, 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 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. 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/         Full Transcript (autogenerated):   Curt Widhalm  00:00 This episode is sponsored by SimplePractice.   Katie Vernoy  00:02 Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what's most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing.   Curt Widhalm  00:18 Stick around for a special offer at the end of this episode.   Katie Vernoy  00:23 This podcast is also sponsored by RevKey.   Curt Widhalm  00:26 RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists digital advertising is all they do, and they know their stuff. When you work with RevKey they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts.   Katie Vernoy  00:49 Listen at the end of the episode for more information on RevKey.   Announcer  00:53 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  01:08 Welcome back modern therapists This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about all things therapists and picking up on last week's episode responding to user reviews, we felt the food getting a little more nuanced and a couple of things. But this review sparked a couple of ideas, check out last week's episode about therapy interfering behaviors. We also wanted to dive into a little bit more of the firing clients maybe terminating prematurely before clients end up getting to their goals, we might want to call this episode firing your clients ethically, Part 1.5. Like it's cuz this does help us dive into a little bit more of some situations where this comes up. We'll talk about this from a clinical approach. We'll talk about this as far as broadly, some of the ways that I've heard ethics committees talk about bad therapy when clients have felt abandoned by therapists, this kind of stuff. So Katie, and I wanted to talk about what are some times where we've heard therapists, quote, unquote, firing their clients looking to terminate prematurely referring out, etc. So Katie, what is first on our list today,   Katie Vernoy  02:37 the most frequent one that I've seen that I've experienced is this idea of a client having a clinical need that either pops up or was on assessed, you know, wasn't appropriately assessed at the beginning, that I don't feel capable to handle. And I see this a lot, where folks will say, well, this person has psychosis or they have an eating disorder, or they have substance abuse, or they have something and I'm not an expert in it. And so I am going to refer them out. And there have been times when I've chosen to refer out and there have been times when I have kept the clients and, and created a treatment team around myself so that there was expertise present. But I see that a lot. I think people get very worried, and sometimes with good reason that if they keep a client for whom they don't have the appropriate clinical expertise, that they will be hurting the client. And so they then terminate the client, which can mean that the client feels abandoned because they have, especially if they've already developed a relationship with you, or if they had difficulty finding a therapist in the first place. And there's not great referrals. So I think that's potentially where we start is when a therapist feels like this is not my expertise. But they've already shown up in your office, either for one session or for 10 sessions. And this is a new clinical issue that pops   Curt Widhalm  03:57 So Katie and I, before recording today, we were talking about a couple of different areas where this has come up in our careers. And part of managing some of these particular situations is having honest discussions with clients. This might be something where it's a lot easier when it's in those first couple of sessions of, Hey, we don't have a real strong therapeutic relationship. But I don't have the skills to be able to help with the goals that you're coming in here with and especially if there may be more high risk or specialized sort of treatments you brought up about eating disorders before the show was recording here. These get a little bit trickier when you're much deeper into relationships with clubs. And for instance, eating disorders that show up in clients after a couple of years of treatment where you have a very strong relationship with a client and it might be outside of your wheelhouse. I've had a couple of clients that I've worked with for a very long time that have eventually started exploring transgender identities and things that are not necessarily within the specifics of my specialties. But feeling the confidence in a therapeutic relationship and knowing what it's like working with me over the long term to begin to explore some of these new identities. And I think, in the way that Katie and I have talked about this is a lot of times, it's not necessarily firing those clients, but it's helping to be able to develop a treatment team of specialists around who's working with those clients to be able to help the clients reach their goals, while also still having the emotional space and the trust in the relationship that they know that they're going to be taken care of.   Katie Vernoy  05:57 For me, I see it as a very attachment based style of therapy that I do, because I think I do longer term therapy, it's very relationship based. And so if I can't be the expert in the room with my clients, I act as a trusted person in their life who's going to figure it out. And I'm going to get the right people around them. And I'm going to advocate for them. Some of this comes from my history of doing more on the kind of social work and of pulling together treatment teams and resources and advocating for my clients. But there are a number of times throughout my career where something has come into my client's life, we have a very strong relationship, and I start doing research, I start gathering people around them. And the work that I do may be impacted by that there may be things that I bring in that is relevant to that particular treatment issue. But it may also be just me talking with them about like, how's it going with a specialist? How are you taking care of yourself? What do I need to know to support you during this time? You know, it's it's something where it has to be within the relationship because a brand new client having to tell you what they need, doesn't feel appropriate, but a client that's been with you for years and has this new issue that they're facing, I think it would be pretty bad. If you were to say, Okay, I'm out, because I don't know about this. So you're on your own, because people are not just these new treatment issues are not just diagnoses.   Curt Widhalm  07:27 And what you're describing There is also getting your own consultation and learning and developing some new skill sets alongside of that, it's not always going to be possible to out of the blue be able to develop a new best practices sort of treatment for these kinds of clients. And that's where handling these difficulties. I think we've discussed this in enough episodes before and just kind of a general enough knowledge within the community that we can move on to our next thing on the list here.   Katie Vernoy  07:59 So one more, I think clients often opt out. But I think sometimes for especially those therapist pleasing clients therapist might have to do it is a therapist like relationship mismatch, that there's something in the relationship that just seems to be getting in the way of the treatment being successful.   Curt Widhalm  08:20 And so sometimes this can be personality wise, this can be things where the agreement on what the treatment plan is, isn't the same. It might be things that a client is particularly hoping can be addressed in therapy that the therapist doesn't or won't work on. And maybe to give an idea of something like this is if a black client is showing up to therapy with issues of depression and wants to talk about some of the systemic causes, especially in the news here in the last couple of years and issues related to that as being part of the causes towards the particular depressive symptoms of this client. With the therapist only wanting to focus on things like medication adherence and behavioral activation techniques that don't necessarily take into account what the client is asking for in those therapeutic sessions. This has the potential of being in one of those areas where clients asking for something a therapist isn't providing. As it's described, this isn't really bad therapy. It's technically sound by using evidence based practices here. But I'd be hesitant to call this good therapy by any means because the client is expressing a desire to be exploring something with the therapist is completely sidestepping.   Katie Vernoy  09:51 I think when we look at it that way, this is where folks come talking about redefining therapy or decolonizing therapy. I think there are arguments, that's pretty bad therapy, when a client clearly is bringing in things that they would like to address, and the therapist is refusing to talk about them, and not seeking any insight from the client on their methods of healing. And so we'll link to a couple episodes in the show notes that kind of talk more specifically about how you can talk more about those types of issues if those that's what your clients seeking out, but yes, I don't think it's unethical or illegal therapy. But   Curt Widhalm  10:28 I do. And that's, that's the wording that that I should use here is that not that particular example. But some of the ethics committee discussions that I see from time to time fall into categories like this, where a client is asking for something very, very specific that the therapist is not addressing, that doesn't go against an ethics code, it doesn't go against a legal statute that falls under this category of just a really bad client therapist match. And I agree that with redefining therapy, reimagining therapy, that decolonizing therapy, by those definitions, that is bad therapy. Yeah. For me, legal and ethical standpoint, there are no legal or ethical codes that define it as such. And so sometimes we'll see client complaints about this that, you know, from a decolonizing, or a reimagining standpoint, would find frustration with that therapist not being investigated not being seen as a, somebody contributing to bad therapy, it's because the rules of law, the rules of ethics don't have anything to investigate those against and therefore there's no punishment to be given, if there's no rule against it.   Katie Vernoy  12:01 My hope is that if someone had that type of a complaint, rather than putting up a huge defensive structure, that they would actually look at what that mismatch was, because to me, I feel like there are clients who need that seeing that being known to be able to make any progress in therapy. And I think sometimes those clients will opt out and recognize that this therapist is not seeing me not potentially even doing some micro aggressions or macro aggressions like it could be something where the mismatches big and I think, bordering on unethical, although I don't know that I have a code. So I won't I won't go that far. But I think that the problem is that some clients, especially clients who have been, who have identities that have been traditionally marginalized, I think they may not know that anyone would be any different. And so my hope is that if a therapist is getting any kind of feedback, or having that push back, that they would make that referral to someone who could have those conversations, I just don't feel convinced that that's going to be the case, I feel like that could be a missed, you know, kind of blank spot in their education and their self awareness.   Curt Widhalm  13:14 At best, it's in that missed blank spot. You know, there are therapists that we have to admit that are out there who will actively go against and argue against that. And those cases, would be very bad therapy. And this is looking at some of those situations too. And this falls across ideological spectrums, here. But when you get into imposing values onto clients, for not believing in whatever it is that you believe, that is bad therapy, especially to the clients perspective, now, I think we're way off of where this episode's focus is supposed to be, as far as when those situations come up from the therapist side of things, you know, give you the credit as a listener here, that you're not imposing your values on the clients here, but when those clients do bring up opposite ideas of how you practice, the show here, we're big advocates of putting your values out there of kinds of work that you do so that way clients can self select in, but sometimes you're gonna end up with clients who don't match up with those things, stances on vaccine mandates, mascot mandates, these kinds of things that a lot of people are gonna have a lot of different ideas about, that this might be a mismatch. It's not something that can necessarily be ignored, but it's not necessarily something that's the place of therapeutic focus. Or is it?   Katie Vernoy  14:49 I mean, I think it's client by client and therapist by therapist, I think the to get us back into how to ethically fire your clients part 1.5 or whatever. We're going to call I think the assessment of is this ideological difference, this mismatch sufficient that you believe you cannot do effective therapy with this client, and then referring them out appropriately, I think is important, but I chose so   Curt Widhalm  15:14 in your mind, how does that referral work? Like, Hey, I think you're an idiot for this thing that doesn't have anything to do with you coming in, like, how do you see those referral conversations going?   Katie Vernoy  15:30 I am not referring someone out because they have an ideological difference. But if they're wanting to talk about things that I have absolutely no experience about, you know, or I don't have a space to you know, I don't feel comfortable in that space. And it's not something that I want to subject them to, as I find my footing, I might say, Hey, I'm noticing that these are the types of things that you're wanting to talk about. And it's outside my my area of expertise. So I want to connect you with somebody for whom that is an area of expertise. And   Curt Widhalm  16:01 if that client says, Now I like you enough, we can we can teach you   Katie Vernoy  16:06 taking that question. I mean, that is that that is harder, because I don't want to abandon my client. I don't want to be in a place where I'm allowing my own, you know, ideological things to get in the way. But if it's truly an ideological difference, whether it's about political ideology, or something along the lines of vaccinations or different things, you know, the things that I may have a strong opinion about, but my clients either have a strong other opinion, or I think the one most recently, it's been kind of vaccine hesitation, I most of my clients are vaccinated, some are not. And for me, I think what I end up doing is I follow the lead of the client, and I work to identify where their mind is, and try to understand them. And that doesn't require an ideological knowledge. Just trying to understand their perspective and look at it doesn't require an ideological knowledge. And I try to determine, do I need to know more about this in order to work with them? Or is is it central? Or is it not central?   Curt Widhalm  17:10 So for those clients that continue to bring things up, because occasionally I'll get clients on the US ideological stance that are just kind of my rights to not get vaccinated? clients? They will, I don't know, get emotionally momentum going in a direction that even an exploring where you're going here, that they'll start to maybe rope you in with like, you know what I'm talking about, right? Don't you agree that people's rights are important? That, you know, are these half sort of things? Do you step in at those times, knowing that you're sitting there being like, I don't agree with literally anything that you're saying right   Katie Vernoy  17:54 now. I think what I've done at different points, sometimes I'll go to psychoeducation. And say, I'm hearing you and I hear that you're saying this, one thing that I'm reading is is this. And so sometimes I'll go to a Hey, let me just add a little bit little tidbit not say like, Oh, well, I think you're totally wrong, but go to like a tidbit of, you know, I actually did that or, or even say, Well, I don't know, I actually, you know, that's not something that I've been looking into, could you share with me some of the things that you're reading, because then I get a better experience of what rabbit holes are going down?   Curt Widhalm  18:33 I'm not, I'm not giving those YouTube links that get sent to me, you know, these 30 minutes, here's where all of the vaccines things are wrong. I'm not clicking on those.   Katie Vernoy  18:45 But I think they're they're there. There's knowledge that potentially you can gain about where someone's head's at, when you actually ask them, how they got there, and not looking at trying to switch it. But I think there are times when just understanding and listening and then providing a little bit of information kind of from outside their information bubble can have an impact. But sometimes it just becomes very clear that there's not common ground. How about for you? How do you manage it when clients are having these gigantic conversations with lots of emotion about things that you think are absolutely wrong?   Curt Widhalm  19:23 I do a lot of reflecting back even when there's direct questions back to me. What does this mean for you? How is this impacting your day to day life? What can you do with this it's very narrative approach in a lot of ways, and I have had some successes where clients are like, Thank you for listening to me, maybe you can help me get some perspective on some other ways of looking at this that is just kind of this being able to validate the process rather than the content of what's discussed. And I'm afraid that a lot of therapists would get sucked into the content part of these arguments and feel Like this is something that I can't help you with. And therefore, I need to go back to what we mentioned earlier in the episode and refer out to somebody who can validate the content of what you're talking about here. Like we mentioned in last week's episode, this is being able to have a really good idea of what your limits are, what kind of impact that the clients are having on you being able to sit with it. And that's, that's a part that, especially developing therapists I see struggle with a lot because this pulls up a lot of that imposter syndrome stuff is just because you're having anxious or bad feelings of what a client is saying, separate from our other fire of clients ethically episode doesn't mean that you're not necessarily providing good therapy in those situations. Just because we want therapy to be easy and us to heal everyone doesn't mean that we're not going to run into some uncomfortable situations with clients. I was sharing with one of my other Professor friends here recently about some of the role plays that I bring into the especially like practicum classes when people haven't started seeing clients yet, just like getting them prepared for stuff. And of course, I'm going to pick situations that make the therapist kind of uncomfortable, and it's surprising how few of these I've ever had to make up completely to kind of put, you know, developing therapists on the spot. And when I was sharing some of these with my professor friends, they were like, what kind of a practice do you have? These are pretty like everyday sort of things. These aren't even like the egregious ones. I say all that to say that sitting through a lot of stuff that makes us uncomfortable, can have a very deep impact for clients that we might feel mismatched with. But it comes back to attuning yourself to the relationship. Now, at that point, and again to the thing from this episode that we seem to have veered really far off from is when we get to those points, and it's still not working out? Is it time for a premature therapeutic sort of termination? Can I help a client in that situation? Yes. Can everybody okay, I would like to think everybody has the capability to know. But if you feel that it is interfering with yourself so much before you get to the point of referring out clients for you feel that the mismatch is so great, ethically, what you're going to want to do is have some really in depth consultations, that some clinical supervision from some people that are not going to just be part of a Facebook group that you're only able to explain, you know, in a few sentences, what's going on. And the chorus of commenters is going to, you know, give you seven or eight words as far as what you should do, but pay for a good consultation around how to manage it, and document that consultation. Not in the client chart, though, not in the client chart, but protect yourself in your process notes that you've explored the ways that this impact could be happening with the client. So that way, it's not just a rash decision, that this is part of the extra workout side of the session that makes you as a better therapist that can lead to trying to provide space for a client to grow. If the results of that consultation are Yeah, you should probably refer this person out, you've got some better community understanding and thought process that goes into it. But if there's space for you to work on and address through some of these issues with clients, depending on whatever specific content it is, with whatever it is that they're bringing up. premature termination at that point, falls more into bad therapy than it does to providing a good space for them.   Katie Vernoy  24:18 Making that assessment I think, can be tough, and I want to get to that. But I want to talk about one more mismatch that I think is actually not as interesting as what we've been talking about. But I think it is an important one to put in there. And then maybe we can talk about how to make the assessment because I think making the assessment and then having really good consultation, I think can be very important. But the other mismatch really is style or personality. You know, whether you're a directive therapist, a non directive, therapist, those types of things, I think that those, they actually make a big difference. And I've had clients where they've been able to give me the feedback and I can shift and be less more or less directive. But I think there's some of us that are just more or less directive. Again, oftentimes when clients are empowered, they opt out themselves. So you're not doing this premature termination. But I think it is important to talk about it just a little bit.   Curt Widhalm  25:12 Absolutely. And as somebody who does far more to the directive side of things, I tend to advertise to my community, the people who come to work with me, they know that I tend to be more directive more honest in the way that I put myself out there, then maybe some of their other therapeutic experiences, clients who want that, and the values that we put forward here, our work is put your values out there, let clients self select into this kind of stuff.   Katie Vernoy  25:45 But sometimes clients don't know they operate in because they think it's a good match. But then you can see them either pushing back against you being directive or shutting down. And I think I think the assessment becomes the clinicians responsibility if the client isn't understanding that that's what the problem is.   Curt Widhalm  26:06 And so those directive therapists out there in this situation would likely have very little problem directing that conversation to that particular problem.   Katie Vernoy  26:15 The opposite, though, I've seen where the non directive therapists kind of stay in therapy with some of these clients forever, and maybe this is you and I bias because we're both more directive. But I've had clients that didn't realize that they wanted more than they were getting, and I think non directive therapy can be hugely beneficial for some folks. Absolutely. But for for clients that want more, if they don't know that that's the case, how do we recommend that non directive therapists try to figure that out?   Curt Widhalm  26:45 I'm gonna be totally biased towards the directive end of things. It's creating the space for that discussion, and really saying, personality wise, that's just not who I am. I can't provide what you're looking for in this situation. That is a really good conversation to have with people, because it's either going to lead into Yeah, but I still like you, as the therapist. Yeah. But what you're asking for is not something that I can really do or be like, you're asking a tiger to change it stripes like, yeah, at that point, it's being able to then have a proper termination, even if it's incomplete towards therapy goals in order to help those clients get matched with somebody who is going to be able to provide what they want.   Katie Vernoy  27:38 I think the knowledge that's required for that conversation, maybe some that either the clients asking for more, the therapist is recognizing that the style isn't matching up. I think sometimes that's not evident. I think people typically can kind of flow together. And if the style is a mismatch, sometimes that's not identified. But I think what can be identifiable? is lack of progress on treatment goals, or stagnation on treatment goals, or the Hey, how are you doing very little going on in the therapy session, that I think therapists, as a matter, of course, should assess progress on treatment goals, and be able to identify that there are a few different things and they want to assess if therapy doesn't seem to be moving forward.   Curt Widhalm  28:23 And some of the ways that you can manage that is making sure that you go back and revisit your treatment plan with your clients every so often. And I know that that's a, I was gonna say, a lot more popular in DMH work, but I don't know that popular is the right word that   Katie Vernoy  28:39 consistent usually requires. Wire. Yeah, that's probably best.   Curt Widhalm  28:46 But for independent practice, doctors, practitioners who aren't, you know, as adherent to those kinds of contracts or rules that require you to go back to those treatment plans, do it anyway. So that way, these kinds of things can emerge sooner and have conversations with your clients about, hey, we're not making any progress towards this goal. What's going on with this? That does allow for the are we doing things right? Is this something that you would get this better out of treatment with somebody else that makes it more of a joint decision, rather than just the therapist being the all knowing or all scared of having to have that conversation with a client, that honest relationship, there's typically really helpful.   Katie Vernoy  29:41 And when you were talking about that, I was remembering a conversation we had really early on in the podcast with Dr. Melissa Hall. I think it's making your documentation meaningful or meaningful documentation, something like that. But she actually really talks about the clinical loop and how making that a regular part of your process helps you close And I play but it also opens this conversation for folks who aren't quite sure what's not working. Because I think when you're documenting and paying attention, I think that can be very helpful. So we've talked about a lot of different things, I think there's, you know, we could go more into a client not making clinical progress as a reason to potentially prematurely terminate.   Curt Widhalm  30:22 I do want to bring up though that man, sometimes building off of last week's conversation around some of these therapy interfering behaviors, there may be times when even examining it through that lens, when you've consistently had these conversations with clients that you've sought the outside consultation, you've documented that the clients continue to break more egregious boundaries, but maybe not to the threatening level of the ones that were discussed in our first episode on firing clients ethically. And these are things where it might be breaking boundaries outside of sessions showing up to your office and hanging out way too long disrupting behaviors in the waiting room that you know, maybe couples who start their arguments in the waiting room that are interfering, the session that you're having and stuff like that, yeah, where those types of behaviors are things that are impacting other people in your practice, that weren't really straightforward boundary conversations that if they continue to happen, are things that you continue to bring them up if those conversations that were used suggested last week in the podcast about how this impacts things, and there is a an active refusal to follow those are acknowledge that those are even problematic behaviors that are impacting you, and especially other clients, that can be a cause that you should very much document quite well, as far as you're welcome to services, not in this way. And if these are things that are coming up, here are appropriate referrals that, you know, we've talked about in termination episodes before being able to provide, these are behaviors that you're demonstrating pair impacting me, we have tried to work on them, they are continuing to impact me in a way where I can no longer serve you. I have sought out consultation, I am working on this. And it is agreed that I am going to cause you more harm. Because of the feelings that are developing, then I can benefit you from this point. That is inappropriate referral. And that is inappropriate termination. They're   Katie Vernoy  32:49 the things that come to mind for me, if I don't have the capacity, and that could be strong clinical expertise. But it also could be time I had a client that I had to refer out because they needed more than I had time to take care of Sure. If they if the relationship is not one, that there would be an element of abandonment, the feeling of abandonment, abandonment is different than the abandonment of just saying today was your last session, audios. The treatment Alliance and we talked about this a lot in both of these episodes. But if the treatment Alliance is strong, there may be things that could be overcome that in other situations, it would be recommended to refer out. But I come back to something that I think is going to be very rampant right now, especially for certain types of specialties and certain types of things is the availability of more suitable resources. And so maybe as our last point, because we are getting pretty long here. But as our last point talking about, I've made the assessment, I've done the consultation, I've had the conversation with the client, I am unable to keep the client ethically, legally, logistically, whatever it is, and I'm having a hard time finding suitable resources to refer them to. At that point, some people keep clients. And I think that there are pros and cons there. But what is our responsibility? If there are just no therapists that are capable of helping this client?   Curt Widhalm  34:26 I think with the accessibility of telehealth now that this is much less of a problem than it has historically been that with providers in every jurisdiction now able to provide telehealth easily that this is going to be where, especially in the private practice end of things, those referrals are more easily found. Hired, indeed higher severity clients, those being sought out through things like DMH you're going to have agency policies that you're going to have to follow in those situations but To give maybe an anticlimactic answer, I don't think that this is as big of a problem here in 2021, as it has historically been described, there, lots of referrals out there, there are clients and therapists who can match across distances now. And that's, you know, one of the things that being more digitally accessible helps to alleviate some of these issues when it does come to providing care for these kinds of clients.   Katie Vernoy  35:30 So basically, the answer was, I'm not going to answer you, okay, because it's not that big of a problem.   Curt Widhalm  35:37 Pretty much.   Katie Vernoy  35:39 So I'm going to actually just put us put my spin on it, because I do think it actually is still a problem. But I think the problem is not more, is there any available resource? It's, is there an acceptable resource to the client? Because oftentimes, it does mean having a therapist who is telehealth and they want to be in person or someone who is not maybe as close of a personality fit but has a specialty and doesn't take their insurance. I mean, there there are some issues here. And I think it's something where, and maybe you can correct me if I'm wrong, in good faith, providing as many as close good enough referrals to this client as you can and trying to do what you can to do some linkage is sufficient. Yeah. Okay.   Curt Widhalm  36:28 You should let us know what you think of this episodes, especially in our Facebook group, the modern therapist, group or on any of our social media. You can also leave us a rating and review and we'll include our show notes over at MTSGpodcast.com. Also, there is still like, hours left for you to be able to get your virtual therapy, reimagined 2021 tickets. We are going entirely virtual again this year, we had hoped to have some people come out and join us in Los Angeles, but enter in the meme of my fall plans and delta variant. Yes, but there's still time you can get those tickets over at therapy reimagined conference calm. And until next time, I'm Curt Widhalm with Katie Vernoy. SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform.   Katie Vernoy  37:37 Get your first two months of SimplePractice for the price of one when you sign up for an account today. This is collusive offer is valid for new customers only. Please note that we are a paid affiliate for a SimplePractice so we'll have a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapy reimagined. And that's where you can learn more.   Curt Widhalm  37:57 This episode is also sponsored by RevKey.   Katie Vernoy  38:01 RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services. RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs.   Curt Widhalm  38:25 You'll never receive a data dump report that means nothing to you. Instead, red key provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners.   Katie Vernoy  38:42 You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener   Announcer  38:48 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.

    What to do When Clients Get in Their Own Way

    Play Episode Listen Later Sep 13, 2021 45:18

    What to do When Clients Get in Their Own Way Curt and Katie chat about what therapy interfering behaviors (TIBs) are and how to address them in therapy. We explore the balance between reducing barriers for clients while also holding them accountable for their behavior. We also talk about how to identify if it is the therapist or the client engaging in a TIB. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: What therapy interfering behaviors (TIBs) are and how TIBs show up in the therapy room. How to address TIBs in therapy (we may disagree a little here). The balance between reducing barriers for clients and holding them accountable. If you should still have session when a client shows up late. Using appropriate self-disclosure to address TIBs. Should you fire clients for TIBs? When therapists engage in TIBs. How to evaluate if it's a client TIB or therapist TIB. Managing imposter syndrome when a client becomes hostile because the therapist cannot provide what the client wants. Our Generous Sponsors: SimplePractice Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what's most important—your clients—by simplifying the business side of private practice like billing, scheduling, and even marketing. More than 100,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform. Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Go to simplepractice.com/therapyreimagined to learn more. *Please note that Therapy Reimagined is a paid affiliate of SimplePractice and will receive a little bit of money in our pockets if you sign up using the above link.   RevKey RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener.   Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might 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: How to Fire Your Clients (Ethically) Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2021  Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, 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 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. 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Full Transcript (autogenerated):   Curt Widhalm  00:00 This episode is sponsored by SimplePractice.   Katie Vernoy  00:02 Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what's most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing.   Curt Widhalm  00:18 Stick around for a special offer at the end of this episode.   Katie Vernoy  00:23 This podcast is also sponsored by RevKey.   Curt Widhalm  00:26 RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists digital advertising is all they do, and they know their stuff. When you work with RevKey they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts.   Katie Vernoy  00:49 Listen at the end of the episode for more information on RevKey.   Announcer  00:53 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  01:10 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 things therapist related what we do with our clients the things that we do, outside of the therapy room, things that we do inside the therapy room. I don't know I'm back to not introducing podcast well.   Katie Vernoy  01:34 This is a podcast interfering behavior.   Curt Widhalm  01:38 On that note, Katie, do you know what you call an Interrupting cow? No. All right, Dad jokes aside. After our episode on firing your clients, ethically, we got a review on Apple from Apple user, vinyl dash. And I'm going to paraphrase quite a bit of this here. But this is a review that we're actually going to have two episodes of response. So we do appreciate all of the feedback that we get from our modern therapist community here. And we do look at a lot of them. So please give us ratings and reviews. Let us know what we're doing well, what you'd like to see us cover. You can do this on any of the review sites or on our social media join our Facebook group, the modern therapist group. But there is a lot here that came from this review. In response to that episode on firing our clients. Apparently, we miss some opportunities for some nuance, and especially in the case of firing our clients. The only issues that we discussed were when therapists feel unsafe or threatened. True, yes. And maybe we could have done a better job of titling that episode to something about therapists safety and firing clients they're going back to this review as a private practice therapist far more common scenario when considering premature termination comes from what they call in DBT, therapy, interfering behaviors or just repeated boundary violations. And after addressing them in session and attempting to help client gain awareness about these behaviors outside of the therapy relationship. These are far more nuanced situations that don't make this reviewer feel unsafe, but do ultimately make it sometimes impossible to continue seeing the client when the clients are often already struggling with abandonment issues. And this user would like us to maybe address that a little bit more. We're going to have this episode and next week's episodes cover some of the nuance here because we try to keep our episodes here about 30 minutes, it doesn't always allow for us within a single episode to get into a lot of the nuance here, Katie and I were talking about now there's kind of two different things here. One is talking about therapy, interfering behaviors and managing them. The other is maybe some other non threatening situations where it might be right to terminate with clients. And that's going to be for next week here. So therapy interfering behaviors, Katie, I think it might help our audience here to know a little bit about how this shows up in the therapeutic relationship. This is something that we know comes from the DBT worlds but whether you're a DBT practitioner or not, this happens across a variety of practices.   Katie Vernoy  04:42 When we look at therapy, interfering behaviors, I think there's acknowledgement that these can happen both from the client and the therapist. And so I want to make sure that we put that front and center because I think oftentimes, clients get blamed for interfering in therapy and I think therapists can contribute and we'll get into that more later. But looking at some of the therapy interfering behaviors that I think are most difficult, and maybe we can just start with the logistical ones up front, are coming late to session missing sessions, last minute cancellations, no shows not paying, maybe trying to reach out to therapists repeatedly in between sessions kind of crossing those boundaries. But I think the the logistical ones, rather than the clinical ones, I think are ones where people can really get in trouble. Where if you're looking at a business model, if you have clients that are consistently not paying or late canceling or, you know, or even canceling right on that, you know, whether it's 24 or 48 hour mark, and you're not able to fill those session times, I think, from a business standpoint, the no brainer is just fire him right, like just these clients need to go. But I think that there are clinical reasons not to and I think there's also actually business reasons not to as well. But how often do you experience these types of therapy interfering behaviors, because I think the argument that a lot of people make is that if you set up your practice properly, and you have appropriate boundaries, you don't see these as often. But I actually think that they're clinical. And I think that some practices will always see them, at least at the beginning. To a certain extent,   Curt Widhalm  06:17 I think that I run into them a lot less now than I did earlier in my career. And part of that is having structured my business with some of the things that we've talked about on the podcast before. Having a client credit card on file shirt makes it to wear them for getting their checkbook doesn't become a therapy, interfering behavior, it's pushing a couple of buttons that allows for me to charge those cards in the first place. Having automated appointment reminders, sure, makes no showing for sessions a lot easier. But probably the most important thing that I've learned is addressing stuff with clients as soon as possible. Yeah. And this is something where I don't consider myself a DBT therapist, but the more that I read about DBT, the more that I recognize that I do use a lot of DBT principles in my practice. And I think one of the main things that I do with my clients, and I have a practice that mostly works with adolescents, so this also includes therapy interfering behaviors from their parents, yep, is not letting a lot of these feelings swell up, and being able to address it right away in the next session. Or if I am getting a lot of frequent contact in between sessions, you know, those clients where you see their phone number pop up, yet again, you get that little feeling in your stomach, where it's like, yep, dealing directly in the therapeutic relationship with clients about how these boundaries end up being crossed, and how it's something that interplays within our relationship, and is likely interplaying within the relationship those clients are having in other places in their lives, is something where providing that direct feedback to them. With the goal of continuing therapy successfully, when you were talking about that there's a lot of therapists who are really quick to, you know, wanting to get rid of these kinds of clients is, this is really coming from the empathic place of I want this and us to work together. And here's the impact that this is having, not only on your progress, but on our relationship towards that progress, that really sets a foundation of GRE addressing these behaviors, we're addressing them again, and we're addressing them again, that helps to bring this insight up for clients that I do see them start to have more of a understanding of the impact of what they're doing, not just for themselves in kind of saving themselves out of their own anxiety plays, but also within the context of the relationships of the people around them.   Katie Vernoy  09:01 I love those interventions. And I also think they're challenging because oftentimes it means putting a little bit more of you in the room, and it's working in the transference, so to speak, how you're treating ni is probably how you're treating others. And let's let's work it out between us. And I think that works really well. But it does make an assumption that there's something that they're doing that is consistent across their life. And that may be true, and I think we need to assess that. But I think I actually start further back, which is trying to understand why it's happening. You know, I go from a place of someone's not doing some overt or covert behavior to try to interfere with therapy, but that there may be logistical issues. You know, the first thing I do is I ask them, is this the time for therapy? Do we need to make a different schedule? Do we need to move this around? Is there something that's keeping you from wanting to come to therapy You know, it's looking at what what is their experience? And is there something in their life that's getting in the way of therapy and not just like, Hey, this is how they treat everyone. They're always late. They always are inconsistent and over inconsiderate, but actually like, did we schedule it a bad time? And part of your clinical issue is that you want to please me, so you don't feel comfortable asking for a different time. So you're always running late? Is it the way that I start therapy annoys you? And so you're you're hesitant to come in? I mean, I feel like to me, and maybe this isn't that different than what you were saying. But I feel like, oftentimes, the assumption is that this is a resistance or a therapy interfering behavior, which I guess it is interfering with therapy, but it may actually be logistical and practical, and just like, Hey, I realize that I'm exhausted at nine in the morning, and I'm going to sleep through my alarm, and I can't do it. So we need to schedule it after to, you know, it's not that I don't want to see you, it's that I've made a commitment I can't keep,   Curt Widhalm  11:01 I think, and maybe where I'm shying away from this a little bit is for some clients, you might be asking for an insights that they don't necessarily have the capability of being able to look at themselves yet. Sure. I work very much in the present the relational aspects of things, and for me with those particular kinds of clients, and as this review is pointing out, being able to talk about the impact that somebody's behavior has, in real time on the person that that behavior is having is the very DBT intervention of modeling emotions and thoughts and being vulnerable about what's happening, you know, everybody's favorite DBT intervention, dear man, of being able to describe what that impact is, and being able to model how that's happening. And sometimes I'll even go so far as to say, here's, here's, dear man in practice, here's me describing what your impact is on me. And here's me expressing what that impact does for me, and once again, asking you to look at how these actions in the collective of them has that and you know, reaffirming, are you really committed to changing these kinds of behaviors, knowing that these behaviors have an impact. This way, it's not getting a lot into the why it's not getting into, you know, the potential of being able to externalize the responsibility onto anything else, traffic, trauma, anxiety, whatever else it is. But looking at the personal responsibility, that's still part of the behavior in real time as it impacts when somebody, ideally, you as the therapists, if you're following what I'm describing here, in a way that is managed, you know, maybe with a slight annoyance, yeah, I'm annoyed when you don't show up when you say that you're going to show up. That helps a real relationship to develop. So that way these clients have the ability to work through these therapy, interfering behaviors, and outside of the room, relationship interfering behaviors, that allows for that insight that you're talking about to start to develop and be able to be expressed more effectively.   Katie Vernoy  13:29 So I agree that's a great intervention. I don't think that that's a bad intervention. I think that it's a wonderful intervention. I think the addition and it sounds like you're saying that maybe this is not a good addition, is actually trying to see if there's anything that's happening on the therapist side of the street coming as a human and saying, Hey, is there a way that we can make this better? Because Is this the right time for you to show up? Is this is there something there because to me, going from the this is your behavior, and you're doing it wrong, doesn't acknowledge that there are real life situations that can get in the way of people doing stuff that when those things are resolved, and when they are actually talked about and it's acceptable to be a human and have some of these things happen? And it's not like, Hey, this is this is a problem behavior, you need to fix it. But it's like, Hey, this is what I'm seeing. I'm trying to understand it. What do you understand about it? What do I understand about it? What can we do about it? It's not saying, Hey, stop it, which is, I think can with the power differential, I think can happen. And I think people can feel very turned off by that.   Curt Widhalm  14:33 Oh, to clarify, I'm not saying what you're doing is wrong. What I'm saying is this behavior has this impact. Okay. And by virtue of being able to bring it up in this way, what we're doing is we're coming to the place that you're describing, which is coming to a joint solution on how to make things work together. And ideally, if a client is able to follow that same sort of process of being able to say when You do this, it impacts me this way. That is therapeutic growth in very much the same way that we've just modeled and is something that we would hope to be able to create the space for them to have that real relationship with you as the therapist there.   Katie Vernoy  15:14 So the big difference then from something that you might do in a, personally is that you just start from a place of this is therapeutic material, and we need to address it, yes, instead of Hey, what's going on?   Curt Widhalm  15:26 Right, because especially with these kinds of clients, we're exhibiting these kinds of therapy interfering behaviors all over the place. There's never a bad time to enforce limits, unless it's way too late. And those limits are the things that we hope that people read in our informed consent, the things that everybody is agreeing to, at the beginning of the first session, when you know, here's all of our practice policies that they're just kind of glossing over, because what they're there for is I want to be healed, I want to be out of this feeling that they're just kind of Yeah, yeah. Now, let me tell you about, it's important to come back to what those limits are, as those limits are being tested, and repeatedly being tested, that leads us as clinicians to feel like, are we actually providing this client with good therapy?   Katie Vernoy  16:17 Some of this It sounds like might be stylistic. And I think it probably depends on the clients that you're seeing, and that kind of stuff, how you approach it, I think, I think we're saying very similar things. I think the nuance here is, for me, I start from the relationship and trying to understand what's happened to you from for it sounds like for you, you start within the relationship and, and holding a boundary. And that doesn't suggest I'm not also holding the boundary. It's just I think we there's not one right way to get to the conversation of Hey, this behavior is interfering with therapy, it may also be interfering with the rest of your life. And how do we make you more successful here, as well as how do we extrapolate that out to your life.   Curt Widhalm  17:03 And I think the approach that I'm taking here is that I'm wanting to keep the client engaged in the process of what is happening, and not bypassing what's happening in the moment and immediately jumping out to other places that this could possibly be happening. And if there is a therapist pleasing aspect of clients in these situations, you can get to kind of this bypass or this ignoring of other places that this is happening for those clients, you know, oh, no, I don't see this happening in other places, even when it totally is that they're just trying to be like, you know, I'm a good client, you know, this is the only place that it's coming up where we might, you know, be chasing a rabbit down one path that needs to go several different paths. I don't know if that metaphor works, but   Katie Vernoy  17:56 I think it's understandable. But yeah, I mean, I think it's some of this is so unique to each client, though, it really depends on what they're working on, and what the therapy and interfering behavior is, I think,   Curt Widhalm  18:08 within this, and you brought up earlier about some of the logistical aspects of this comes with the way that we might choose to run our sessions. How for you, if a client's running late to a session, do you set limits on like, well, if you're not here by 20 minutes, and we're canceling the session, and I'm just going to charge you anyway.   Katie Vernoy  18:28 Sometimes it depends on the client, I have clients that have chronic illnesses, and different things that may interfere with their ability to come right on time, or those types of things. And so those are discussed and addressed. But I don't necessarily say if you're not available by this time, I'm going to close the session out like I'm not going to, I'm not going to do a 30 minute session, if you show up 20 minutes late, I don't say that, for me the flexibility of enforcing the time limit, and charging them for the session, kind of whether they show or not, I think that lives, but I think the tardiness is more enforced interpersonally and if someone's 20 minutes late, or 30 minutes late, and they're like, hey, should I still come? I say no. But if if they come into a session at the 1520 minute mark, or they tell me Hey, I'm going to be there in five minutes, I will honor the session. I think for me there's a humanity that I add that maybe others see is not having great boundaries. But for me that that I understand that people have unique experiences and my timeliness is pretty good. Overall, my attendance rates pretty good overall, I kind of go from the place of I understand and value that you're doing your bus and if you're not showing up on time or you're not showing up consistently, that's something we need to talk about. So that's how I manage it. How do you manage it?   Curt Widhalm  19:54 If the client is 48 minutes late session, we have a two minute session. And I say that because I mean, if they're paying for a 15 minute session, and I've got that 15 minutes blocked out for them, but if they show up, it gives us the opportunity, even in those two minutes to begin to address what is happening and what the impact is. Yeah. And you'll see this in a variety of situations, I'm going to change a bunch of details about a client here. So that way, I can keep this anonymous at a client several years ago, that would always have digestive issues. The minute before the sessions were to begin in our office, this client would show up to the office, they will call eight, and my office would go on appropriately, about eight or nine minutes before the session, but it would be as soon as I would come out, hey, I gotta go the bathroom. And it would oftentimes be 3040 minutes in the bathroom, that when this client would eventually come back, the discussion would be, what are you getting out of the therapy, because, you know, what we've agreed upon. And the treatment plan that we set out together was to be able to look at the way that your behaviors are kind of procrastinating. And it sure seems like this is happening here. And what I'm hearing from you that therapy is not being successful, I look at moments like these. And it feels like you're trying to blame me for therapy not working. But we're missing 40 minutes out of the session. This is where it took several months of having conversations like these a number of times when this client was upset because I was charging them for the agreed upon our and, you know, having these two 510 minute sessions that address these behaviors, this client terminated with me for a while and came back 18 months, two years later, and said that that was an opportunity that they saw that they were having this kind of avoidant behavior with a number of other places in their lives. But it took somebody consistently pointing that out to them, for them to now come back to therapy and want to actually start addressing it. So clients like these can seem highly motivated, even in the midst of their therapy interfering behaviors going on. Yeah, but setting up this foundation, and really being able to not go beyond your own limits as far as what you're emotionally, having happen with the clients managing your own countertransference. But appropriately, self disclosing can set these clients up for a lot longer process of being able to come to the realizations that they had hoped that they would get in the first place. And this is where a lot of my clients come to eventually say something to me as far as this is what makes your therapy very real. You're very honest about what you're doing. And about the impacts that things are happening. You're not just kind of setting up some rules and not explaining why.   Katie Vernoy  23:16 I think that's the important point is explaining why the rules are there and having that transparency, because I think if it feels punitive, if it feels dehumanized, you didn't show up until two minutes. So we'll do the two minutes and I'm charging you for the whole time. I think that doesn't necessarily resonate with some folks. And so I think if it's like you're describing, you're actually talking about it within the relationship. I think that is so critical, because so many of the clients that I've had come to me have talked about feeling like their therapist didn't care about them. They were very punitive toward them, or they didn't see them. And I think for me that that element of being able to hold both pieces, the strong boundaries and infrastructure, as well as the caring human connection. I think that's what's most important to me.   Curt Widhalm  24:07 And this comes back to the idea of we can't infantilized or treat our clients like they're inherently weak, that having a real relationship, even if it's a chaotic real relationship is something that does provide the space for growth for these kinds of clients and ultimately allows for the growth of the clients to be able to carry the same kind of principles through other places in their life, and being able to consistently show up and have that acceptance of our own limits. Being able to describe the acceptance were on limits, and really being able to model it even when it's initially in bringing it up with clients like this drives our own anxiety through the roof because it's not an easy transition of going from a therapist. Who's expecting clients show up and just immediately start doing the work to being able to address things immediately, because we're trying to keep that professionalism in place. But I think being able to have that honest relationship to appropriately self disclose wouldn't you know, when we hear about this appropriately, self disclosing for the client's benefit, where I don't talk about things is, I don't talk about them not showing up is having impact on my money, I don't want them to take the message that they're just you know, in my life, because they're paying me part of that is maintaining the boundary of you reserve some time, that time, cost this amount of money that time was reserved for you, and I'm holding that boundary with you. Yeah, I don't, you know, put this in sort of this punitive. Well, you did this. So I'm doing this, it's more in that nuanced. I had this experience of your behavior. And it left me with this impact. It is radically self accepting my own reactions to that. I don't go so far as to being like, and I want to punish you for this.   Katie Vernoy  26:15 But I think oftentimes, folks will see consequences of their behavior as punishment. That's why how it is presented, how the boundaries are presented are important. I'm looking at the time and I want to shift to some other stuff, because I think we're, we've we've covered I think, the logistical elements except when do we fire clients for these types of boundary crossings of coming late missing sessions last minute cancellations are not paying?   Curt Widhalm  26:41 I typically don't I find that all of these behaviors are in yellow words, grist for the mill of psychotherapy, that these are all processable, being able to continue to talk about it, you know, if it's logistical things like, okay, scheduling is something that it's hard for clients to get to our office during rush hour, we'll work towards appropriate accommodations. I don't make promises of let me move seven other clients so that way you can get your ideal time. It's let's look at my calendar and see if there is a more appropriate time that you can fit in. Yeah, that is, again, it's bringing together these principles of I have limits to   Katie Vernoy  27:28 Yeah, I think you finish there, I start there, I think we have a similar way to handle it. But I actually there are times when I think that it may be appropriate to terminate with clients. One is if they truly are not paying the credit card on file is expired, and they're not getting back to you at a certain point for keeping that client. I think if clients are consistently missing, you know, last minute cancellations, and you're seeing them very infrequently. I think there's a time at which that becomes clinically irresponsible to have them on your caseload. I think if you're able to keep the conversation going, that's one thing. But I think if it's something where you're absolutely not doing any treatment with them, because they come in once a month, you're discussing therapy interfering behaviors with them, they go all right. All right. All right, and then they don't come back for three or four weeks. I think it's I think at some point, you know, you do have a responsibility both to yourself and to your client to not pretend that therapy. So shifting gears, there are these logistical reasons that I think we've talked about pretty well. But there's also some clinical reasons that are called therapy, interfering behaviors, whether it's not trying out interventions, not participating, not speaking a lot asking or demanding more than a therapist can offer, or even being disrespectful or hostile or critical to the therapist. And I would refer people for that part, potentially back to the episode on how to fire clients ethically, although I think there's ways to keep those clients are not expressing your emotions effectively as another one just to add that in. But when I'm thinking about this, for me, I go to this conversation that we've had about resistance. And some of this I feel like is blaming clients for therapist failures. Say more, if a client is not trying out an intervention that a therapist think is the right intervention, or they're not engaging in the conversation in the therapy room, or they're asking for more than the therapist can offer. And I think the assessment of what that means, potentially the client is saying, I don't agree, I don't I'm not signed on for this treatment plan. You're not helping me to have an engaging conversation here. And I want more than what you're offering to me because I don't feel like I'm getting better. Now. Obviously, the assessment is the most important part of that. But I think if therapists go to my clients are interfering with their own behavior because they're not trying what I want them to do when they're not talking to me and they're not and they're asking me for more I think the therapist needs to do a self evaluation, are you actually aligned with what the client wants to work with? And what they want to work on?   Curt Widhalm  30:09 And you gave a couple of answers even within your question there. One is, if this is not the treatment plan I agreed to, then you've done the wrong treatment plan is the therapist. And that's where you need to go back to part of this is going to be dictated by the theory that you're working from, that. A lot of times what I'll see is especially like kids with anxiety, that don't want to use anxiety management techniques, and I'll hear parents, you know, come into the beginning or the end of the session and be like, my kids still anxious. Okay, let's shift treatment theories, let's go from working CBT with a kid to family systems to see how parents are reinforcing some of the anxiety relief seeking behaviors that running to mom or dad to appease some of the anxiety rather than having mom and dad reinforced, now's the time to use those anxiety techniques to be able to clinically address this in a way kind of is going to really depend on the context of whichever client but it takes the step back on the therapist part to really evaluate is the working Alliance there, do we agree on what the problem is and how we're going to get there, because that's going to set up your treatment plan. And your treatment plan is going to be something that the client, clinically ethically should be involved with, if they have any capacity to start working on it. And that is going to be the vast majority of clients. So this is part of where really being the therapist is being able to have that wide variety of different ways to approach this, as you described,   Katie Vernoy  31:55 the other element is potentially my framework, which is the client as the expert of their own experience. And so if I were to suggest a specific intervention, they come back the next week, they haven't tried it, or they didn't do the homework or whatever it is they didn't do it, my approach will potentially be the same regardless if I think it's therapy interfering, or I had a, you know, an misalignment on the treatment planning. But it's what happened? What made it so that you chose not to do that? And how do we either figure out how you do it, which is, hey, you interfered with therapy? Because you didn't do what I told you to do. And we all agreed that you were going to do it and it's great. Or it's how did I What did I miss? What's not feeling right for you? What are the steps, maybe were three steps forward, and we need to take five steps back to identify the behavior ahead of it that's getting in the way of you being ready for this, that or the feelings or emotions or whatever the perception ahead of it. That's that you're not ready for this. To me, I feel like when clients consistently are coming in Week after week, not having done the work, so to speak. My instinct is not that's a therapy interfering behavior. My instinct is that it's me, I'll address it similarly. But I think for me, it's sometimes I hear clinicians getting very upset because their clients aren't doing what they think they should be doing. And I'm always cautious to assume that therapy interfering behaviors on the clients part.   Curt Widhalm  33:31 It's worth evaluating. Why can't it be both? That   Katie Vernoy  33:37 absolutely is.   Curt Widhalm  33:40 And this is, again, working radically within what's happening in real time in that relationship with clients is being able to explore both with clients that, hey, you're here to work on these things. We've agreed to this plan. Is this a plan that we need to reevaluate so that way you can be successful? Sometimes, yeah, where I often see this coming up is kids who are drugged into therapy by their parents, and the kids don't really want to be in therapy. But then it's being able to shift what therapeutic goals are to something that does speak to the kids. It's being able to frame it in a way these are, you know, the therapists responsibility ends of things. But I've worked with plenty of kids who don't agree that the problem is what the same problem is that their parents bring them in with. And again, this comes with some of the experience, particular to my practice the intake session, I make sure that parents are involved in the first several minutes of the session to be able to say, all right, describe what you want for your kid here. And you know, after a few minutes of laying out kind of what the problem is, what the limits of confidentiality are all those you know, wonderful four session things. And I send mom and dad back out To the waiting room, I'll turn to the kid and be like, Alright, I heard mom and dad story, what's up with him, and kids almost universally are like, Alright, see, now I get to describe what my part of the problem is. It's it's a symbolic shift over to the client and that situation to give them more control over the therapy process. So that way, it's meeting the client where they're at, not where somebody else wants them to be. And this is where clients will talk about, you know, my therapist forced me into this thing I didn't want to do. But you can set your client and therefore yourself up for more success by really focusing on that therapeutic alliance upfront to make sure that you're working towards the thing that you both agree that you need to be working on.   Katie Vernoy  35:46 Well, and I think, to me, a critical distinction is desired outcome and intervention. Because I think, and this is just a nuance to kind of explain it to the audience, I know that you agree with us. But we agree to work toward an outcome, I don't know, except for more specific types of treatment, like EMDR, DBT, that kind of stuff that people are agreeing on specific interventions. I think that those things, by nature need to be fluid, unless there's an evidence based practice that suggests a specific structure for the therapy. And so to me, and maybe this comes back to motivational interviewing, and how do we get the person ready to go and make sure that it's their decision to make a change, or maybe it goes to really understanding the client as a human and being present for them while they figure out, you know, their particular method of healing. I also think that there's things that we can't know, deeply in our souls, and maybe not even intuitively because many of us didn't learn these things in grad school, but the different cultural methods of healing and being able to align those I think, if we are caught in our own, this is what I think my clients should do. I think we're going to experience more of these types of therapy, interfering behaviors versus coming from a place of collaboration and connection when we when we run up against these things.   Curt Widhalm  37:13 Absolutely. You're right. I was ready to fight you when you said that. You knew that I would agree with it. But   Katie Vernoy  37:20 I know you all too well. So the final one is this kind of disrespectful, hostile critical, the therapist are demanding more than the therapist can offer. And I think that's similar to what we were talking about with safety. But we talked to in that regard, we were talking about how to fire the client in that episode, which will obviously link to in the show notes. But I think that there's also, how do you actually deal with that if you're wanting to keep the client in the session, if a client is being hostile towards you, like absolutely hostile?   Curt Widhalm  37:49 I think that a lot of times, this is where those kinds of behaviors first bring up a lot of that imposter syndrome for a lot of therapists have like, oh, they're seeing through what I can't do. And, again, this comes with experience, it comes with supervision, consultation, your own therapy, of being okay with where your limits are, sometimes clients are going to ask for more than what you can provide. And it's okay to be honest of this is, you know, something that you as a client, you're asking for something that I can't do. And there might be feelings, there might be continued hostility about that. Now, this is honestly mostly where I would suggest that you talk about this as far as clinical techniques. I want EMDR, I want brain spinning. I sorry, I can't do that. That's not part of my training, that helps to, again, model an appropriate reaction, don't take it necessarily, personally, but it's being able to first recognize your own feelings that are coming up in these situations helps to more successfully navigate this. Clients are going to have bad days from time to time, they're going to project stuff onto you that you're going to be the target of whatever just happened to the car. Again, number of teenagers that show up in my office just upset of whatever the conversation was in between school and my office ends up being something that gets kind of pushed at me. So the first steps of it is, is there still a place to make therapy work? Sometimes these clients have these moments, and it makes them very unlikable in the moment but getting through these moments are things that helps to make the real relationship of therapy continue to grow and develop, which makes these clients more likeable. But it's being able to know your own reactions know your own limits within what's coming up as appropriately, setting the right kinds of boundaries. doesn't help me when you Talk with me like this. And if it doesn't help me, it's not helping us.   Katie Vernoy  40:03 Yeah, I think there's I mean, I always go back to, is the client hostile towards me? or angry at me because of a clinical misstep or an interpersonal misstep? I always want to have that assessment be the first thing that I do. And sometimes it's like, absolutely not, I was fine. This is, you know, whether we call it transference or therapy interfering, or whatever, you know, then then I'm okay, you know, my side of the street is clean over here, let me figure out what's going on for them and help them to process it, and not necessarily give them the same experience someone outside would give them because most people would walk out of the room or snap back or whatever. But give them an understanding of what that experience is and what they're putting out. So I see that there have been times when clients are pissed at me because I made a mistake. And so I think, recognizing that there are times that I'm going to have to come back and say, Hey, I missed something there. Let's talk that through. And most of the time, not always, but most of the time, the client and I are able to come to a better understanding and improves communication. And it's also modeling, apology and repair, as well as providing them with an opportunity to figure out what do I do when I've blown up at somebody, and then the relationship continues, which I think is really powerful. So to me, I feel like there's, there's a lot that as therapists were being asked to do, that potentially no one in their life would put up with, for our clients. And so to me, it's it's sorting out how do we walk through them in a way that allows for healing to happen, while then still taking care of ourselves. So when I've got a client that's hostile towards me, whether I've done something or not, I'm gonna be calling colleagues to consult or at least event or whatever, so that I can get myself back in the right place. If I've got clients who are consistently making my schedule of mass, I might consult again and say, Hey, you know, what boundaries? Am I missing? How can I get this back under control? Or what are the things that are coming up for me that I keep helping this client move their appointment all over the week? You know, whatever it is. But I think the doing of these things of having these hard conversations of giving this feedback that most people won't give our clients, I think is hard enough. But it is we did sign up for it. Maybe not every client maybe not every situation, but we did sign up for this.   Curt Widhalm  42:37 We would love to hear more from you. You can talk about the episode in our Facebook groups bot and therapists group, let us know on social media or leave us a rating and review but we'd love to hear about how you handle therapy interfering behaviors from your clients. And you can check out our show notes at MTSGpodcast.com. And also check out the now entirely virtual therapy reimagined 2021 conference, we've had to make some adjustments. We're looking at the COVID numbers and decided that we'd love to hang out with you. We don't want to hang out with the Delta pair yet. So join us online you can get your virtual tickets over at therapyreimaginedconference.com And until next time I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  43:27 Thanks again to our sponsor SimplePractice.   Curt Widhalm  43:30 SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform.   Katie Vernoy  43:48 Get your first two months of SimplePractice for the price of one when you sign up for an account today. This is collusive offer is valid for new customers only. Please note that we are a paid affiliate for a SimplePractice so we'll have a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapy reimagined. And that's where you can learn more.   Curt Widhalm  44:09 This episode is also sponsored by RevKey.   Katie Vernoy  44:13 RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services. RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs.   Curt Widhalm  44:36 You'll never receive a data dump report that means nothing to you. Instead, red key provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners.   Katie Vernoy  44:53 You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener   Announcer  45:00 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.

    Are You Even Trauma-Informed?

    Play Episode Listen Later Sep 6, 2021 39:03

    Episode 224: Are You Even Trauma-Informed? An interview with Laura Reagan, LCSW-C, on trauma-informed care, including what it looks like in practice. Curt and Katie talk with Laura about the barriers clients face when trying to find a good trauma therapist and how trauma therapists can advertise in a trauma-informed way. We also explore how COVID is impacting trauma treatment and tips for providing virtual trauma therapy. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.   Interview with Laura Reagan LCSW-C, Laura Reagan, LCSW-C is an integrative trauma therapist, clinical supervisor, consultant and coach. Since 2015 she has hosted Therapy Chat Podcast, where she interviews therapists, authors, researchers and other experts about psychotherapy, trauma, attachment, creativity, mindfulness, relationships and self compassion. In 2021 she launched a new podcast entitled Trauma Chat for anyone who is curious about what trauma is, how it shows up in our lives and how to find the right kind of help for your specific experience. She is the founder of Trauma Therapist Network, a website providing information and resources on trauma and a membership community for therapists. Learn more at www.traumatherapistnetwork.com.   In this episode we talk about: Who Laura Reagan is and what she puts out in the world. What therapists get wrong with trauma-informed care in regard to advertising. How trauma therapists can be trauma-informed in their advertising. Factors that make it difficult for clients to find a good trauma therapist. What is trauma and what is trauma therapy? How COVID is playing a role in trauma treatment. Tips on how to provide effective virtual trauma therapy. What therapists can do to support clients that do not have an ideal virtual environment. If therapists should obtain more trauma training due to the impact of COVID. Considerations therapists can make when deciding to specialize in trauma.     Our Generous Sponsors: SimplePractice Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what's most important—your clients—by simplifying the business side of private practice like billing, scheduling, and even marketing. More than 100,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform.   Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Go to simplepractice.com/therapyreimagined to learn more.   *Please note that Therapy Reimagined is a paid affiliate of SimplePractice and will receive a little bit of money in our pockets if you sign up using the above link.   RevKey RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs. You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners. You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener. Resources mentioned: 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! Trauma Therapist Network Therapy Chat Podcast Trauma Chat Podcast Relevant Episodes: Managing Vicarious Trauma What the Grief Just Happened? Trauma Informed Workplace Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined Conferences   Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated)   Curt Widhalm  00:00 This episode is sponsored by SimplePractice.   Katie Vernoy  00:02 Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what's most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing.   Curt Widhalm  00:18 Stick around for a special offer at the end of this episode.   Katie Vernoy  00:23 This podcast is also sponsored by RevKey   Curt Widhalm  00:26 RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists. Digital advertising is all they do, and they know their stuff. When you work with RevKey, they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts.   Katie Vernoy  00:49 Listen at the end of the episode for more information on RevKey.   Announcer  00:53 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  01:09 Welcome back Modern Therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast about all things therapists for therapists. And we are once again joined by one of our therapy reimagined 2021 speakers. And returning to the podcast for the first time in like three plus years is Laura Reagan LCSW. And we are so excited to have you back. And once again talking about a lot of ways that we can improve and working with clients with trauma. So thank you for spending some time with us today.   Laura Reagan  01:45 Thanks so much for having me back. I'm really excited to be here.   Katie Vernoy  01:49 Yay. We're so excited to have you back. And we always ask our folks who are you? And what are you putting out into the world? And we'll share your other episode in our show notes. But you're putting something new out into the world. So for our new listeners, who are you and for our long standing listeners, what are you putting out into the world now?   Laura Reagan  02:08 Well, one of the things I put out into the world is that I'm a trauma therapist in the Baltimore area. And I work with clients directly and run a group practice. But also, I have two podcasts now, therapy chat, which has been out for six years. And then my new show is called trauma chat. That's really for the general public to learn about trauma and connected with both of those, after years and years of being asked by so many listeners for how they can find a trauma therapist, I created a new resource that's called trauma therapist network that includes information and resources about trauma. And it has a trauma therapists directory, which is the part that to me is the most exciting because it feels like something that's been needed for such a long time   Curt Widhalm  02:55 When it comes to trauma informed care that this is not just the things that we say and do when clients have come in, we've had a couple of sessions with them that a lot of this starts from people's first Google search of us that really being informed comes with the ways that we even advertise ourselves. In your experience of working in the trauma community and with trauma therapists. What are you seeing that some therapists might not be doing right, that might not be the most trauma informed as far as even like their advertising goes?   Laura Reagan  03:35 Well, that's a great question. I mean, one of the things is, if anybody pulls up a listing on Psychology Today, for example, everybody knows that is a pretty big therapists directory, you might, you know, you might find Suzy Smith, LPC and, you know, Eugene Oregon, who, there's 50 checkmarks, filled in on Susie's profile that say, you know, beginning with A, it's like, ADHD, anxiety, you know, depression, that everything and then when you get to P, it says, or T trauma slash PTSD. So, if someone is looking for a trauma therapist, and they find that, you know, and they also see that Susie specializes in Bipolar Disorder, you know, every mental health diagnosis under the sun, it's for the potential client who's looking they're like, so what lets me know, this person knows about trauma, like it seems like they do at all it's like a general kind of thing. And, you know, trauma is so specific, even though it's super common in mental health treatment seeking populations. You know, it's a very common experience for people. It's not the same as just, I know how to help you with anxiety. People who are looking for a trauma therapist are overwhelmed, because trauma makes you feel overwhelmed. And it, you know, it's hard to focus, there's a lot of ways that it can really impact you. So once you realize that you need a trauma therapist, and you go looking for one, and then you've, you know, Susie and 25, other people come up on that page on Psychology Today. And they all have all the same things marked. It's really hard for clients to discern how to know if this is going to be the right person to help them with the specific thing that they need help with. Because even in the umbrella term of trauma, there's so many specific types of trauma that are not all. treated the same way even though you may use some of the same methods, it's, you know, you need some specific understanding of how those particular issues affect people.   Katie Vernoy  05:52 What would you recommend that trauma therapists, true trauma therapists do to make it clear that they are trauma therapists? The type of traumas they work with? Like, what what do you think would be helpful? And I think kind of nodding to Curt's question, what would be trauma informed in them setting up a profile or a website? Or those types of things? What are the things that would be helpful there?   Laura Reagan  06:16 I think some of the things that are really important are, you want to come across as non judgmental, not just say, I'm non judgmental, but you want it to feel like that when people look, and people want to feel that you're going to understand them. They want to feel a warmth from you. But also like, not too jargony not too wordy. You know, like, concise, speak to   Curt Widhalm  06:43 Don't, don't throw out the 9 million acronyms of letters that all of us therapists are so keen on collecting.   Laura Reagan  06:51 Right? limited to six or less different acronyms after your name. Maybe two, if you have to. But um, no, just like, you know, they want to, they want to know, like, do you know how to do EMDR? What population Do you specialize with? You know, Curt you and I talked to my podcasts recently, and you work with teens. And you can use EMDR with a broad range of presenting issues, but let them know what you're good at what you're really experienced with so that they can see, okay, I have combat trauma, and this person has specialization in people who lived through their house burning down. You know, it's not the same. I mean, there's similarities, there's a lot of overlap in all trauma work. But there's, there's also, you know, there's a difference between someone who was physically abused in childhood, someone who was emotionally neglected, someone who was sexually abused in childhood, someone who was raped in college, you know, they're all the different, someone who lost a parent when they were 15, someone who lost a parent when they were five, you know, different, even different developmental stages of traumatic experiences can impact us differently. And, you know, was it an ongoing traumatic experience, like being in an abusive relationship as an adult? Or was it a, you know, trauma from being assaulted at a bar fight, it's different. So people who work with trauma, do know those differences, but they may not always convey that in what they're presenting out to clients who are looking for them.   Curt Widhalm  08:36 So you're speaking to, you know, this from kind of the therapist side of things as far as things that we do that confused clients? Are there other things that we might not be touching on yet that makes it really hard for clients to find a good trauma therapist?   Laura Reagan  08:56 Well, yeah, what comes to mind immediately is that people don't recognize that they have trauma, which is one of the reasons why I made trauma chat, podcast and the website, because experiences that are common, like feeling like nobody paid attention to you when you were growing up. That's not uncommon in our culture, in the US, but you know, if you feel worthless, and you don't love yourself, you hate yourself. And it's related to that. You think you hate yourself, because you should be hating yourself because you're awful, but really, it's because of what what happened when you were younger. So I think a big piece is and one of the things that I'm really trying to do both with therapy chat trauma chat, while all three the website are to help people begin to recognize that if you feel this way and this happened in your life, it's highly likely that the reason you feel that way is because you're impacted by trauma or and when I say trauma, and this isn't what everyone does, but for me when I say trauma, I'm really lumping attachment wounds from childhood into that as well, because those are, you know, part of what makes part of what makes healing from trauma so difficult. After you go through a traumatic situation, if people help you, they believe you, they care, they take it seriously and they, you know, they attend to what you need, you're going to not be as likely to have long term impact like PTSD, as you would if you you go through something and it's minimized, your parents are telling you not to just, you know, get over it not talk about how you feel. And I'm like keep saying like childhood trauma, because that's what's so prevalent. We know from the adverse childhood experiences study, it's more than 60% of adults in the US. But, you know, it's pretty much thought to be carries over around the world have childhood trauma. So if, if people don't take you seriously, they don't believe you, they minimize invalidate, and they're not attuned to how you're feeling, following those traumatic experiences, you're much more likely to develop PTSD, or complex PTSD symptoms. So the attachment piece is an important part of healing from trauma.   Katie Vernoy  11:25 So I'm hearing you say that therapists need to be specific and talk about the types of traumas they work with. But there's also this other piece of being able to really educate or explain what could be trauma, you know, these attachment wounds or those types of things so that clients can identify themselves and and know, they're getting a trauma therapist that has particular training, as well as they can identify that they have trauma, and I see how that could be very, very helpful. I, I guess, and and this is maybe maybe I'm going down a rabbit hole, but I feel like there's there's kind of the colloquial, I'm so traumatized this is trauma, everything has become trauma. And then there are the types of things that really require trauma informed or specific trauma treatments. So I guess the question is a two part like, what is trauma? And what is trauma therapy? Because I think, for our we have, like you we have audience that is both therapy, therapy therapists and therapy clients. And so how are you defining trauma and trauma therapy?   Laura Reagan  12:38 That's a good question, I guess, it depends would be my best answer. But, you know, so if you if you're someone who, let's say you have persistent anxiety that you've dealt with, say, you're 35 years old, you're you've always been anxious, and then you become a parent and your anxiety starts to increase, you may not be thinking, I need to go find trauma therapy. So a therapist who's trauma informed, should be able to identify that it's highly likely that someone who's always been anxious is probably anxious because of something related to either unmet attachment needs in childhood or something traumatic that happened, that they may not be identifying that way. And so you know, you would want to know, if they've been through anything traumatic. And I think, you know, this is a sidebar, but one of the big mistakes that therapists make is they ask people in the initial intake, do you have any history of trauma? And the person says, “No”, and they go, “Okay, well, you have anxiety, so we'll just work with the anxiety.” And yeah, you should work with the anxiety, of course, but, you know, longer term trauma therapy is always about, why do you have this anxiety, you weren't just born with anxiety, or you were, but it's got to be related to something. Somehow it started, you know, that's not our natural state. So, of course, feeling anxious is something we all have. And sometimes we're sad, but I'm not talking about just sometimes being anxious or sometimes being sad, but I'm talking about like, persistent, always anxious, you know, and sometimes it's panic attacks or whatever. So, a trauma informed therapist could identify that this person probably is impacted by trauma and asked questions about their family of origin or their relationships just to get, you know, a sense of what that's like and maybe figure out what their attachment style is, and, and work with that even without really saying, we're going to work with your attachment style, and we're gonna work on healing your attachments and all that. So, then there's people who are like, I've been to a therapist. I've learned coping skills It's great. But they don't always work. Some of these things just I can't seem to change. And that's when people are more likely to be searching for real. Like, I want trauma therapy. And then they think you know that a lot of people think that means like, I'm going to go to therapy, I'm going to tell my story from beginning to end, you know, I'm going to talk about what happened, and until it doesn't hurt to talk about it anymore, but that's not really what most of the time is happening in trauma therapy nowadays.   Laura Reagan  15:32 So it's more, you know, for me what trauma therapy is, I use a longer term model, I usually work with people for, you know, a minimum of a year, but usually, you know, two to three years or more, because it takes a while to heal the attachment wounds that, you know, through the therapeutic relationship in the work. So, there's a three phase approach that explained in Judith Harmons, 1992, book, Trauma And Recovery, that, you know, it starts with safety and stabilization, then you move into remembrance and mourning, and then integration of the traumatic experiences into your life. So it's basically taking someone from being very fragmented at the beginning and in crisis. So it's emotional safety and physical safety that you're working with, depending on their situation. And then remembrance and mourning is, you know, all those fragments that have not really been able to be part of who you are, because your capacity to cope during those experiences was overwhelmed. You know, you begin to look at them and say, oh, when, you know, the first day of school when I was so scared, and you know, my mom didn't even ask me how my day went when I got home. Or, you know, so I just felt like, I couldn't talk about it. And I just had to deal with it by myself. Now, that might be considered traumatic. I know, people might not really necessarily think of that that way. But yeah, or I went home and no one was there. And then, you know, just like usual, everyone ignored me. And I felt alone. And I just went and played video games until I fell asleep or something like that. That's when you start to look at those things and say, “How did I really feel about that”, and, you know, begin to work with expanding the person's window of tolerance, to be able to think about those experiences and feel the emotions that go with them without having to dissociate from them. And then kind of grieving what was lost. And then reintegration is when you kind of are like, bringing it all back to being one whole person with those experiences that yes, they did happen, but they don't derail you now, you know, they were painful, but you can talk about them, you can feel the feelings, and you can still stay within your window of tolerance. I mean, briefly, that's what, that's what trauma therapy is like when you're doing longer term work. And I think a really important piece is understanding dissociation, which is something that even for people who get training in trauma, a lot of times dissociation is not part of it. And so they don't learn how to assess and identify when the client is dissociating during the sessions. And so sometimes they're accidentally re traumatizing the client by, you know, getting into material that the client is seemingly, they're talking with you about it, but really, they're not fully here with you at all. And you don't, you don't know how to, you don't know how to like see that when it's happening and help them get back to being within their window of tolerance. So that's a really important piece is the dissociation and that's still just kind of beginning to come to some people's awareness, despite the fact that, you know, places like ISSTD have been talking about it for, like 30 years.   Curt Widhalm  18:55 I don't think that this conversation is complete in modern time without bringing up, how are you seeing the role of COVID play out and some of this longer term treatment to?   Laura Reagan  19:05 Yeah, well, for me, I'd be interested to hear if you want to share anything about that. But for me, it's like, if you're working with people virtually during COVID, how safe are they where they are, even first of all, like, do they have privacy? And how? How much in survival mode are they right now? You know, being able to assess how well they're really functioning. Because if they're doing their session at home, and they do have privacy, it might look like they're more grounded than they would normally be in the session. But what's, you know, how supportive is their environment when when the session ends for them to have space to feel what they feel and I'm pretty cautious about I definitely have not been doing as deep work with most of my clients during COVID Because, you know, I know that they have an ongoing trauma that they're living through now. And for some people, it's much more that they're really in crisis and in survival mode. And for other people. They are okay, because they're really well resourced. But somewhere in the middle, I think there's somewhat of a complacency about COVID, for many of us at this time, but, you know, if you think about what's going to activate your threat response system, in response to a trauma, you know, an invisible threat outside that is in all other people, and you don't know what, who's the one that's going to cause you to get the life threatening disease, that's a pretty severe an invisible threat that you have no control over is pretty much a huge trauma trigger. And, and the long-sustained time of living under that, sort of like living in an abusive home and just being so used to it that you don't even know you're in an abusive home.   Katie Vernoy  21:05 It's interesting, because you talked about the virtual elements, as well as the the kind of the collective trauma of COVID. I know, for myself, I have, I've had, it's gone in phases, where there's been a lot of safety and resourcing and coping strategies and trying to make sure kind of like, let's get from day to day, let's get through this thing. And then there are times when it feels like things can go deeper. But I've also been very cautious of going too deep, because I think there isn't the same resources. You know, social support looked very different for a long time. And still does, I think people are, you know, I've also got clients who are setting better boundaries, because there's this, you know, this way to do it. So I think that, you know, it's definitely an individual experience. But for me, and I think this continues forward, because we have some therapists who want to stay virtual kind of continuously, like, this is the new thing, I'm gonna be virtual forever. And I think it, I kept wanting a resource that's like, okay, okay, I know how to set up the setup. I know, ethically and legally what to do with a virtual therapy office. But how do I do good clinical work? And I think on top of that, how do I do really good trauma informed care? via video? And so what do you know about that, Laura? Because Because you're in this space, and you're talking to so many people, what are the best practices, especially for trauma survivors, folks, you know, that have had and technically I guess all of society is being traumatized. So this is everyone. But how do we do this? How do we do this? with video?   Laura Reagan  22:45 Yeah, I don't think I have all the answers by any means. But I think it's umm, I didn't think that the presence and energy would be able to be felt, as well through virtual therapy, as it turns out to be, you know, I can still be talking with someone, yesterday I was talking with someone and a couple things, they said, I got chills all over my body. You know, and that's a typical, like your mirror neurons picking up what the other person is feeling during a session. So that's normal during an in person session to just be having all kinds of somatic indicators telling you, either your stuff is getting triggered, or giving you information about what's coming up for the other person. And that's still happens in virtual sessions for me, but you know, I think it's the relationship and the presence that you bring, and really knowing your client and being attuned to what's happening. There's a lot of drawbacks. I mean, I do practice from a somatic perspective, and I can't see their whole body. You know, so a lot of times, like, they're kind of shaken a little bit. I'm like, you know, what's is your foot going, like, what's happening? What are you noticing right now? And they might say,” Oh, well, you can't see. But my foots like shaking really fast”, or things like that, or, you know, there's a lot of limitations to it. But another thing that sort of a unexpected twist, for my experience of it is, is noticing how some of my clients are so much more comfortable, because they're at their house, and they're not in my office space, you know, which I think of as this warm and safe little nest for them, but that's not necessarily their experience. They've they're coming here, it's my it's my warm nest, it's not their warm nest. So yeah, those are some of the benefits being able to be in their own space and feel comfortable and then being able to take care of themselves and not having to drive because sometimes when you leave a therapy session, you're a little bit disoriented and then you got to go back out in rush hour traffic. So but I would say you know, all the typical things about, certainly if someone's in an unhealthy relationship or an unsafe relationship, that therapist should be very attuned to who's there any signs that, you know, the someone else could be, you know, intruding or crossing boundaries about the client's privacy, especially teens, you know, kids, parent that's just sort of standing like right out of the frame where you can't see them. And the kids like, acting less open, and you're not sure why but you hear sneeze and you're like, wait a second. Or you notice I'm looking, you know, it's like, what's what's happening? So? I don't I don't have all the answers on that. But it's definitely a dance.   Curt Widhalm  25:47 What kinds of things have you learned over this last year, as far as supporting clients in their environments where they are facing kind of this constant, like, if I go outside COVID possibility, if they are in their houses, with the very people who have caused all of those emotional traumas from growing up, etc. Anecdotally, what are you finding works for your clients,   Laura Reagan  26:18 As the therapist, you have to be very flexible. And attunement is just so important, you know, knowing your client, and I've seen people's dissociative symptoms worsen when they're, let's say, a college student who goes home for the summer, and they're in their parents house, and that's where their abuse took place. And, you know, even though no one else is home during the session, they can't feel grounded and safe there. So, you know, let's say we were doing phase three work before COVID, we're probably going to be doing phase one work, you know, safety and stabilization. So, but again, some people can go deeper than you expect. Maybe they can go deeper than they did when they were in your office or my office, because they feel comfortable where they are. So they can let their guard down more I don't, you know, it's probably a balance, some people are more constricted, and some people are more expansive, because of the fact that they're doing the session in their house. But I know for some clients who have some physical disabilities, and a lack of privacy at home, there's been great difficulty in being able to find virtual sessions to be effective, because there's many factors that are interfering with being able to just even be comfortable in the session.   Katie Vernoy  27:52 So I think we could dive into virtual therapy forever, because I think there's going to be so much more therapy done there. But I guess I want to switch gears a little bit and go to the fact that most of society has had at least a small t trauma, if not a big T trauma with a global pandemic. And there is a huge need for therapists to at least be trauma informed, if not to become trauma therapists. So for the new therapists, for the students out there, what is it important for those therapists to know, when deciding to specialize in trauma.   Laura Reagan  28:31 There's a set of factors that should be present if you want to practice in a trauma informed way. And it has everything to do with how you are with the client, how the space is that you are with the client in so if you're together in a physical space, you know, everything from the way the lighting is, you know, I mean, there's a big difference between how comfortable people feel when they walk into a waiting room with indirect lighting and comfortable seating and a fountain going and some spa music versus clinic where it's institutional looking fluorescent lights. And we can't always control that. But, you know, everything we can do that makes it feel more calm, and regulating to the nervous system, all the way around, both from the space and the way we interact with people is, is really important. And I mean, like you, I think that everyone's going to need to be at least trauma informed because of the pandemic. But I also think that everybody really needs to be trauma informed anyway, because of how prevalent trauma is. You don't have to specialize in trauma. But you should assume that the majority of people that you come into contact with as clients have experienced some kind of trauma like you said, little t trauma or something that's probably related to why they feel the way they do. And an empathic attuned presence is more important than any training you get in having successful therapeutic relationships with clients who have experienced trauma, be really cognizant about victim blaming and minimizing and like, you're still upset about that. But that was five years ago, 20 years ago, you know, because that's what people think already, people who've experienced trauma. You know, there's certain phrases that everyone says, if they've been through trauma like, well, what I went through wasn't that bad. I mean, so many other people have been through so much worse, that's almost like a script that every single client who has trauma says, or well, I should have known better, or I shouldn't have done this, or well, it's pretty much my own fault, because this, those are clues that the person might be having a trauma reaction, so but also the importance of self-care for the therapist, you know, and this isn't about directly how we work with clients. But it is because if we're not taking care of ourselves, getting enough rest, sleep, there's rest, and then there's sleep, two separate things, movement, oftentimes being in our own therapy, to work through our own issues that we've had in our lives, being aware of vicarious trauma, if you do work with people who have experienced trauma, and I think vicarious trauma is worse, when you don't really understand the impact of trauma on your clients, because you don't understand why you're having the reaction you're having. But vicarious trauma is pretty much an occupational hazard for therapists and therapists who work with trauma. So the way you space out your sessions, the more you make sure that you are, well, obviously, the better you'll be in your work with clients. And when you aren't able to do that as much as you need. That's when we risk doing harm, which we never want to do. Trauma informed, I think if you have a trauma informed approach, working with trauma, clients who have trauma is appropriate. But if you don't believe in trauma, or you don't think it's really you think it's just nothing special. Nothing different. And it's tricky, because our schools of our grad schools don't really teach us about trauma in general. You can really, unintentionally do harm, and it can drive people away from seeking help. It's, it's really hard for people who have trauma, to ask for help anyway, because their experiences, nobody cares. No one will understand. It wasn't that big of a deal. There's just something wrong with me. And that's why it seems like such a big deal to me. And those unfortunately, those messages get reinforced through negative experiences in therapy, even when it's unintentional on the therapist part,   Curt Widhalm  33:10 Where can people find out more about you, and all of the projects that you've got going on?   Laura Reagan  33:18 Everything I'm doing now is on my website, traumatherapistsnetwork.com. And I would like to say that Trauma Therapists Network and the directory that it has, it's not just for people who specialize in trauma, if you use a trauma informed approach, you can definitely sign up. Because, you know, some people might think, Oh, I'm not certified in trauma. So I shouldn't sign up for this. But it's really about really letting people know what you know. So there are places to, you know, the checkmarks are like what types of trainings you've had? And what specific areas of trauma you do best with? You know, is it domestic violence? Or is it combat trauma? Or is it loss of a parent and childhood? Or is it someone who was in a car crash, or bike accident? It's all it's all there and needing help. And all of those presentations are there, people are out there. And if you can let them know what you know, they can link up with the one that's really the right fit for their specific situation. And that's, that's the whole idea of the directory aspect.   Katie Vernoy  34:31 You said that it's a directory and a network I what are the other things that are included there? I know you have your two podcasts, what else? What else? What's the whole picture? Okay, yeah.   Laura Reagan  34:41 So of course, it's it's developing. I mean, it's it just went live 10 days ago, but right now it has blog posts that are you know, informational about trauma and there are more being added all the time. The podcasts episodes are there with transcripts for both podcasts. And there are resource lists of specific things. So not everybody who has trauma wants or can get trauma therapy for whatever reason. So hotlines, websites, books, podcasts, and one of the things I really like and want to develop for therapists who participate is for them to be able to share the blog posts that they've written podcasts that they've been on, not just therapy chatter, trauma chat podcast episodes, but their, you know, think your podcast and other things that people have done YouTube videos, they have courses they're offering. So it's a way to really let people find help with trauma, whether it's just learning about it, or reading about it, you know, and, and pursuing something on their own to taking a course doing some kind of webinar, you know, somatic work in trauma, that isn't therapy, you know, so. And then for the therapists, again, it's also going to be, we're going to gather, so I don't know when we'll be able to gather in person, but we're going to have at least virtual meetings where you know, we can share and support one another. And because, you know, whether you're a therapist or a client, trauma is very isolating. And so the more we can bring connection, that's why I'm calling it a network I want I want clients to feel like they're connecting. And I want therapists to feel like they're connecting both with clients and other therapists and other people who do this work.   Katie Vernoy  36:41 That sounds amazing.   Curt Widhalm  36:43 And we'll include links to all of Laura's stuff and her network in our show notes. You can find those over at MTSGpodcast.com And check out all of the latest updates on the therapy, reimagined conference and all of our speakers and all the cool things that we're doing for that you can find that out at therapyreimaginedconference.com, and follow us on our social media. And until next time, I'm Curt Widhalm with Katie Vernoy and Laura Reagan.   Katie Vernoy  37:12 Thanks again to our sponsor, SimplePractice.   Curt Widhalm  37:15 SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth session schedule appointments, file insurance claims market, their practice, and so much more. All on one HIPAA compliant platform.   Katie Vernoy  37:33 Get your first two months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only. Please note that we are a paid affiliate for SimplePractice. So we'll get a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapyreimagined. And that's where you can learn more.   Curt Widhalm  37:54 This episode is also sponsored by RevKey.   Katie Vernoy  37:58 RevKey specializes in working with mental health professionals like you to increase not only clicks to your website, but helps you find your ideal patients. From simple startup packages and one time consultations to full Digital Marketing Management Services, RevKey can help you run successful digital marketing ads. RevKey creates customized packages and digital marketing budget recommendations that fit your business needs.   Curt Widhalm  38:21 You'll never receive a data dump report that means nothing to you. Instead, RevKey provides clear concise communication about how your digital marketing ads are performing through meetings for video updates recorded just for you. RevKey is offering $150 off any setup fees for Modern Therapist Survival Guide listeners.   Katie Vernoy  38:38 You can find more at RevKey.com and make sure to mention that you're a Modern Therapist Survival Guide listener.   Announcer  38:45 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.

    The Balance Between Boundaries and Humanity

    Play Episode Listen Later Aug 30, 2021 36:00

    The Balance Between Boundaries and Humanity An interview with Jamie Marich, Ph.D, on what it means to redefine therapy and how therapists can incorporate this idea into their practice. Curt and Katie talk with Jamie about the importance of therapists being vulnerable both with clients and publicly about their own mental health struggles to reduce the mental health stigma. We also explore factors that keep therapists from being vulnerable as well as other therapeutic and cultural considerations when doing so. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.   Interview with Jamie Marich, Ph.D, Dr. Jamie Marich (she/they) is a clinical trauma specialist, expressive artist, writer, yogini, performer, short filmmaker, Reiki master, TEDx speaker, and recovery advocate, she unites all of these elements in her mission to inspire healing in others. Jamie maintains a private practice and online education operations in her home base of Warren, OH. Marich is the founder of the Institute for Creative Mindfulness and the developer of the Dancing Mindfulness approach to expressive arts therapy. Marich is the author of several books, including EMDR Made Simple: 4 Approaches for Using EMDR with Every Client (2011), Trauma and the Twelve Steps: A Complete Guide for Recovery Enhancement (2012), Trauma Made Simple: Competencies in Assessment, Treatment, and Working with Survivors, and Dancing Mindfulness: A Creative Path to Healing and Transformation (2015). NALGAP: The Association of Gay, Lesbian, Bisexual, Transgender Addiction Professionals and Their Allies awarded Jamie with their esteemed President's Award in 2015 for her work as an LGBT advocate. The EMDR International Association (EMDRIA) granted Jamie the 2019 Advocacy in EMDR Award for her using her public platform in media and in the addiction field to advance awareness about EMDR therapy. Marich is in long-term addiction recovery and is actively living with a Dissociative Disorder. In this episode we talk about: Who Jamie Marich is and what she puts out in the world. The story behind #RedefineTherapy. A look at what needs to be redefined in therapy and why. Discussion about balancing the art and science of therapy to allow for more flexibility within our field. Factors that contribute to clinicians rigidly adhering to evidenced based practices. How clinicians can make changes at a societal level to redefine therapy. The importance of clinicians being vulnerable and sharing their own struggles with mental health. An exploration of the balance between being authentic/vulnerable with clients and setting appropriate boundaries. Cultural considerations in redefining therapy. What keeps therapist from being vulnerable in therapy. Using a both/and approach to merge how therapy has been done in the past and how it will be done in the future as therapy continues to be redefined and reimagined. Our Generous Sponsor: Buying Time, LLC Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They've got you covered. Don't know where to start? Check out the systems inventory checklist which helps business owners figure out what they don't want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/ Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/   Resources mentioned: 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! Institute for Creative Mindfulness Trauma Made Simple Relevant Episodes: Exploring Trauma and the 12 Steps Dissociation in Therapy Being a Therapist on Both Sides of the Couch How To Be a Therapist Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined Conferences   Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/         Transcript (Autogenerated)   Curt Widhalm  00:00 This episode of the modern therapist travel guide is sponsored by Buying Time,   Katie Vernoy  00:04 Buying Time as a full team of virtual assistants with a wide variety of skill sets to support your business. from basic admin support customer service and email management to marketing and bookkeeping. They've got you covered. Don't know where to start, check out the system's inventory checklists which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at BuyingTimellc.com/system-checklist   Curt Widhalm  00:31 Listen at the end of the episode for more information.   Announcer  00:34 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  00:50 Welcome back modern therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast about all things therapists. And we are once again joined by one of our audience's favorite, one of my favorite people. Dr. Jamie Marich. She's back with us for a third time, she has talked about dissociation before, trauma, and the 12 steps. She's joining us as one of our keynote presenters at Therapy Reimagined 2021. And just always so pleasant to have you. And thank you for spending some of your day with us.   Jamie Marich  01:27 Well, it's my great pleasure to be here again for the third time.     Katie Vernoy  01:32 First, third time guests first real third time guests. Sorry, Ben. I'm excited. So we'll definitely put your other episodes in our show notes so people can find all of the wonderful knowledge that you've shared. But for our new listeners, who are you and what are you putting out into the world.   Jamie Marich  01:50 So I am Jamie Marich, my pronouns are she/they, I am the founder and director of the Institute for Creative Mindfulness. That's my main professional gig. We are a training program primarily focusing on EMDR therapy. Yet, we also do training in expressive arts therapy and some of the modalities that are related. Curt was in one of our first classes of EMDR therapy training. So Curt has a special place in our heart. And EMDR therapy has been my primary trauma modality that I've used through my whole career. Although expressive arts trauma and forming 12 step work, clinical trauma focused yoga, meditation, I do a lot of things, because I do think that is required to be a good trauma focused therapist to have have a pretty amazing repertoire. So I also write books, I love to write mostly for other clinicians, yet some of the writing I've done has also ventured out into reaching the general public. And I just love hanging out and chatting with people who are doing innovative things. Because to really change this world, we don't just need to think outside of the box. I really think we need to shatter it and a lot of ways. So I'm game to chat with people who are doing that.   Curt Widhalm  03:02 We have Therapy Reimagined. And you've been using hashtag redefine therapy kind of independently, we've kind of each come to our own conclusions in this. What's your story behind redefine therapy?   Jamie Marich  03:18 Yeah, so the redefine therapy hashtag was birthed in 2015. Right when my book dancing, mindfulness came out. So dancing, mindfulness is a movement modality that I, I don't like to say I created it because dance and mindfulness are two of the oldest healing mechanisms on the planet. I believe I put them together as a modality for trauma informed expressive arts therapy. And that happened pretty early on in my work. And then in 2015, I got to deal with skylight press publishing, to put out a book on Dancing Mindfulness that was more for encouraging people to develop an individualized practice and dancing mindfulness. And in the last chapter, I wrote in that book, how, yes, I'm a counselor, yes, I'm proud to be a counselor. But it's not really what's going on in traditional counseling offices that are exciting me so much anymore. It's what I see happening in communities with advocacy, what's happening in expressive modalities, what's happening with people connecting back with indigenous roots of healing. And I really think our therapy, especially our therapeutic profession, that's defined largely just by the talking cure needs a serious facelift. And I'm not that excited by therapy anymore, if that's what our field is going to be. And so I wrote up this chapter and then my editor at the time Emily comes back with Why don't you name this chapter redefining therapy? And I saw it I got chills. Everything in me said yes. And at the time, I thought was Oh, I can't do that. Like The establishment is going to think even more ill of me than they do already. But because I felt so excited by her suggesting that chapter titled redefining therapy, I said, This is what, this is what we got to do for sure. And then Holly Spielberg, who was my social media person at the time, started the hashtag redefine therapy. And I think since then, when you package together everything I do my approach to EMDR, my approach to therapy in general doing the expressive work, the community work. redefined. Therapy really defines who I am as a person. So it's very much a hashtag that I identify with and love to use.   Katie Vernoy  05:36 What parts of therapy needs redefining?   Jamie Marich  05:39 All of it? It's my gut answer. Well, oh, well, you know, where do I begin? I want to be very careful here. Because when I answer this question, I know it could come across like I am disparaging science, like I am disparaging research. And let me be very clear, I am not anti-science, especially around medical issues, as evidenced by what's going on in our modern climate. I do think, however, that when it comes to human services, when it comes to therapy, when it comes to the human condition, we actually do us a disservice by looking at it just as a science, because the human experience cannot be fully quantified. And I know a lot of people try, in order to legitimize us what we do as therapists to legitimize conditions like dissociative identity disorder, we have to scale it to prove that it exists. And as a result, a lot of the lived experience which really defined the building of healing professions gets neglected. So I trained in my doctoral work as a phenomenologist, which is a big fancy word saying the study of lived experience. And one of the core tenants of phenomenology as defined by Edmund Husserl is that the human experience cannot be quantified. That by its definition, phenomenology rejects any kind of Galilean scientific notions that the human experience can be quantified. And unfortunately, what what tends to happen is in in more modern times, when there's been more of this push to manualize, to go so medical model in order to legitimize what we're doing, a lot of the soul gets missing. And that's a idea that I have been emphasizing in a lot of my more recent writing. So I think if we're looking at overall, what needs to be redefined, it's that that therapists need to go back to listen, really listening to their clients. And I'm working on a new book right now. the working title is dissociation made simple, but we're still kind of playing around with that a little bit. Because I have other Made Simple books. But it's really giving me a platform to say everything I've ever really wanted to say about dissociation and in written form, I had the good chance, the good fortune for my interviews to interview Curt Rounds, and who's an EMDR legend and has been a mentor to me and was one of the true voices that I think really gets dissociation and the EMDR world and I asked him just like helped me understand your evolution, 40 years as a therapist, and he said something that really stuck with me that if you want to be a good therapist, work with a DID client and really listen to them, really listen to them. And so many of the other interviews that I'm doing for this book, which I'm in process of writing right now, are people revealing, I went to see a helper, whether that be a psychiatrist, whether that be a clinician, and it's like they were just throwing their fixes on me. And we're not really listening to what I needed.   Curt Widhalm  08:48 One of the things that I've really learned in my trainings under the Institute for Creative Mindfulness is really this embracing of providing a space for healing, that it's not just about treatment, as you just kind of defined in all of this kind of looking at the traditional therapeutic establishment, what is keeping them so rigid even as we do incorporate more and more different cultural ideals. We listen to more people with lived experience, we do take on more of this healing aspect. What's keeping the Fuddy duddies so rigid   Jamie Marich  09:32 I think it's a fear of them looking at their own trauma, a fear of them doing a lot of their own work. Even Curt and Katie amongst EMDR therapists who are, in theory supposed to be more trauma informed, right? I have observed such an us versus them mentality, with the people with complex trauma and dissociation. People with so called personality disorders and I find that once clinicians are willing to really drop that us versus them and do their own work, and I don't mean just like the 24 prerequisite hours, you may have to do in your graduate program, or just do a little spot check CBT here and there when you need it, but really do have yourself what you're asking your clients to do. And I think until the field embraces that more widespread, we are going to stay very stuck, we are going to stay very manualized we are going to stay very much in this, like expert pion type of role, which I don't think healing was ever intended to be in the first place. I mean, part of my work has taken me really into looking at indigenous roots of healing. And so many things from those indigenous cultures and their lessons of healing teaches us things like if you can go outside with people go outside with people - be in nature, it doesn't have to be so office bound, right? The importance of singing, silence, the expressive arts, dancing, drumming, getting actually experiential, with your healing, having a feeling experience, instead of just a thinking experience, is all very important. And I think so much of our modern culture has brought us to and I don't think there's necessarily anything unique about this last century that's done it, I think this has always been the human condition. And intense commercialization has just made it worse is this idea that feelings are bad. If you have feelings are weak. And I think as a society, we suffer long term and widespread from something I call feelings phobia. And I would wish that would not be an issue amongst clinical professionals. But the more and more clinical professionals I train, the more and more clinical professionals I interact with, there could still be this idea of I don't know what to do with their feelings, meaning my clients because I don't know what to do with my own. And that's where more of your cognitive manualized interventions just become safer.   Katie Vernoy  12:04 When there's so much of a competent space of like, I hear -  this is what I do I do this to the clients I am able to, it's very controlled. And I think the messiness of real life is lost when we get so manualized I'm I was just as you were talking, I was thinking about how, in community mental health, I was taught how to write a behavioral note, and how to get the clients to say the things that I needed for my behavioral treatment plan, like it became this puzzle that oftentimes had nothing to do with the client at all. And so to me, this idea of being able to embrace the the lived experience, the messiness, I love getting outside, I love all of the things that you're talking about, it seems so important for us to make these moves, but you're saying it's societal, like as a society, we're not going to be able to do what we need to do. How do we address it at a, at a societal level? I mean, as therapists if that's what we're doing, we need to address it at a societal level, what are the what are the moves to make here?   Jamie Marich  13:14 So first thing I don't know when exactly this is going to air, we're recording it here, kind of middle-ish of August. I look at what just happened with Simone Biles and the Olympics. And the decision that she made to take care of herself physically because mentally she was not in the best place. And as anybody who follows current events knows there tended to be a split opinion online on Twitter, a lot of us applauding her for taking care of herself and then people disparaging her as weak. And I mean, I applaud Michael Phelps who not just in response to what happened with Simone Biles, but for the last several years has really been drawing attention to, to the plight of mental health. Well, I don't think celebrity holds all the answers, because there's certainly a lot of issue with celebrity culture, too. I really feel that people coming out is more of the answer. And I'll speak to what that means for us as therapists too, because I do think it can have a lot of impact when people have celebrity who are admired especially and I know, this is gonna sound a little weird, but especially someone like Michael Phelps, who is the greatest of all time and swimming and somebody who's seen as like this behemoth, who had good mental strength and all of this and I just applaud his willingness in recent years to show his vulnerability. If you haven't seen the weight of gold on HBO, it's fantastic. It's a deep dive into what a lot of athletes go through. But even at a non celebrity level, more of us just need to come out about our struggles. And that needs to include professionals like us, who on the surface allegedly have our shit together, because we have podcasts and accompany and run conference and yeah, and all of this. And as both of you know, I have progressively come out more and more with my struggles with every year of my life here and more and more about my background. And I get so many messages of people saying things like, Thank you Dr Marich for your vulnerability, and I'm so grateful for it, etc, etc. And I told my friend once I live for the day, when that's not such an oddity, and I get those kind of messages, because I think everybody has a right and could make an impact if they learned to, or were inspired to embrace vulnerability to or got what they needed, that might be the better way to say it got what they needed to feel safe enough to come out and be more vulnerable about struggles,   Curt Widhalm  15:44 In that sense. And with all of the social change that has been happening here over the last couple of years, whether it's regard to COVID, whether it's in regard to Black Lives Matter. Or we as a field, actually embracing these ideals. I mean, I know, people like you, and Katie and myself are but are we seeing these echoes really come out that is creating the space, because it does feel like we're potentially at a tipping point in our field to, embrace this.     Jamie Marich  16:18 And I think like a lot of places have tipping points, you're naturally going to have people who want to embrace it, you're going to have people who want to resist it. And you'll have people in that middle ground who know that change is inevitable, know that it's probably going to be best for them and their folks they work with if they embrace change, but they're dealing with the cobwebs, the sticking points. What What is keeping me from doing this? and Curt, I'm glad you mentioned, so much of what has been brought to the surface in the last year or COVID and Black Lives Matter, of course, being the obvious examples, although both represents struggles that are nothing new, as far as I'm concerned, right. And, you know, questions come up all the time. Is it the space of the therapist to be an advocate? Is it the space of the therapist to be political? Or do we need to be this blank slate as much as possible for our clients? And the answer for me has always been both/and because I know, as a clinician, I need to be able to bracket my biases enough if I'm working with somebody who sees the world differently than me. But I also know that with my public face, I think the more and more we have a public face like us, the more that we're established in our therapeutic community, we have to speak up. We have to really be be an advocate for these kinds of changes. And for me, my main platform, I've mounted as being vulnerable about your struggles, because that's the only way we'll break this divide because I think so much of what ails the world, the human condition is this excessive tendency we have the other and one of my books I cite pastor Nadia Weber has a super awesome progressive preacher. And she says, “I think our drug of choice in this society is thinking we're better than other people.”   Katie Vernoy  18:05 Oh, yeah.   Jamie Marich  18:07 Yes. And, and I think a lot of the changes that dominant culture members are being asked to make requires them to look at release any implicit lessons they've gotten that they're somehow better than others. So there's that there's there's a lot of work to do. But I think it is important for therapists, especially therapists who are more public facing meaning who have podcasts or run conferences or run training organizations to take these stands. I mean, that's something that we as ICM looked at very deeply last year where I, I took bolder stances with some of the political stances that we took, knowing I might alienate some customers. Right now, the Institute for Creative Mindfulness is sponsoring an EMDR therapy training program specifically for BIPOC. Clinicians. ICM is fortunate enough to have enough staff members, team members who are persons of color where they can run the training and the rest of us can stay out of the way. We've gotten hate mail about that from other therapists from other therapists, because they see it as separatists and divisive and ignoring the fact that there's literature and research and lived experience to show how people of color can benefit from having their own spaces without the white gaze, and how so many folks who are coming into the BIPOC training now are saying they were hesitant to do EMDR training before because they weren't sure how they were going to be met.   Katie Vernoy  19:44 It's a very different stance that you're describing. Then obviously the blank slate and curtain I've obviously talked about this a number of times that that the blank slate is bullshit but like how you know only only white men can be blank slates, right? I mean, there's, there's something we're bringing into the room. But even in that regard, I don't think that's true, either. It's just anyway, I won't go down that rabbit hole. But I think it's something where, when you've been talking about this vulnerability in public spaces, and an even this, us/them and getting rid of the stem, for me, I just have been really reflecting on conversations I've had with my own therapist, when I start relating to the stories that my clients have been telling and recognizing I'm like them, when I thought I wasn't, and, and it's, this is older work, but I felt like that was so monumental to me. And I hadn't realized how, like, the way you described, it really helped me put it into into kind of a frame is that in separating myself, it was very much for my safety and not for the benefit of the client. And I think oftentimes, the way when I was trained a million years ago, it was that we must kind of hold this safe frame, we have to kind of keep ourselves out of the room, we have to keep ourselves out of that. And we can't be vulnerable with our clients. And, and to me, I think it lacks an authenticity and it lacks connection. And it completely stifles creativity if we have to be so in this box of this protected space of I am the expert. So I don't know if I have a question there. But yeah,   Jamie Marich  21:40 I do have a response. Because to that, I would say and I'm really getting this lesson from doing the research on the new book. It's not to say we as therapists can't have boundaries with our clients. It's not to say we as therapists can't have boundaries about what we share publicly, because I think, and this is right from Brene Brown, how Yes, vulnerabilities, obviously, radically paraphrasing her. But basically, vulnerability is a good thing as she emphasizes in her work, but it does come with boundaries. So I think we could definitely have those boundaries. But a word that's been coming up a lot in the new interviews with for the book is the word transparency. So even for folks who have like profound DID, profound attachment trauma, who can get skittish, who can get very reactionary, when a boundary is set, have shared with me, we know that we value transparency, like saying upfront, this is what I can or can't do as a therapist, this is what I am or am not willing to do as a therapist. And if you can be transparent about that and get that established upfront. I think it does open the path to more vulnerability and authentic sharing in a way where it becomes safe enough for you and the client both because yeah, that's a whole other issue we can look at to right is what is appropriate to disclose of ourselves to clients, because I do think it has to be navigated on a case by case basis. I wrote an article on that once where you never wants to be making it all about you. But I also think a good part of therapy is getting feedback from your clients. And I'm not talking about like the survey feedback, because there's a whole school of therapy that promotes that. And yeah, I think that's for the more quantitatively minded, but for those of us who are more qualitatively minded, it's asking your clients questions like, how is this working for you? Is there any adjustments we feel we need to make here in order for you to get the most out of what you need here to reach your goals? And I've done right, ask clients before, do you find it helpful when I share about myself or not? And I, I will honor that.   Curt Widhalm  23:44 I think it's something that, you know, I serve on an ethics committee, I teach law and ethics. And this is a an area of the field that I see us embracing more of that we should share what our values are, and how we make our approaches because that does help make our clients better able to choose from an informed place better able to choose who their providers are. Right. And I think what this will do is help us to embrace you know, from from a client end and minimize the number of just like bad matches with therapists in order to create better opportunities for healing rather than pretending that we're this homogenous field.   Jamie Marich  24:32 Right. Yes, yes, yes. And you know, Curt, I touched on this in the EMDR training, where when we speak on complex trauma, we are in a newer world, where if a client asks you what you believe about something, you have to be able to answer it transparently. And it's not to say that, well, if you're a Trump supporter, and I'm a Biden supporter, we can't do therapy together because I know a lot of my folks do therapy across party lines. etc, etc. But I think the key is, sometimes when these conversations are had a person, a client decides they need to go elsewhere. I know when I chose my last therapist, and I was interviewing her, I wanted to know what she believed I needed to know what she believed. And her candidness, her transparency above that has really helped. Yet, I mean, I've also spent most of my career practicing in an area where a lot of people here believe differently than I do. And often times those roadblocks can provide an opportunity for building communication or working through a breach who I know, however, you may look at it. So I think part of redefining therapy is also recognizing a lot of the conversations we may have had back in grad school are not the real conversations we need to be having about how we handle doing therapy in the modern climate. So there's, there's that facet of it as well. Talking about law and ethics. Curt, you might find this interesting, I just did a really cool interview this week for the book with my state board here in Ohio. Because when I talk about coming out and radical transparency at a public level of therapists, a lot of the concern I get is, what if somebody turns me into my state board? What if a client sees something I've done publicly and turns me in, etc, etc. And, and there's a lot of this fear that by coming out, you're somehow going to be discredited. And that's a fear that I've worked through personally, because I've long stopped caring what people say about me. But I think there can be that sense of scariness with, you know, well, my livelihood be taken away, if it comes out what a hot mess I really am. And you had a very delightful conversation with the board about how things are handled, at least in our state, where I know it definitely put me at ease about being someone who's out. And I don't know if that would have been the case many, many years ago. So I think some of this, this advocacy about ending the stigma and people in the field are human, too, has has taken us in a good direction. But I really think and I know, I've talked about therapists coming out, and we've talked about celebrities coming out. But I think it can also be super amazingly powerful when someone like a lawyer comes out, or a finance manager, or just people in all walks of life, all walks of professions, it's been delightful having conversations with my legal team about mental health, opening the door for that. It's also I just think, so many people think they're the only one who go through things. And that's not an unusual thing. We've talked about that before. But I think people in professional positions who are afraid of getting discredited, they often feel they're the only ones going through something. And there's just a lot of power in admitting that we're not realizing that we can have connection and community together.   Katie Vernoy  28:06 It's an interesting idea to have community around mental health concerns, because I think that that idea of I'm not the only one. And all of those things, I guess the the place that my mind keeps going to is this fear that they that folks have around laws and ethics and, and that there's this movement of folks, whether it's decolonizing, therapy, reimagining therapy, redefining therapy, you know, blowing up therapy like that there's there's this idea that if we were to actually take therapy where it needs to go, all of the current law and ethics laws and ethics wouldn't actually apply. I think the three of us here, I don't think believe that. But I I think that the question I have is, is there room to truly move into these healing spaces as licensed clinicians, in ways that still still tie back to what we originally learned? Because it seems like there's, there's a spectrum of beliefs around the usefulness of therapy as it has been practiced.   Jamie Marich  29:19 That's a great question. I think my short answer is I don't know, it's, it's an evolving, it's an evolving answer. It's an evolving answer. And, and I think I'm at my own career crossroads right now, where I look at going forward. Will I do more good as an advocate than a therapist, and I was an advocate who was a therapist, you know, or has therapeutic insight because I think about what's the definition of clinical work at least in Ohio, it's the diagnosis and treatment of mental and emotional disorders, right. And even though I'm you know, up in the air about the utility of dialects, even something like diagnosis, let's start there. I have a both and feeling about diagnosis, because on one hand, I think we can get too caught up in labeling people, we can get too caught up in defining people by their diagnosis. But I've also seen cases of where people read a diagnosis. And they feel completely empowered, because something actually describes me. Like, oh my gosh, never, nobody's ever shared this diagnosis, like the PTSD diagnosis, or we see it with with a dissociative diagnosis. And I've even seen some people get moved when they read the borderline personality disorder diagnosis, because it's while these, this describes what I struggled with, so I mean, that's an example of a both and where I'm not at the place where I'm totally anti diagnosis. But there's some clients I'll work with where it's like, I don't think really, we need to worry about the label. Like we know, trauma is an issue. We know trauma healing is an issue. What do we need to put down to play the game? You know, so to speak. But then if you look at the second part of that, in our definition, treatment of mental and emotional disorders now part of the conversation now is, okay, what's a disorder. And we know the correct definition here, where there's functional impairment at cetera, et cetera. But even a lot of us in the dissociation community, like I technically have a dissociative disorder by diagnosis, at least how I was diagnosed. But I've embraced the identifier that one of my colleagues uses right now, which is dissociative mind, or she'll say I have a dissociative experience of life. Because for me, it's no longer a disorder. But it is still something that I live with. I think a big part of being trauma informed is a willingness to be flexible with language, a willingness to be flexible with concepts. And I'm always the kind of person who's lived in the both/and where I and I think, you know, that with my trauma and 12 step work, like I'm a vicious 12 step critic, but I don't think we have to throw it all out either. And at least for now, as I tried to negotiate this question of up, does the therapeutic system need to have blown up? I like that you said that, Katie, because there are some days, I feel that there are some days, I feel like I'm working in the service of the therapy industrial complex. And the real good work I do is when I still talk to 12 step sponsors, and it's a relationship or no money is exchanged. It's just the human experience. But you know, do we have a right to make? So all of these questions, they can keep me up at night? I'm not gonna lie. Unfortunately, I've tools to deal with a lot of that. But I think for now, even answering your question here, I think a lot of it is the both/and I think we need quantitative and qualitative, for example, with research and something I'm going to talk about in the conference presentation, is how quantitative empirical research can be viewed as the language of white supremacy. Whereas qualitative research encompasses more of the indigenous lived experience of healing. We're living in a world right now where we're navigating both. So let's bring in both   Curt Widhalm  33:06 Where can people find out more about you? And I would just say, the projects that you're working on, because I know that your resume of books and presentations and everything else, where can people find out more about you?   Jamie Marich  33:23 Well, they could come hang out with us at the Therapy Reimagined. Coming up here in September, I'm so delighted to be keynoting. A couple different places to find me online Instituteforcreative mindfulness.com is my main website for the company that I run, JamieMarich.com is the easiest way you can get all my books cataloged in one place. And then traumamadesimple.com is the free resources site that I keep, that's where all of my videos, articles, things I've done for free, are collected in one place on Twitter, I'm at Jamie Marich, Instagram, Dr. Jamie M. And just type in my name on Facebook, you'll find me in a couple different professional contexts.   Curt Widhalm  34:06 Yeah. And we will include links to all of that in our show notes over at MTSGpodcast calm. And as Jamie mentioned, she'll be therapy reimagined. And for all of our latest updates on that, get your tickets and all of our latest COVID precautions. Check out therapy reimagined conference calm and our social media will also include links to those in the show notes as well for all of the updates and they're just changing every single day. So we will do our best to keep things updated as well as we can on our social media and on our websites. So until next time, I'm Curt Widhalm with Katie Vernoy and Dr. Jamie Marich.   Katie Vernoy  34:55 Thanks again to our sponsor Buying Time   Curt Widhalm  34:57 Buying Times VA support businesses. by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more, their sole purpose is to create the opportunity for you to focus on supporting those you serve, while ensuring that your back office runs smoothly for the full team of vas gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available.   Katie Vernoy  35:26 Book a consultation to see where and how you can get started getting the support you need. That's buyingtimellc.com/book-consultation.com once again, buyingtimellc.com/book-consultation.com.   Announcer  35:42 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.

    Understanding the Psychological Impacts of Leaving Afghanistan, Part 2: Afghan Americans

    Play Episode Listen Later Aug 24, 2021 37:20

    Understanding the Psychological Impacts of Leaving Afghanistan, Part 2: Afghan Americans An interview with Sara Stanizai, LMFT, on how Afghan Americans are responding as the US leaves Afghanistan. Curt and Katie talk with Sara about her experience as an Afghan American therapist, looking at the misconceptions, lack of knowledge, and bias that can harm Afghan American clients. We look at clinical best practices for immigrants to the US, as well as some of the history and cultural norms of the country, the uniqueness of the experience, and the importance of finding primary sources to understand what is really going on. Sara also shares ideas for what we can do to support the Afghan people in Afghanistan and the diaspora at this time. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Sara Stanizai, LMFT Sara Stanizai, LMFT (she/her) is a licensed therapist, clinical supervisor, and the owner of Prospect Therapy, a queer- and trans-affirming therapy practice based in Long Beach, CA, with a special focus on serving first-generation American and immigrant communities. A queer first-gen herself, Sara's clinical and professional work focuses on serving the Afghan diaspora, specifically, fellow Afghan-American women, and bicultural communities in general. She runs a weekly Afghan-American women's group and will be offering this free of charge in the coming weeks to meet the mental health needs of her community.  In addition to running her group practice, she is on the Board of Directors of the Los Angeles Bisexual Task Force, a 501c3 organization that champions education, advocacy and visibility for the bi+ communities of greater Los Angeles. She is a certified cognitive therapist through the Academy of Cognitive Therapy and holds an advanced certificate in transgender affirming therapy from Widener University. She completed her MA in Clinical Psychology from the Chicago School of Professional Psychology and her undergraduate degree at Mount Holyoke College.  In this episode we talk about: Sara's experience being an Afghan American, especially since 9/11; as well as her response to the US withdrawal from Afghanistan Afghan Americans: the displaced among the displaced The real issues that folks in Afghanistan are facing, separate from the perspective of western cultural and the differences in the Afghan American experience Historical context for Afghanistan and the memories of Afghan Americans that shape their views: Culture, art, progressive, beautiful, diverse Not feeling Afghan enough or American enough The value of hospitality and how Afghanistan will always welcome Afghan Americans How Islam intertwines (but is not equivalent) to the Afghan culture Modesty and values and the bias toward Muslim women who wear headscarves Bias and misperceptions that can negatively impact clients The complexity of Islam and how it can be perceived both as beautiful and nature-loving as well as dangerous and militant The challenge to identity being an Afghan American The danger of pity coming into the therapy room The importance and nuance of educating yourself outside of the therapy room, while also encouraging the client of sharing their own experience. Not: What does this mean? Instead: What does this mean to you? The Afghan culture requires offering 3 times before determining that the answer is no Collectivism and the importance of family Impact of intergenerational trauma and military involvement in a home country Seeking out primary sources, with a focus on Afghan voices as the experience is truly unique Avoid sensationalized headlines and images Challenging what has been “truth” especially when looking at these sensationalized stories Ways of healing and clinical practice that are better aligned to these clients Prayer and healing within safe community spaces Considerations on scheduling session around prayer time and understanding fasting The lack of language for what is being experienced Offering connection, even when you don't know what to say The focus on trying to get family and friends out of Afghanistan, constantly watching the news Ideas for what you can do to support the people of Afghanistan The importance of legal support, translation services, and advocacy at this time The support group for Afghan women that Sara runs Our Generous Sponsor: Buying Time, LLC Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They've got you covered. Don't know where to start? Check out the systems inventory checklist which helps business owners figure out what they don't want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/ Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/ Resources mentioned: 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! Sara's website: Prospect Therapy Sara's Instagram: Prospect Therapy Sara's group for Afghan Women Literacy and Love Hand to Hand Sadaqah group Instagram - ideas of how to take action from Sara Article from New York Times: How to Help Afghan Refugees and the Relief Effort   Relevant Episodes: Invisible and Scrutinized Iran, The News, and Our Clients   Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined Conferences   Our consultation services: The Fifty-Minute Hour Who we are: 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 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: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/   Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript (Autogenerated)   Curt Widhalm  00:00 This episode of the Modern Therapist's Survival Guide is sponsored by Buying Time.   Katie Vernoy  00:04 Buying Time is a full team of virtual assistants with a wide variety of skill sets to support your business. from basic admin support customer service and email management to marketing and bookkeeping, they've got you covered. Don't know where to start, check out the system's inventory checklist, which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at buying time.llc.com/systems-checklist   Curt Widhalm  00:31 Listen at the end of the episode for more information.   Announcer  00:34 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  00:50 Welcome back modern therapists. This is the Modern Therapist's Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast that deals with All Things therapists and the things that show up in our office and in our continuing conversation around the world events happening in Afghanistan, and our reactions. And as we've continued to do throughout our podcast history of trying to bring in very timely episodes to help our community. We had spoken yesterday with Rob Bates about working with military members. And we are also very fortunate to have one of our very close friends from the show. Sara Stanizai is a licensed Marriage and Family Therapist and owner of Prospect Therapy talking about working with Afghan Americans and people from the community of people who have personal ties to Afghanistan, whether familial or friends. And helping us to be able to work in the healing process for this community as this very deeply and troubling time for them is coming out. And we're just so thankful for the expertise and the opportunity to have this discussion here. Today's thank you for joining us, Sara.   Sara Stanizai  02:13 Thanks for having me.   Katie Vernoy  02:14 There's some some things to talk about today. And, and so I want to just open this space. And the first question that we ask all of our guests is Who are you? And what are you putting out to the world?   Sara Stanizai  02:26 I'm a lot of things. I'm glad to be here. And I'm glad to have this conversation. It is a very weird time. But you know, a lot of the organizers that I'm in communication with reminded us to take every opportunity and say yes to the interviews and make sure that this issue gets accurate visibility. And we hear from people who are affected by it. Like  Curt said, when he introduced me, my name is Sara Stanizai I'm a licensed therapist, and I run a group practice based out of Long Beach, California, we focus on serving the queer and trans community as well as first generation Americans like myself. Over the past almost two years, I have focused more on serving the African American community, my family's from Afghanistan, my sister and I were both born here, born in West LA. But both of my parents were born and raised there and came, you know, in 79, escaping something similar to what's going on now. But I think, you know, it's also true that we haven't really seen anything like this. So what I put out into the world is my goal is to really help people understand and accept all the different parts of their identities. And for myself, my relationship with the Afghan part of my identity has been, you know, a lifelong process. And so I'm really happy that I get to help others on that same journey as well.   Katie Vernoy  04:02 I started watching your video on your website around accepting your identity as an Afghan American and how hard that has been for you. What do you feel comfortable sharing about that now?   Sara Stanizai  04:15 Yeah, it's really interesting. I am comfortable sharing about it, which in itself is testament to how I've kind of integrated that as part of myself. But I work with a lot of African Americans now and we're all at different parts of that process. There are some common themes such as, there's so much mystery around Afghanistan and people didn't know what it was that never heard of it. Many people don't understand Islam in general. And that was hard to. It was hard to kind of be the only one that a lot of people knew. But many times that's actually preferable because then when people did become aware Around 911. And now after this, their understanding and the associations they make with a when it's done are misinformed often or, you know, there's a whole spectrum. But it's we have had to kind of choose between either being invisible or being hyper visible for terrible things that have nothing to do with it. So, you know, I work with immigrants and children of immigrants, people come from all over the world, but the Afghan experience is very specific, because, you know, I refer to us as the displaced among the displaced, because we come from a place that it's almost as soon as our families left it, it almost, it feels very inaccessible. And I do also want to point out the fact that, you know, I was born and raised in the US, I do come from a very westernized culture, people are always surprised, at how, frankly, like, educated I am, and but I have tattoos and but I I like to think I have cute style, but   Katie Vernoy  06:03 you definitely have cute style, let's like, straighten that out right now, you definitely have cute..   Sara Stanizai  06:12 But people are often surprised by that. And it's true, I think, you know, we in the diaspora have very specific experience that is even removed from what's happening in Afghanistan, and I think we owe a lot of respect and deference to the people who do still live there, you know, probably had opportunities to leave and chose not to run away and leave a home that they have known their whole life. Just one example, you know, people are very excited to see, of course, you know, resistant to the Taliban, or, or, you know, people doing things that are very dangerous and risky. But that's not how everyone feels, I don't want to stand because there's been fighting and war for so long that, you know, it's easy for me to go to the protest this weekend. And, you know, that's not lost on me, I want to and I feel proud to and I can't not do that. However, I have an immense amount of privilege doing that, where I think our responsibility in the diaspora is to amplify Afghan voices as much as possible, not just Afghan American, or Afghan Canadian, or any other immigrant voices   Curt Widhalm  07:26 is part of this mystery for many of us in the West, around Afghanistan, that it's a place that for the entirety of my lifetime has been a place of conflict, very confusing, and not, it's a country that's not set up in the same way that many of us here in the West really conceptualize things. And I think it might help our audience a little bit to talk about Afghanistan, even before the US occupation and operations over there. Of a little bit more of what some of these generations of people from Afghanistan, Afghan Americans are facing in this very transformative change, not just here in the last week, but really over the last 40 years.   Sara Stanizai  08:17 Yeah, you're talking about the Afghanistan that my dad and mom would tell me about when we were growing up. that exists, you know, only in their memories, and Afghanistan is not a perfect place. It there was and has always been corruption in the government Find me a government that doesn't have corruption, there is racism and intolerance with among different tribes and communities within Afghanistan there have been lots of imperfect things. But what I remember, what I grew up hearing about was a very I guess I'll use the word modern. I don't know why I need to like point that out. But just a really beautiful society. Both of my parents, you know, my parents met and fell in love at Kabul University. I see pictures of them. My mom also had a really great sense of style. I really think it's an Afghan thing. To make sure we look good. I went to a protest last two weekends ago definitely saw very nice handbags. I was like, Yes, I'm among Afghans like this. We always make sure we look at but you know, my mom would tell me that she was obsessed with Elizabeth Taylor and the Beatles and also Afghan culture and music as well. My dad in many places in the country and actually came here twice. The first time he came as a Fulbright scholar and lived in Seattle. So he did a year of high school in Seattle, actually, with the Vonnegut those running, which is wow, favorite story. And he went back but then when my parents married then they came shortly after that, as well. So a very progressive, open society similar to many other places around the world, really beautiful tons of art and culture, and tons of history. What a lot of what I often tell my clients and the people I work with their concern is, I don't feel Afghan enough. And I don't feel American enough. I don't speak the language. I don't feel connected to my culture. I didn't think that was allowed, and no one really encourages where I grew up. And so we have, we're stuck in this in between place. And what I remind people is that it is never too late. Afghanistan always welcomes us. Our culture always welcomes us. That's a defining characteristic of Afghan culture is hospitality. It's super annoying when you're like, a 12 year old, and everybody's offering you food multiple times. And you're like, Okay, I cannot eat anymore, but it is very rude. I think a lot of children of immigrants have that experience. But hospitality and generosity is a hallmark of Afghan culture. And that also applies to us that our our Motherland, and our culture always welcomes us, no matter how long it takes. So I grew up understanding Afghanistan as a place full of ancient culture, some really good looking jewelry, really strong fighters, and just a very diverse, beautiful place. And that place doesn't seem to exist right now.   Katie Vernoy  11:35 Seems like there has been such a huge transformation of the perception of Afghanistan. And you mentioned September 11. I, we've got a couple of other conversations that are relevant that will we'll link in the show notes that I think provide we have one that's about Iran, and one that's about the MENA culture generally. But I think it's it's something where when you talk about this, and each time you kind of, well, I don't know why I need to say modern or I don't know why I need to say it this way. And it seems like there is a perception. And this is kind of a different take on or what therapists get wrong question, because we asked that for most folks, but it seems like there is this misperception and this deep seated bias that has plagued Afghan Americans, at least since September 11, if not, prior to that. So can you talk a little bit about that?   Sara Stanizai  12:24 Absolutely. That's a really good point. I think there's also a misconception to something that is very intertwined with Afghanistan, which is Islam. You kind of can't, they're not the same thing, but you can't talk about one without the other. And of course, just like any community, there is a spectrum of how devout people are, how conservative people are, what cultures they choose to continue, you know, and that's always people's choice. I think people in the West love to latch on to these sensationalized out of context, images and swoop in with savior savior ism about well, we have to liberate people from their own culture. And I've been thinking about this a lot like, the whole modesty thing about people wearing headscarves or wearing modest clothes. Like, we were all cheering when Billy Eilish was doing it on the cover of whatever magazine and her political statement about wearing baggy clothes when nobody can objectify her body. But when all countries have women do it, it's apparently Oh, poor things. Anyway, that's a side note. that's a that's a blog post in the making. But I think there has been, it's we, unfortunately, we we suffer from this either complete invisibility and mystery, or that's not my concern, or that's over there. Or just this really distilled, stereotypical highlighting of things that may or may not even be part of our culture, some of those things are part of our culture, and there's nothing wrong with them, many of those things are not. And I had a conversation with a client who is really exploring Sufism, and mysticism and other aspects of Islam, which my dad is a scholar and will take any opportunity to teach me slash lecture me about. So I grew up with a very peaceful, merciful beautiful, like nature based version of Islam. That is very, I mean, I just have warm fuzzy feelings about it all the time. And I know my peers did not. So it's for me personally, it's really hard to wrap my head around the idea of Islam as some sort of oppressive scare, you know, God fearing like any sort of, there's a spectrum you can be very conservative about certain things but that has never been part of my experience and not part of a lot of people's experience. And so I think I do feel this obligation to say like, you know, not all Muslims. Because I'm sort of it's either there's no id