Podcast appearances and mentions of Ben Caldwell

Welcome to the (Not So) New 52, a real-time retrospective of DC Comics' New 52 imprint! Discussed this week: 0:00:00 - Intro 0:03:39 - Multiversity #2 (Grant Morrison and Ivan Reis) 0:17:33 - Justice League #40 (Geoff Johns and Jason Fabok) 0:25:53 - Batman #40 (Scott Snyder and Greg Capullo) 0:38:30 - Superman #40 (John Romita Jr.) 0:48:18 - Free Comic Book Day 2015: Divergence #1 (Various) 0:58:40 - Convergence #4 (Jeff King and Stephen Segovia) 1:08:36 - Convergence: Action Comics #1 (Justin Gray and Claude St. Aubin) 1:15:49 - Convergence: Detective Comics #1 (Len Wein and Denys Cowan) 1:25:11 - Convergence: Justice Society of America #1 (Dan Abnett and Tom Derenick) 1:32:07 - Convergence: Infinity Inc. #1 (Jerry Ordway and Ben Caldwell) 1:41:23 - Convergence: World's Finest #1 (Paul Levitz and Jim Fern, Shannon Wheeler) 1:50:28 - Convergence: Shazam! #1 (Jeff Parker and Evan Shaner) 2:00:20 - Convergence: Blue Beetle #1 (Scott Lobdell and Yishan Li) 2:10:07 - Convergence: Booster Gold #1 (Dan Jurgens and Alvaro Martinez) 2:21:17 - Convergence: Crime Syndicate #1 (Brian Buccellato and Phil Winslade) 2:29:30 - Convergence: Plastic Man and the Freedom Fighters #1 (Simon Oliver and John McCrea) 2:37:38 - Next Week's Books patreon: https://www.patreon.com/mildfuzztv twitter: @DCComicsPodcast (Use #New52) discord: https://discord.gg/8fbyCehMTy Other Links: https://linktr.ee/mildfuzz Find out more at https://the-not-so-new-52.pinecast.co

(Airdate 3/26/25) Ben Caldwell is the community-minded filmmaker, educator, and cultural producer who in 1984 opened KAOS Network, the intergenerational media arts hub that has helped steward Leimert Park Village's traditions of Black artistry, fellowship, and love. Kaosz Network is best known for it's world-famous hip-hop lab "Project Blowed" which spawned rappers like Aceyalone, Medusa, Freestyle Fellowship and more.https://www.instagram.com/kaosnetworkz/https://www.instagram.com/diprimaradio/

Welcome to the (Not So) New 52, a real-time retrospective of DC Comics' New 52 imprint! Discussed this week: 0:00:00 - Intro 0:04:32 - Harley Quinn Valentine's Day Special #1 (Amanda Conner, Jimmy Palmiotti and John Timms, Ben Caldwell, Aaron Campbell, Thony Silas) 0:20:48 - Green Lantern Corps #39 (Van Jensen and Bernard Chang) 0:29:27 - Justice League 3000 #14 (Keith Giffen, J.M. DeMatteis and Andy Kuhn) 0:41:14 - Justice League United #9 (Jeff Lemire and Neil Edwards) 0:49:59 - Worlds' Finest #31 (Paul Levitz and Jed Dougherty) 0:57:35 - New Suicide Squad #7 (Sean Ryan and Tom Derenick, Rob Hunter) 1:04:46 - Secret Six #2 (Gail Simone and Ken Lashley) 1:14:04 - Constantine #22 (Ray Fawkes and Jeremy Haun) 1:23:48 - Klarion #5 (Ann Nocenti and Trevor McCarthy, Szymon Kudranski) 1:33:04 - Batman Eternal #45 (Snyder, Tynion, Fawkes, Higgins, Seeley and Javier Fernandez) 1:43:04 - New 52: Futures End #41 (Azzarello, Lemire, Jurgens, Giffen and Andy MacDonald, Jesus Merino) 1:50:55 - Earth 2: World's End #19 (Bennett, Johnson, Wilson and Various) 1:58:46 - Next Week's Books patreon: https://www.patreon.com/mildfuzztv twitter: @DCComicsPodcast (Use #New52) discord: https://discord.gg/8fbyCehMTy Other Links: https://linktr.ee/mildfuzz Find out more at https://the-not-so-new-52.pinecast.co

AI Therapy is Already Here: An interview with Dr. Ben Caldwell Curt and Katie interview Dr. Ben Caldwell about the state of Artificial Intelligence in therapy. We look at the “AI Therapists” that are already working as well as how they are being regulated (or not). We talk about how AI therapy chatbots are being received and likely next steps in innovation. We also explore what “human therapists” can do to protect their practices and address the influx of low cost, always available AI therapy. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we look at the latest developments in Artificial Intelligence in Mental Health Our friend Dr. Ben Caldwell has been writing some articles on the current state of AI in therapy. We decided this information needed to come to the podcast, so we invited him back on the podcast. What is the current state of AI in the therapy profession? ·      There are chatbots providing “therapy” or mental health support ·      Some apps are going the path of becoming registered as a medical device with the FDA, some are staying in the coaching space Who is regulating AI therapy? ·      Licensing boards for “human therapists” may have no ability to regulate the use of the term therapy by apps, medical devices, or “AI therapists” ·      State legislators may be the avenue for regulation, but there may not be an appetite to do so ·      FDA can regulate apps that get registered as a medical device Who wants AI therapy? ·      Clients or patients will seek out AI therapy as a very cost-effective and available option for mental health support, also AI therapists will not judge clients and will always remember what clients have said ·      Insurance providers will see AI therapy as a way to expand networks ·      Legislators will likely purchase AI therapy for state and county Medi-caid services as well as support expansion to address mental health shortages ·      Basically, everyone wants AI therapy except for human therapists What are the concerns about AI therapy? ·      It is only approximating the relationship between therapist and client ·      An AI therapist doesn't have morals and values, ethics ·      The apps are working only from manualized treatments ·      It may be only psychoeducation, without current ability for deeper work What can therapists do to protect their practices now that AI therapy is here? ·      Make sure to vet any AI services or applications that you use ·      Shift to services that AI therapy doesn't provide (like diagnosis, or more niche services with children, families, and couples) ·      Move to overseeing AI as an adjunct to therapy (i.e., “prescribe” a particular chatbot or AI therapist and check in with clients periodically or when the client is in crisis) ·      Work with AI therapy companies to train the AI therapists Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

Welcome to the (Not So) New 52, a real-time retrospective of DC Comics' New 52 imprint! Discussed this week: 0:00:00 - Intro 0:03:49 - Batman: Futures End #1 (Scott Snyder, Ray Fawkes and ACO) 0:13:08 - Batgirl: Futures End #1 (Gail Simone and Javier Garron) 0:23:57 - Birds of Prey: Futures End #1 (Christy Marx and Scott McDaniel, Robson Rocha) 0:31:45 - Superboy: Futures End #1 (Frank Barbiere and Ben Caldwell) 0:39:31 - Green Lantern Corps: Futures End #1 (Van Jensen and Igor Lima) 0:48:12 - Justice League United: Futures End #1 (Jeff Lemire and Jed Dougherty) 0:57:05 - Worlds' Finest: Futures End #1 (Paul Levitz, Keith Giffen and Yildiray Cinar) 1:04:13 - Constantine: Futures End #1 (Ray Fawkes and Juan Ferreyra) 1:14:22 - Infinity Man and the Forever People: Futures End #1 (Dan DiDio, Keith Giffen and Philip Tan) 1:21:32 - New Suicide Squad: Futures End #1 (Sean Ryan and Andre Coelho) 1:29:28 - Superman Unchained #8 (Scott Snyder and Jim Lee) 1:39:46 - Batman Eternal #23 (Snyder, Tynion, Fawkes, Layman, Seeley and Dustin Nguyen) 1:49:58 - New 52: Futures End #19 (Azzarello, Lemire, Jurgens, Giffen and Scot Eaton) 2:00:22 - Next Week's Books patreon: https://www.patreon.com/mildfuzztv twitter: @DCComicsPodcast (Use #New52) discord: https://discord.gg/8fbyCehMTy Other Links: https://linktr.ee/mildfuzz Find out more at https://the-not-so-new-52.pinecast.co

Welcome to the (Not So) New 52, a real-time retrospective of DC Comics' New 52 imprint! Discussed this week: 0:00:00 - Intro 0:03:57 - Robin Rises: Omega #1 (Peter Tomasi and Andy Kubert) 0:15:41 - Harley Quinn Invades Comic-Con International: San Diego #1 (Amanda Conner, Jimmy Palmiotti and Various) 0:29:58 - Teen Titans #1 (Will Pfeifer and Kenneth Rocafort) 0:40:41 - Batwoman #33 (Marc Andreyko and Jeremy Haun, Scott Kolins) 0:48:24 - Red Hood and the Outlaws #33 (Scott Lobdell and R.B. Silva) 0:55:43 - Supergirl #33 (Tony Bedard, Frank Barbiere and Emanuela Lupacchino, Jeff Johnson, Ben Caldwell) 1:05:57 - Green Lantern: New Guardians #33 (Justin Jordan and Brad Walker, Diogenes Neves) 1:14:59 - Batman Eternal #15 (Snyder, Tynion, Fawkes, Layman, Seeley and Dustin Nguyen) 1:24:47 - New 52: Futures End #11 (Azzarello, Lemire, Jurgens, Giffen and Georges Jeanty) 1:35:27 - Next Week's Books patreon: https://www.patreon.com/mildfuzztv twitter: @DCComicsPodcast (Use #New52) discord: https://discord.gg/8fbyCehMTy Other Links: https://linktr.ee/mildfuzz Find out more at https://the-not-so-new-52.pinecast.co

Authors, artists, and activists will share how film, music, public art, and other art practices can help build communities and imagine new futures. Ben Caldwell is an arts educator, independent filmmaker, and creator of the KAOS Network, whose goal is to be the bridge that connects South LA communities with the new technology of the 21st century as a vanguard in all the art forms. Caldwell is the co-author and subject of KAOS Theory: The Afrokosmic Ark of Ben Caldwell.  Robeson Taj Frazier is a writer, associate professor at the USC Annenberg School for Communication and Journalism, and director of the Institute for Diversity and Empowerment at Annenberg (IDEA). He is the author of The East is Black: Cold War China in the Black Radical Imagination, producer of the documentary film It's Yours: A Story About Hip Hop and the Internet, and host of the PBS Digital Studios production, Hip Hop and the Metaverse. Jonathan Leal is an assistant professor of English at USC. Originally from the Rio Grande Valley, the South Texas region located at the border of the U.S. and Mexico, and now based in Los Angeles, the Latino author, composer, and scholar creates writing, music, and integrative arts projects that amplify creative resistances to bordered life. He is the author of Dreams in Double Time: On Race, Freedom, and Bebop, co-editor of Cybermedia: Explorations in Science, Sound, and Vision, and co-creator of numerous musical projects, including, most recently, After Now. Brettany Shannon, co-author of Co-Creative Placekeeping in Los Angeles: Artists and Communities Working Together, is an urban scholar researching the intersection of art, technology, public space, and community participation. Shannon is the co-editor of Planning for AuthentiCITIES and is an adjunct professor at California State Polytechnic Institute, Pomona; California State University, Northridge; and Woodbury University. Moderator: Annette Kim is associate professor at the USC Price School of Public Policy and affiliated faculty at the USC Roski School of Art and Design. Her books include Sidewalk City: Re-Mapping Public Space in Ho Chi Minh City and Learning to be Capitalists: Entrepreneurs in Vietnam's Transition Economy. Her current research project, ethniCITY, remaps how race and ethnicity shapes spatial patterns in Los Angeles. She founded and directs SLAB (USC's Spacial Analysis Lab) an helped found the RAP collective about race, arts, and placemaking.

In this episode, Australian hosts Jason and Joelle chat with Ben Caldwell, communications coordinator for Rangitīkei District Council. He shares his approach to creating a personality for a local government social media account ("Ben from Comms"), and the value that an engaging social media presence can provide to local government. He talks about the types of psychosocial hazards he experiences in his social media work, and shares suggested strategies for individuals and employers to better protect people who work in social media.

#227: Today, we're once again enlisting some local independent booksellers to help us understand L.A. better. This time we headed to Tía Chucha's Centro Cultural & Bookstore in Sylmar, Octavia's Bookshelf in Pasadena, Vroman's Bookstore in Pasadena and Reparations Club near West Adams. Books mentioned: "Ask the Dust" by John Fante "Mercurochrome: New Poems" by Wanda Coleman "Always Running" by Luis J. Rodriguez "Kindred" by Octavia Butler "Parable of the Sower" by Octavia Butler "The Lost Cause" by Cory Doctorow "KAOS Theory: The Afrokosmic Ark of Ben Caldwell" by Robeson Taj Frazier with Ben Caldwell "There Goes the Neighborhood" by Jade Adia "The White Boy Shuffle" by Paul Beatty "South of Pico: African American Artists in Los Angeles in the 1960s and 1970s" by Kellie Jones

Want to Fix Mental Health Workforce Shortages? Speed up the Licensing Boards: An interview with Dr. Ben Caldwell Curt and Katie interview Benjamin E. Caldwell, PsyD, about licensing board inefficiencies leading to incredible delays in folks getting licensed. We talk about the impacts of paperwork processing delays as well the inadequate infrastructure of most licensing boards. We also explore policy and individual options to mitigate or address these problems. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we talk about how the mental health workforce shortages are exacerbated by licensing boards Curt and Katie decided to invite Dr. Ben Caldwell back onto the podcast to talk about how licensing board inefficiencies are exacerbating mental health workforce shortages. Impacts of delays of paperwork processing on clients and clinicians ·   Delays of folks increasing income as a licensed clinician ·   Lack of mental health clinicians in the work force ·   Prospective clinicians dropping out of the process to become licensed due to the time and financial burden Licensing board infrastructure is often inadequate to get individuals licensed timely ·   Computer systems that licensing boards use are not typically modern ·   The contracts for streamlining processes are often restrictive to specific systems or to how quickly these improvements can move ·   There is little that is automated, but rather includes manual entry which is inefficient and introduces opportunities for error What are potential solutions for the pervasive inefficiency found in licensing boards? ·   Scanning and using optical recognition software for applications and counting hours ·   Contracting with private technology companies that are already gathering this data ·   Finding automated systems that are set up properly from the beginning to minimize training needs ·   Legislation to put pressure on state licensing boards to update computer systems ·   Hiring more people to take on these tasks ·   Using financial reserves to improve systems ·   Mitigating the effects of the delays on the workers (i.e., being able to take required exams for licensure while accruing your hours) ·   Simplifying processes wherever possible (i.e., less buckets of hours with minimum and maximum hours that need to be met) ·   Simplifying applications to make them more understandable for both applicants and reviewers ·   Policy analysis related to the rules – boards make the inaccurate assumption that if a rule exists it must be good ·   Using the legislative process to hold licensing boards accountable for not getting through applications timely and potentially even giving folks provisional licenses while waiting for the application to be reviewed What can individual therapists do to address the delays in processing licensing paperwork? ·   Be as clear as possible in applications and communication to the board to decrease confusion ·   Don't apply for licensure early (i.e., before requirements are completed) ·   Show up to board meetings and let the licensing board know that delays are a huge problem ·   Advocate with your professional org and/or to your legislators Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

What does it mean to think systemically? And how do you demonstrate systemic thought on an exam? These questions come from a prior edition of the official handbook for the National MFT Exam. Both questions are derived from the same case vignette. A couple has been married for 1 ½ years and have a newborn baby. They seek therapy to deal with behavioral problems involving the mother's three children from a previous marriage. The father angrily says that the children, 9, 12, and 16, mouth back at him and do not respect their mother's authority. The couple has started having serious fights. The therapist decides to focus initially on the times when the father has thought that the children were respecting their mother's authority. The purpose of this focus is to help the: Parents unite the marital dyad. Father accept his role as a stepparent. Parents feel hopeful about the situation. Mother perceive her part in the interaction. Which of the following statements should the therapist make to help the family perceive their complaints from a systems perspective?  “It is difficult to be a stepfather.” “The children are having difficulty adapting to the new baby.” “The marital relationship is being affected by your wife's children.” “You are experiencing a normal adjustment to becoming a stepfamily.” Ben Caldwell Labs is now High Pass Education. Ben Caldwell's license exam prep programs are available here.  Intro/outro music: "Swampy Lands" by Adam Saban, licensed via Soundstripe.

Robeson Taj Frazier is an associate professor of communication and director of IDEA (the Institute for Diversity and Empowerment at Annenberg), as well as the author of The East is Black: Cold War China in the Black Radical Imagination and KAOS Theory: The Afrokosmic Ark of Ben Caldwell, and producer of IT'S YOURS: A Story About Hip-Hop and the Internet and Hip-Hop and the Metaverse on PBS. Reflecting on his roots and early influences, he takes us through his journey from New Jersey to China to academia, having produced both books and multimedia along the way.Here are some of the references from this episode, for those who want to dig a little deeper:Robeson Taj FrazierIDEA: Institute for Diversity & Empowerment @ AnnenbergBooks:The East Is Black: Cold War China in the Black Radical ImaginationKAOS Theory: The Afrokosmic Ark of Ben CaldwellFilm/TV:IT'S YOURS documentaryHip-Hop and the Metaverse | PBSEarly influences:Mr T. as B.A. Baracus on the A-TeamGI JoeJemAugust Wilson's The Piano Lesson with Charles S. DuttonWatermelon ManAmerican Culture in China (1990s):Mariah Carey / YanniW.E.B. DuBoisPaul RobesonDiscmanDarlie toothpasteMarguerite de BourgoingThe Misadventures of AWKWARD Black Girl (Issa Rae)Tricia RoseLupe FiascoRobloxBen Caldwell / KAOS Network:Project Blowed, a workshop space utilized by:The Pharcyde, Freestyle Fellowship, Doja Cat, Kendrick LamarLeimert Phone Company projectMIT Radiation Laboratory history / videoWelcome to MetaSecond LifeShare your thoughts via Twitter with Henry, Colin and the How Do You Like It So Far? account! You can also email us at howdoyoulikeitsofarpodcast@gmail.com.Music:“In Time” by Dylan Emmett and “Spaceship” by Lesion X.––––––––––––––––––––––––––––––In Time (Instrumental) by Dylan Emmet  https://soundcloud.com/dylanemmetSpaceship by Lesion X https://soundcloud.com/lesionxbeatsCreative Commons — Attribution 3.0 Unported — CC BY 3.0Free Download / Stream: https://bit.ly/in-time-instrumentalFree Download / Stream: https://bit.ly/lesion-x-spaceshipMusic promoted by Audio Library https://youtu.be/AzYoVrMLa1Q––––––––––––––––––––––––––––––

Today on AirTalk, UAW reached a deal with GM ending a six week strike. Also on the show, Sierra Nevada's Bighorn Sheep; Larry interviews authors of KAOS Theory: The Afrokosmic Ark of Ben Caldwell book; the history of SoCal water; the climate crisis impact on local trails and more. General Motors Reaches Tentative Deal With The United Auto Workers, Ending Six-Week Strike (00:17) The State Of Bighorn Sheep In The Sierra Nevadas And Why It Matters (16:15)  Agent Of KAOS: How Local Multimedia Artist Ben Caldwell's Vision Of Creating A Nucleus For Black Art In Leimert Park Became A Reality (33:54)  SoCal History Monday: A Deep Dive Into The SoCal Waters Of Aqueducts, Aquifers And Underground Basins (50:39) Electric Vehicle Prices Are Dropping. Is Consumer Demand Waning? (1:11:32) How The Climate Crisis Is Impacting Local Trails (1:22:51)

Exam developers work diligently to produce what they believe to be strong, accurate exams. But just like everyone else, they occasionally make mistakes. What should you do when you read a question and you think, none of these answers sound right? This question comes from the current edition of the official California LPCC Law & Ethics Exam Plan, available here. During an initial session, a client tells the counselor that she is currently seeing another counselor. She expresses angry feelings toward the other counselor and would like to get another perspective on her problems. What action should the counselor take? Contract a set number of sessions with the client before sending her back to her current counselor Inform the client that she needs to terminate her ongoing therapy before the counselor can provide treatment See the client until she makes up her mind which counselor she wants to have for therapy Call the current counselor to inform him about the client's desire to change counselors  Ben Caldwell Labs is now High Pass Education. Ben Caldwell's license exam prep programs are available here.  Intro/outro music: "Swampy Lands" by Adam Saban, licensed via Soundstripe.

The whole point of the temple was for God to be with his people, Israel. Today Emma Dotter is joined by today's devo writer and Watermark Elder, Ben Caldwell. These friends challenge us that we don't want to miss the hope that is found in this passage. God brings restoration knowing full well that his people would rebel. We need to long for intimacy with God more than any temporal thing.   Additional Scriptures used in this passage:  1 John 1:9, “If we confess our sins, he is faithful and just to forgive us of our sins and to cleanse us from all unrighteousness.”   Proverbs 13:24, “A man who spares the rod hates his son…”  Hebrews 12:11, “For the moment of all discipline seems painful rather than pleasant, but later is yields the peaceful fruit of righteousness.”   Grab a NEW Join The Journey Journal: https://www.amazon.com/dp/B0C7TCKPR1/ref=sr_1_14crid=3MDHUUF0FW85G&keywords=join+the+journey+volume+2&qid=1686688452&sprefix=join+the+journ%2Caps%2C122&sr=8-14  Join the Journey Jr. https://www.jointhejourney.com/jr/5781-do-you-remember-god-s-promises-to-abraham

What's your moral framework? That can heavily influence your clinical and ethical decision-making -- but it might not line up well with the approach you're being tested on. This episode is especially true to our title: In deciding right and wrong, to Think Like the Test means to think from a much more rule-based approach than how many clinicians actually work. This question comes from prior edition of our book Preparing for the 2023 California Clinical Social Work Law & Ethics Exam. Your client has health insurance, but the insurance carrier is refusing to cover the client's therapy because she is seeing you for couple therapy and does not, in your assessment, qualify for a diagnosis of mental illness. You should: Assess the client's ability to advocate on her own behalf with the insurance company. Offer to include an “insurance diagnosis” on the client's paperwork to facilitate coverage. Work with the client to develop an alternative plan for payment. Discontinue therapy.  Ben Caldwell's license exam prep programs are available here.  Intro/outro music: "Swampy Lands" by Adam Saban, licensed via Soundstripe.

Therapists and reality TV shows are often not a great mix. And yet, it turns out that both of your esteemed hosts have some history with Hollywood. Learn more about how to think about dual-relationship exam questions -- and Ben's dark secret. This question comes from an older edition of one of our books. A therapist is concluding short-term treatment with a casting director for a production company that is interested in developing reality television shows about therapists. The client asks whether the therapist might be willing to be considered for one of the company's shows that will be casting in a few months. The client would not be involved in the casting decision, and would not inform others at the company that he had been in therapy with the therapist. The therapist should: Politely refuse the offer, as the casting decision would be made less than two years after the conclusion of therapy. Politely refuse the offer, as it would be a prohibited dual relationship. Consider the offer and inquire as to what the client's ongoing role in the show would be. Consider the offer under the condition that the client disclose the therapeutic relationship. Ben Caldwell's license exam prep programs are available here.  Intro/outro music: "Swampy Lands" by Adam Saban, licensed via Soundstripe.

Let's get controversial! Is it a good idea for a therapist to project their own political views onto a client? For today's guest Ruth, the answer is a resounding “no.” We hear her story of a therapist who took her political advocacy too far, and Dr. Ben Caldwell rejoins us to explore the ethics of discussing politics in therapy. Plus, how can therapists know if they are trauma-informed enough for their clients?   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today's episode is sponsored by Journal Party.   Introduction: 0:00 – 8:55 Part One: 8:55 – 44:33 Part Two: 44:33 – 1:24:21 Part Three: 1:24:21 – 1:27:42   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to Samaritan's Purse (Ethiopia Projects) Ben Caldwell Labs Think Like the Test Podcast Marketing of professional counselors: A Q-Sort study of best practices. Da Poetry Lounge

Logic is one of the most important test-taking skills. If you can rule out even one part of a response choice, you can rule out that entire response choice. In today's question, Carrie ties herself in knots, as many examinees do. Ben explains how to focus your attention to answer complex questions quickly and correctly.  This question comes from the current BBS handbook for the California MFT Clinical Exam.  A 25-year-old client initiates therapy with complaints of chronic depression and lack of motivation. The client currently lives with his grandparents, does not have any money, and is attempting to finish graduate school. He discloses that his parents had a traumatic divorce several years ago and he fears he will become like his father, who had an emotional breakdown and abused his mother. The client currently has a girlfriend who lives in another state, and he says he feels alone without her. Which of the following actions should the therapist take to assess this client? Gather family history, explore client's strengths, identify coping mechanisms Gather family history, determine somatic symptoms, identify familial coping patterns Explore substance use, determine somatic symptoms, identify coping mechanisms Explore substance use, explore client's strengths, identify familial coping patterns Ben Caldwell Labs is now High Pass Education. Ben Caldwell's prep program for the California MFT Clinical Exam is available here. For Ben's other exam prep resources, visit highpass.com. Intro/outro music: "Swampy Lands" by Adam Saban, licensed via Soundstripe.

Carrie Wiita and Ben Caldwell talk through a sample question to start our discussion of test-taking skills, and Carrie comes one step closer to an important life goal. This question comes from an older version of the BBS California LMFT Law & Ethics Exam handbook. It would equally apply to the LPCC and LCSW Law & Ethics exams. A client initiates therapy for depression following a failed marriage. The therapist finds the client very attractive. Which of the following actions should the therapist take to manage the ethical obligation in this case? Suppress personal feelings of attraction and continue providing therapy Inform the client of the therapist's feelings and discuss therapeutic boundaries Explain the ethical issue to the client and provide a referral to an alternate therapist Seek consultation to manage the attraction and monitor therapeutic boundaries Intro/outro music: "Swampy Lands" by Adam Saban, licensed via Soundstripe.

We are celebrating 100 episodes of the Creative Impact Podcast with special guest, Ben Caldwell!!! Ben and I (Rachel) share a bit of our story as a couple, and we chat about Ben's journey in the arts. He gives us a glimpse into his time as a dancer and dance teacher, and he shares fun and moving stories from his international travels for dance ministry. We also talk about Ben's transition out of full-time dancing, processing the losses that come with change, and rediscovering hope for the future.Thank you so much for being part of the Creative Impact Podcast community! We are so grateful for your support, and are excited to celebrate with you today!Check out our website https://creativeimpactpodcast.com for the full show notes that include Ben's biography and additional links mentioned in this episode. You can be sure not to miss a Creative Impact conversation by subscribing through your favorite podcast app.  We are so grateful to have you as a part of the Creative Impact community and would love it if you would share the show with your friends!Support the show

Ben is a very interesting bloke who makes superb wines under a number of umbrellas. He and his business partner Mauricio Ruiz Cantu are currently the biggest Aussie exporter to Mexico under their label Juguette... Richo and Ben also chat about Somos wines and more importantly; 7 Eves from the Saint Clar vineyard in Macclesfield (Adelaide Hills). Their low intervention wines are stylish and unpretentious whilst remaining true to their variety and vineyard. But more importantly the flavour is sensational and the price isn't prohibitive. Did i mention the Syrah took the trophy for best wine in show at the 2022 Adelaide Hills Wine Show??? Pretty impressive.....

The Daily Rios Digest for February 11th, 2023: Ben Caldwell's Wonder Woman in Wednesday Comics. Thoughts on...

Addressing Racism in Clinical Licensing Exams: An Interview with Ben Caldwell and Tony Rousmaniere Curt and Katie interview Dr. Ben Caldwell and Dr. Tony Rousmaniere about the problems with the Clinical Licensing exams for therapists. We discuss the recent report from ASWB on their pass rates as well as the concerns about the EPPP2 implementation, the poor predictive validity and utility of these licensing exams, and suggestions for what to do with our licensing processes given these concerns. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we talk about recent data that licensing exams are racist Friends of the show, Dr. Ben Caldwell and Dr. Tony Rousmaniere wrote a white paper in response to a recent report from the ASWB that shows their licensing exams appear to be racist. We wanted to talk with them about their calls to discontinue these exams. How are the clinical exams racist? ·      The number one predictor of whether you pass the exam is your race ·      The structure of the exam seems to advantage those with more affinity to these types of tests (i.e., those who are educationally privileged) ·      There may also be content or language concerns leading to these disparities What is the purpose of the clinical exams for therapists? ·      Said that it is to be an assessment of knowledge and training, consumer protection, etc. ·      Little predictive validity (of competence or consumer safety) for these tests ·      The test is an unfair hurdle for folks without academic privilege ·      There does not seem to be a need for this test (due to the rigor of training and supervised experience) What would be better alternatives to requiring a clinical exam? ·      Alternate pathways that some states have taken ·      Addressing workforce shortages by allowing folks who have gotten through every other requirement (aside from the clinical exam) to be licensed ·      Just don't require a clinical exam What can therapists do to try to get rid of licensing exams? ·      Advocacy to state boards to not implement EPPP2 ·      Other advocacy related to master's level clinical exams ·      Organizations to #StopASWB and address the EPPP2 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! White Paper: Clinical Licensing Exams in Mental Health Care by Benjamin E. Caldwell, PsyD and Tony Rousmaniere, PsyD ASWB Report on Social Work Licensing Exam Pass Rates Very Bad Therapy BenCaldwellLabs.com SentioCC.org Stop the Adoption of EPPP2 Website ASWB: End Discriminatory Social Work Licensing Exams A sample letter you can send to your licensing board will be on our show notes at mtsgpodcast.com. Relevant Episodes of MTSG Podcast: Fixing Mental Healthcare in America Unlearning Very Bad Therapy Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Patreon Buy Me A Coffee Podcast Homepage Therapy Reimagined Homepage Link tree: https://linktr.ee/therapyreimagined Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

In the United States, mental health professionals must pass a clinical exam to become licensed in their field. These exams appear to do nothing to make psychotherapy more effective or safe. They are, however, very efficient at furthering structural racism. Dr. Ben Caldwell joins us to make a very compelling, research-based argument for why these clinical exams should be abolished immediately.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today's episode is sponsored by Sentio Counseling Center – high-quality, low-fee online therapy in California with immediate availability for new clients.   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Clinical Licensing Exams in Mental Health Care (White Paper) Report: Clinical exams in mental health licensing are structural racism 2022 ASWB Exam Pass Rate Analysis org – ASWB: End Discriminatory Social Work Licensing Exams California BBS discussion of the ASWB report Racial Bias and ASWB Exams: A Failure of Data Equity Ben Caldwell: Email / Ben Caldwell Labs / Psychotherapy Notes

It's not unusual for clients to develop feelings for their therapist. It's also not unusual for therapists to develop feelings for their clients. So why is it such a bad idea for a therapist to share (or act) on those feelings? Today's guest Kate shares a story that illustrates exactly why, and Dr. Ben Caldwell rejoins us to talk about what should happen when clients and therapists develop feelings for one another.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today's episode is sponsored by The Organized Therapist – Social Media for Therapists and Sentio Counseling Center – high-quality, low-fee online therapy in California with immediate availability for new clients.   Introduction: 0:00 – 8:40 Part One: 8:40 – 44:35 Part Two: 44:35 – 1:30:32   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to NAMI: National Alliance on Mental Illness Ben Caldwell on Authory The Patient on Hulu Mentour Pilot (YouTube) Does sorry work? The impact of apology laws on medical malpractice “Sorry” Is Never Enough: How State Apology Laws Fail to Reduce Medical Malpractice Liability Risk

What Goes in Your Notes? Interstate therapy practice and documentation for clients considering abortion or gender affirming care Curt and Katie chat about documentation and practice questions related to abortion or gender affirming care when providing therapy to folks in states where these types of medical care are banned or will be banned soon. We look at medical documentation privacy concerns (related to HIPAA and the 21st Century Cures Act), how therapists avoid “aiding and abetting” a client to get an abortion, what to include in your notes, and special considerations related to duty to warn and child abuse reporting. This is a law and ethics continuing education podcourse. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode we explore post-Roe documentation for therapists We've heard a lot of questions about what therapists should do now that Roe has been overturned. We decided to dig into practice and documentation guidelines to help modern therapists navigate the changing times. Medical documentation privacy concerns with interstate practice and the new abortion bans “Your records aren't as private as you think that they are.”  - Curt Widhalm, LMFT HIPAA and the 21st Century Cures Act The impact on clients who move from safe haven states to states with abortion bans The impact of the Counseling Compact (and similar mental health compacts) and how many participating states have trigger laws to ban or limit abortion Paying attention to jurisdictional differences and where the client lives Who qualifies as a HIPAA covered entity? Psychotherapy (Process) Notes versus Progress Notes Psychotherapy notes are not defined the same and/or protected in every state The impact of civil law suits on confidentiality of process notes The huge challenge of information blocking and who may pass along your treatment information Talk to an attorney or your professional organization when subpoenaed How do you avoid “aiding and abetting” a client to get an abortion during mental health treatment? Processing feelings and helping client to make their own decisions Aiding and abetting can include telling them where to go, encouraging them to get an abortion, or providing practical support (like money or a ride) How to provide resources without aiding and abetting Self-empowerment and clients making their own decisions Liability and risk in practice (check with your malpractice insurance) Whether/how you let your clients know where you stand on the overturn of Roe v Wade What do you include in your notes when talking about abortion and gender affirming care? “You need to give meaningful consideration to what goes in [the mental health] record and you also want to be clear in what you're talking about with your clients. So, that way you're not unintentionally aiding and abetting a client who's living in one of these states where an abortion ban is currently in place.” – Curt Widhalm, LMFT What is relevant to your treatment goals? Documenting progress toward treatment goals Creating a policy related to medical decision-making Phrases that you can use to briefly describe what is happening in session How much to document and the recommendation to be less specific in progress notes when discussing medical decisions The special considerations related to duty to warn and child abuse reporting when talking about abortion and gender affirming care No case law to guide us here The difference between permissive versus required reporting Vast differences across the states with all of the different pieces HIPAA says that we should not report, but we will be impacted by state laws Recommendations to pay attention to what is happening in the states where you practice and to identify advocacy opportunities to protect information, safe haven laws Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Thrizer Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee! Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That's right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time. Receive Continuing Education for this Episode of the Modern Therapist's Survival Guide Hey modern therapists, we're so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!  Once you've listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that's all completed - you'll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com. You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/ Continuing Education Approvals: When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit. Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! 21st Century Cures Act Person-Centered Tech (help to become HIPAA compliant) What the End of Roe v. Wade Does (and Doesn't) Mean for Your Relationship With Your Therapist | by Monika Sudakov | Jul, 2022 | Medium Frequently asked questions about abortion laws and psychology practice (apaservices.org) Information blocking FAQs  HIPAA, Psychotherapy Notes, and Other Mental Health Records by Holland and Hart Additional references mentioned in this continuing education podcast: Holloway, J.D. (2003). More protections for patients and psychologists under HIPAA. American Psychological Association. https://www.apa.org/monitor/feb03/hipaa#:~:text=Under%20HIPAA%2C%20psychotherapy%20notes%20are,can%20contain%20information%20that%20is Stranger, K. (2020). HIPAA, Psychotherapy Notes, and Other Mental Health Records. https://www.jdsupra.com/legalnews/hipaa-psychotherapy-notes-and-other-42359/ U.S. Department of Health and Human Services (2013). Summary of the HIPAA Privacy Rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html#:~:text=The%20Privacy%20Rule%20protects%20all,health%20information%20(PHI).%22 Zubrzycki, C. (2022) Abortion's Interoperability Trap: How the Law of Medical Records Will Facilitate Interstate Persecution of Contested Medical Procedures, and What to Do about It. Yale Law Journal Forum, Forthcoming, http://dx.doi.org/10.2139/ssrn.4147900   *The full reference list can be found in the course on our learning platform.   Relevant Episodes of MTSG Podcast: What Therapists Need to Know about Abortion and Termination for Medical Reasons: An Interview with Jane Armstrong The Practicalities of Mental Health and Gender Affirming Care for Trans Youth: An Interview with Jordan Held, LCSW Working with Trans Clients: Trans Resilience and Gender Euphoria: An interview with Beck Gee-Cohen Is the Counseling Compact Good for Therapists? Now Therapists Have to Document Every F*cking Thing in Our Progress Notes? Noteworthy Documentation: An interview with Dr. Ben Caldwell (on the 21st Century Cures Act) Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Patreon Buy Me A Coffee Podcast Homepage Therapy Reimagined Homepage Facebook Twitter Instagram YouTube   Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

Today's guest Marie shares her thought-provoking story about a preoccupied telehealth therapist, and we drag Dr. Ben Caldwell into another one of our philosophical crises about what constitutes very bad therapy. Is it not following a treatment plan? Having young children show up in session? Ignoring ruptures? Regularly showing up late? And while we're at it, what even is therapy? Who should get to be a therapist during the pandemic? Join us on the struggle bus as we try to parse out issues related to telehealth, laws, ethics, clinical practices, privilege, social systems…and bullshit.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today's episode is sponsored by The Organized Therapist – Social Media for Therapists and Empifany (Instagram / Facebook).   Introduction: 0:00 – 11:20 Part One: 11:20 – 54:41 Part Two: 54:41 – 1:57:06 Part Three: 1:57:06 – 2:02:04   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to Cystic Fibrosis Foundation Ben Caldwell Labs Psychotherapy Notes SimplePractice Learning Calling Bullshit: The Art of Skepticism in a Data-Driven World Potential fabrication in research images threatens key theory of Alzheimer's disease Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: A proof-of-concept randomized controlled trial The Radical Therapist #100 – Single Session Narrative Therapy w/ Michale Morar

The Clinical Supervision Crisis for Early Career Therapists: An Interview with Dr. Amy Parks Curt and Katie interview Dr. Amy Parks about the lack of resources for pre- and provisionally licensed mental health professionals to find a clinical supervisor. We discuss the current state of clinical supervision, the barriers for folks becoming clinical supervisors, what makes a good supervisor, navigating online supervision, and what licensed folks might consider when seeking consultation. Transcripts for this episode will be available at mtsgpodcast.com! An Interview with Dr. Amy Parks, Founder of the Clinical Supervision Directory Dr. Amy Fortney Parks brings with her over 30 years of experience working with children, adolescents and families as both an educator and psychologist.  She is a passionate “BRAIN -ENTHUSIAST” and strives to help everyone she works with understand the brain science of communication, activation and relationships. Dr. Parks has a Doctorate in Educational Psychology with a specialty in developmental neuroscience. She is a Child & Adolescent Psychologist as well as the founder and Clinical Director of WISE Mind Solutions LLC and The Wise Family Counseling, Assessment & Education in Virginia.  She is also the founder of the Clinical Supervision Directory – a connection super-highway for supervision-seekers working towards licensure in counseling and social work across the US. Dr. Parks serves as a Clinical Supervisor for Virginia LPC Residents, as well as Dominion Psychiatric Hospital. Additionally, she is an adjunct professor at George Washington University & The Chicago School of Professional Psychology. Dr. Parks is a frequently sought-after parent coach and speaker for families and groups around the world.   In this podcast episode, we talk about clinical supervision for modern therapists We look at the gap in clinical supervision for prelicensed or provisionally licensed mental health professionals. What is the state of clinical supervision for mental health professionals? “Arbitrary reasons or barriers to entry are one of the main reasons why we're not getting more clinical counselors on the ground to serve the public. Because when somebody graduates from graduate school… hundreds of thousands of clinicians are graduating, and hundreds of thousands of them will not get connected to supervisors, until they figure out where to find their lists.” – Dr. Amy Parks No consistent resources for newly graduated clinicians to find supervisors Different state to state or area to area Lack of supervisors and a lack of a mechanism to connect supervisors and supervisees What are the barriers to folks becoming clinical supervisors? Different standards in different states Sometimes becoming a supervisor is too overwhelming, complicated, or too much responsibility The need for advanced training in supervision What makes a good supervisor? “Everyone should have supervision as part of their employment. It should be excellent. It should be professional, and it should be a benefit, period, end of discussion. But I can guarantee you 100% that that is not the majority of the country. And that's not the way it's done in every career field either.” – Dr. Amy Parks Training Diverse experience Understanding the boundaries between supervision and counseling Supervisor, consultant, teacher roles Cultural humility, bias – looking at clients and supervisees Navigating Online Supervision Video supervision (rather than phone) Have supervisees record (video) their sessions for feedback Research shows that telesupervision is as effective as in person Laws related to in-person versus virtual supervision Supervision or Consultation After Licensure The value of getting consultation after you're licensed The importance of a beginner's mind The challenges of finding good consultation Finding the right match when seeking supervision or consultation Our Generous Sponsors for this episode of the Modern Therapist's Survival Guide: Thrizer Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client's insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don't need to give up your rate. They charge a standard 3% payment processing fee! Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won't be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code 'moderntherapists' for 1 month of no credit card fees or payment processing fees! That's right - you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.   Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Clinical Supervision Directory Clinical Supervision Directory Sign up to be a Supervisor coupon code for $50 off the first year: FRIEND50 NBCC accredited supervisor program Instagram @ClinicalSupervisionDirectory Facebook @ClinicalSupervisionDirectory LinkedIn - Clinical Supervision Directory Amy's practice: The Wise Family Relevant Episodes of MTSG Podcast: Giving and Getting Good Supervision Getting the Supervision You Want Bilingual Supervision: An Interview with Adriana Rodriguez, LMFT Waiving Goodbye to Telehealth Progress: An Interview with Dr. Ben Caldwell   Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Patreon Buy Me A Coffee Podcast Homepage Therapy Reimagined Homepage Facebook Twitter Instagram YouTube   Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

How should Christians think about aspirations and goals? In this episode, Emma Dotter is joined by Watermark Elder, Ben Caldwell, to talk all things 1 Timothy 3.

We're back with Dr. Ben Caldwell to conclude our thoughts on grad school and the surprising reality that it isn't meant to make you a good therapist. We talk about starting supervision, avoiding moral injury, and most importantly, all the things that graduate education does very well in supporting early-career clinicians. Plus, we share our best advice for anyone getting started in their career in mental health.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community.   Join our charity drive! We are matching up to $6,000 of your donations to the world's most effective charities. To contribute, visit GiveWell.org and use the fundraising code VBT.   Introduction: 0:00 – 2:38 Part One: 2:38 – 1:03:04 Part Two: 1:03:04 – 1:14:45   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Ben Caldwell Labs – Exam Prep / Books / Saving Psychotherapy Sentio University: Mastering Psychotherapy Webinars

The Risks and Consequences of Failing to Report Child Abuse Curt and Katie discuss the CA Board of Behavioral Sciences case against Barbara Dixon, LMFT who failed to report child abuse for Gabriel Fernandez and Anthony Avalos who both subsequently died from abuse by caregivers. We look at what this therapist missed as well as appropriate child abuse reporting, including the nuance of when to report. CW: details of child abuse discussed. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode we talk about the importance of child abuse reporting We talk about the failure to report abuse by Barbara Dixon, LMFT that has recently been in the news related to the deaths of Gabriel Fernandez and Anthony Avalos. The case related to the child abuse death of Gabriel Fernandez Content Warning: Details of the case, including the actions taken (and not taken) by Barbara Dixon, LMFT The decision-making process with child abuse reporting Who is responsible to decide to report child abuse – the clinician or the supervisor? “I hear [prelicensees] wrongly state that ‘I'm working under somebody else's license; this falls on them' … I cannot emphasize enough that decisions like this, in [Barbara Dixon's] case, really do indicate that it is your responsibility, no matter what your agency says… People can and do get punished for not following through on their individual licensee or registration responsibilities as mandated reporters.” – Curt Widhalm When supervisors or agencies tell clinicians under supervision not to report child abuse report The individual responsibility that each clinician holds The myth that you're working “under” your supervisor's license How do you decide whether you should report child abuse? “It's these gray areas where there's this nuance that I think feels really overwhelming. And for some folks, they'll lean towards reporting or consulting to identify if it's reportable. And for other folks, they use that as cover to not report when it feels too uncomfortable.” – Katie Vernoy Clarity from child abuse reporting laws Hesitation based on systemic response, the therapeutic relationship, and the paperwork hassle Where there are gray areas and nuance The consequences of failing to report child abuse or adequately document services or risks Your agency or supervisor may not be held liable for your actions (especially if you don't document what you did) Incomplete documentation hurts – it doesn't help you hide from liability Appropriate Child Abuse Assessment and Reporting Interviewing the child separately Following up on what you've asked for Understanding at what point it becomes our responsibility (i.e., having sufficient information) Documenting each stage and make sure to appropriately close out treatment file when needed Consultation and not making the decision on your own Defining the injury and assess from there Understanding normal childhood response to typical life events (and noting changes) Navigating the gray areas in child abuse assessment Looking at impact, intent, and injury Using the context to help decide when there isn't a definitive line Adequately documenting, even when you aren't sure you're making the right decision, is important and necessary Looking at what needs systemic intervention and what needs family therapy Getting past the discomfort to report child abuse report It is your responsibility Taking a moment to understand the purpose of reporting Reducing your own liability Obtaining resources for families Understanding the risk for families of systems getting involved Our Generous Sponsors for this episode of the Modern Therapist's Survival Guide: OOTify OOTify. "OOT" or "uth" (उठ) means "lift up" in the Hindi language. OOTify is a digital health solution that acts as an evidence-based hub to unify relevant mental health resources. Community, Connection, and Collaboration are critical to OOTIFY.  As they lift the mental healthcare system, they ensure providers are part of the process. OOTIFY is a platform for providers, built by providers, and owned by providers. OOTIFY is the process of lifting up mental healthcare, while lifting each other up. We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We're going to go through trials and tribulations. But if we can work on our mental health, proactively, our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, “Hey, listen, I'm going through this too.” Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates. Turning Point Financial Life Planning Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans. Turning Point is a financial planning & coaching firm that helps therapists stop worrying about money. Dave at Turning Point will help you navigate every aspect of your financial life - from practice financials and personal budgeting to investing, taxes and student loans. He'll help you move through that feeling of being stuck, frustrated and overwhelmed... And arrive at a place where you feel relief, validation, motivation and hope. And for listeners of MTSG, you'll receive $200 off the price of any service. Just enter promo code Modern Therapist. Be sure and visit turningpointHQ.com and download the free whitepaper “7 Money Mindset Shifts to Reduce Financial Anxiety” Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Los Angeles Times Article: Counselor who didn't report abuse of Gabriel Fernandez, Anthony Avalos put on 4-year probation Citation/Enforcement Decision on Barbara Dixon LA Times Article: Charges dismissed against social workers linked to Gabriel Fernandez's killing Relevant Episodes of MTSG Podcast: Now Modern Therapists Have to Document Every F*cking Thing in Our Progress Notes? Do Therapists Curse in Session? Toxic Work Environments Giving and Getting Good Supervision Make Your Paperwork Meaningful: An interview with Dr. Maelisa McCaffrey Hall Noteworthy Documentation: An interview with Dr. Ben Caldwell, LMFT CYA for Court: An interview with Nicol Stolar-Peterson, LCSW   Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Patreon Buy Me A Coffee Podcast Homepage Therapy Reimagined Homepage Facebook Twitter Instagram YouTube   Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group   Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

Dr. Ben Caldwell joins us to discuss everything you need to know about going to school to become a therapist. His most important message? Treat grad school like a convenience store – get in and get out. We explore how to choose a school, how to get the most out of the experience, and where to focus your energy along the way. This episode is for anyone interested in becoming a therapist or for those already in grad school – especially if some of your experiences don't seem to make sense.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today's episode is sponsored by courtmandatedtraining.com.   Join our charity drive! We are matching up to $6,000 of your donations to the world's most effective charities. To contribute, visit GiveWell.org and use the fundraising code VBT.   Introduction: 0:00 – 5:44 Part One: 5:44 – 1:16:15   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: MFT California Ben Caldwell Labs – Exam Prep / Books / Saving Psychotherapy

Now Modern Therapists Need to Document Every F*cking Thing in Our Progress Notes?!? Curt and Katie discuss a recent citation from the California Board of Behavioral Sciences (BBS) to a therapist for cursing while in session. We explore: How do we document ruptures during the therapy session? Is the BBS over-reaching by controlling what therapists document? What are the best practices for note taking? All of this and more in the episode. In this podcast episode we talk about appropriate documentation practices for modern therapists As therapists it's important that we take accurate notes. But what is important to include in the notes, and how much should we really be documenting? Wait – Is it alright to use curse words in session? Therapists should be first and foremost aware of the client and their potential reaction. Note the therapeutic relationship with the client, their history, and how the client empowers themself when making language selections. If considering using casual language, consider the client's vernacular. Follow the client's lead when it comes to their language in session, including cursing. The BBS has no specific statute related to cursing or swearing. “If things aren't written down, they did still happen – but now it's open to interpretation.” - Curt Widhalm What should modern therapists document in clinical notes? It is important to document any bold interventions or ruptures in the therapeutic relationship and repair attempts for ruptures. In note taking, it is important to follow the clinical loop: assessment, diagnosis, treatment plan, intervention, use of intervention, and the client's reaction and progress. Your notes will be a balance of covering your liability and creating notes that help you remember the session. Therapists should consider documenting the use of any language that could be deemed not clinically appropriate, even positive statements like “I'm proud of you,” or “Yes, my dear.” “I think any rupture in the treatment relationship is worthy to document because it's potentially clinically rich, but also a point of liability.” – Katie Vernoy Does the California Board of Behavioral Sciences (BBS) outline what we should say in our notes? In the 300-page PDF outlining the statutes for LPCCs, LMFTs, LCSWs, and Educational Psychologists, notes are only mentioned 10 times. There is no mention in the statutes of what can be said and what can't be said in notes. Some agencies and institutions will stress writing very little to ensure protection from liability, but as this citation showcases, this might not be best practice. The BBS wants to ensure the protection of clients and you might need to justify your words, just as you would justify the use of an intervention. This is a reminder that the BBS can and do look at therapist's notes. Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Dr. Tequilla Hill The practice of psychotherapy is unique, creative, and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion, fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey. If you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill a mindful entrepreneur, yoga, and somatic meditation teacher has curated How to Stay Well While You Work Therapist Wellness Guide to support providers that are struggling to manage your own self-care.  Subscribe to Dr. Hill's Stay Well While You Work! Therapist Wellness Guide and you can find many of the inspiring offerings from Dr. Hill's 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast. Support The Modern Therapist's Survival Guide on Patreon! If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings, and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more. If you don't think you can make a monthly contribution – no worries – we also have a buy me a coffee profile for one-time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymeacoffee.com/moderntherapist. Thanks everyone. Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Statutes and Regulations Relating to the Practices of Professional Clinical Counseling, Marriage and Family Therapy, Educational Psychology, and Clinical Social Work The Case for Cursing Client's Experiences and Perceptions of the Therapist's use of Swear Words and the Resulting Impact on the Therapeutic Alliance in the Context of the Therapeutic Relationship by HollyAnne Giffin Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel “Swear” Words by Richard Stephens and Olly Robertson Relevant Episodes of MTSG Podcast: Do Therapists Curse in Session? Make Your Paperwork Meaningful: An Interview with Dr. Maelisa McCaffrey Hall of QA Prep Noteworthy Documentation: An Interview with Dr. Ben Caldwell, PsyD, LMFT CAMFT Ethics Code Updates Bad Business Practices Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Patreon Buy Me A Coffee Podcast Homepage Therapy Reimagined Homepage Facebook Twitter Instagram YouTube   Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group   Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated): Curt Widhalm  00:00 This episode of The Modern Therapist's Survival Guide is brought to you by Dr. Tequilla Hill.   Katie Vernoy  00:05 The practice of psychotherapy is unique, creative and multifaceted. However, combining a more demanding schedule and handling our own pandemic related stresses can give rise to experiencing compassion fatigue, and the dreaded burnout. Unfortunately, many therapists struggle silently with prioritizing their own wellness across their professional journey.   Curt Widhalm  00:26 Dr. Tequilla Hill with mindful entrepreneur, yoga and somatic meditation teacher has curated how to stay well while you work therapist wellness guide to support providers that are struggling to manage your own self care. Stay tuned at the end of the episode to learn more.   Katie Vernoy  00:41 Hey everyone, before we get started with the episode Curt and I wanted to make sure you were aware that we have opportunities for you to support us for as little as $2 a month.   Curt Widhalm  00:50 Whether you want to make that monthly contribution at patreon.com/MTSGpodcast or a one time donation over at buymeacoffee.com/moderntherapist. Every donation helps us out and continues to help us bring great content to you. Listen at the end of the episode for more information.   Announcer  01:12 You're listening to The Modern Therapist's Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.   Curt Widhalm  01:30 Welcome back modern therapists. This is The Modern Therapist's Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all of the things that therapists should worry about. And this is part two of an episode that we started last week about a citation from the California Board of Behavioral Sciences to a therapist about using a curse word in session. And if you haven't listened to last week's episodes, we talked a little bit about, we talked a lot about using curse words and sessions. And today, we're gonna focus on a different part of the citation. In the citation, it talks about the therapist not documenting about their decision to use a curse word, how it fits within the treatment, what the client's response to it was, and this being a part of why the therapist was being investigated and wanting to do a dive into: what are we actually supposed to put in our notes? We've had a couple of episodes in the past. So one with Dr. Melissa Hall and one with Dr. Ben Caldwell about what you need to put in your notes. We'll link to those in our show notes over at MTSGpodcast.com. We're not talking about SOAP Notes or structure, that kind of stuff. Today we're talking about legitimately, what do you need to put in your notes? And what is this signal by the California BBS really mean for the rest of us here? So, Katie, what needs to go in our notes?   Katie Vernoy  03:11 Well, I think just for folks that want a quick primer, because I when they can go over to both of those episodes and get stuff I'll say something and kind of lead into the rest of this. The documentation for services should follow the clinical loop. Dr. Melissa McCaffrey Hall is someone who talked about it really well and meaningful documentation. But you start with an assessment that leads to a diagnosis that then has a treatment plan, that then on a weekly or a session by session basis, you talk about the interventions that you're putting forward to help the client to meet their treatment goals that's on the treatment plan. And that's a clinical loop, you know, diagnosis, treatment plan, session notes - comes back, and hopefully you're addressing the diagnosis. In this situation. Again, we talked about the cursing before, it seems like there is a discussion around were all of the interventions put into the note. And I don't know if we have to include all interventions. I think there's a lot of mirroring and reflection and active listening and all of those things. But I think potentially you can put some of those things in the notes, but I don't think every single micro intervention needs to go in notes. But I think big interventions probably do, especially ones that are truly impactful to our clients, as well as the responses to those interventions and an even like group notes or SOAP Notes or any of the notes. There is an idea, pretty established, that we must put down the interventions that we're using and the client response.   Curt Widhalm  04:55 So in the very nature of this you're bringing up intervention is there are planned interventions, and then there are also the ones that just kind of slip out. And I think it's important for us to read from this citation. So that way, our audience here has the same knowledge of what's going on here. So I'm going to quote, I'm going to quote from the citation. And once again, we're not releasing the name of the therapists themselves, due to respecting their privacy on this, but I think that this is a key indicator of looking at how our licensing boards are enforcing stuff Yeah, and, and potentially looking at their their overreach here. So jumping into the middle of this, we talked in last week's episode about the therapists use of a curse words towards a minor in session, and quoting from the citation, regarding the record keeping a portion of your notes which you had handwritten are illegible. Additionally, your notes failed to identify which minor you had confronted during the session. Furthermore, your notes do not document either your decision to use a curse word as part of your description of the minor clients behavior. What's your rationale was for doing so what the minor client's response was to your description of his behavior, or that you would apologized to the minor client regarding the wording you had to use to describe his behavior. End quote.   Katie Vernoy  06:25 I think that there are pieces of that that are fair. And I feel like there's still information that we don't know to identify at the word that you used as overreach. I think that the level of policing around our documentation seems surprising to me. But I don't know if I particularly disagree with any of their statements. It sounds like you do, though.   Curt Widhalm  06:49 My reaction on this is, if this is in fact used as an intervention within the the treatment session, which by all accounts seems to be what this therapist and the therapist attorney justified that no other ways of reaching this client really made any sort of emphasis. That doing something big and bold in session in order to try and get through a client does seem to be a maybe very on the spot decision as an intervention to kind of disrupt and shake things up a little bit. That maybe not planned as a intervention strategy. You know, I think last week, you and I both admitted that, yeah, we use curse words in sessions from time to time. I don't think that any of my treatment plans will ever include session seven, use curse word with this client to disrupt what is the therapy in order to help them gain a new perspective. But I think it is something where, with intentional interventions, and that that clinical feedback loops that you were talking about, yeah, we do need to include in our notes, intervention use client reaction. And I think that that's the language that the Board of Behavioral Sciences is using here, that is kind of a catch all for this. Where maybe there's a little bit more nuance in here is in some of the off the cuff interventions that we do, or things that are human relations, sort of impacts that we have on other people that we might not consider in the traditional sense of interventions that it gets into kind of a fuzzy space of are we leaning towards the the cya of covering our asses of needing to transcribe the entirety of our sessions just to prove what has happened? That's kind of where my initial reading of this is. Do we have to document everything that is said, and moving into even some of the direct quotations that we use in session with more frequency?   Katie Vernoy  09:06 That may be what the BBS is describing? I think, for me, I don't take that in in that way. I think in this situation, it is hard to know if this is something that is coming from a parent that is is upset at the therapist or the therapist decision making. I'm not sure if this is a truly harmful therapist who is saying really inappropriate things in session, or some other thing, right. Like I can't speak to this particular situation. And I certainly don't feel like we need to do transcription of our sessions and quotations of our own stuff. So that's, that's my caveat. If I was in a session, and I said something to a client, they said that hurt my feelings, and we talked about it and I apologized and there was a repair or there wasn't a repair, I would document that I think any rupture in the treatment relationship is worthy to document because it's potentially very clinically rich, but it also is a point of liability. And so to me, it feels like if I recognize that a client is upset by an intervention or specific words that I use, I would document that.   Curt Widhalm  10:24 And I think that this is the difficulty in looking at information like this because it gets much more complicated with the more people who are in the room. Having worked on legislative language before and worked on trying to define things before and creating language for statutes that is broad enough that it speaks to what we do in our profession. A lot of times, we just borrow language from where it's already written. And one of the things, especially for couples and family therapy is that there hasn't really been a good definition of how in statute, it looks different than working with individuals. You know, we have 100 plus years of psychologists language to, you know, work with individual people. But sure, the theories around marriage and family therapy, we can borrow some of the language that statutes should suggest that those go in there. But for really being conscious of the steps that we're making towards putting this information into our documentation. What I'm hearing you say is that if you're really calling out one member in this citation saying the same thing, if you're really holding one member accountable, you need to be specific to that up to an including emphatic language. Is that what you're saying here?   Katie Vernoy  12:01 Well, I think you're, we're talking and I feel like we're talking into different areas. I think, in this situation, we have someone who clearly was overwhelmed, or at least that's what we've assumed, has illegible notes, and there's not specifics in it. So to me, the flavor I'm getting is that if this person if this therapist would have put in their notes, something along the lines of confronted X member of the family or use disruption by confronting X member and had some bold language and discuss the use of that language, and provided a repair within the session, without saying, I cursed at this kid, the family got upset, and I whatever, but like actually using clinical language to describe what happened, the confrontation, the disruption within the family system, as well as repair and planning for the future. To me, I don't know that we would, that this would have been part of the citation. We're assuming because they said you did not you say you used a curse word and your rationale for using the curse word that we're like, oh, we have to transcribe. I don't know that. I don't know that. I agree with that. And I do share your concern that should this become statute? Yeah. I don't think we need to transcribe our sessions, or put forward really dramatic tales in our progress notes, so that we cover everything. But I think it's, it's a jump in this situation to say, Oh, well, they wanted this. It sounds like they were appalled at what they found. And they put language to how they put it forward. I honestly have no idea. And I don't fault this therapist at all. I can't make a judgment on that. But if we're looking at the notes were illegible and incomplete. Everything was missing. Right?   Curt Widhalm  13:55 Well, the eligibility, part of it, I think, is a curious piece. And I think you and I have both heard from clinicians. And I haven't heard this as much in the last 10 years. And yeah, I do want to give you credit for being the one who brings up this point, before we started recording today. So but you and I both heard for most of our careers, about therapists who've taken the approach of well, if it's illegible, then people have to ask me what was meant there. And that's another way of protecting me in my practice. And this is a very clear indication that that is not true.   Katie Vernoy  14:35 Not true at all. We need to type stuff into an electronic health record. That's pretty clear at this point.   Curt Widhalm  14:43 I think it's really important to be able to have clear notes, do them well. And I think getting into the nuance of just like how descriptive do we need to be in the response to that But I take your point, as far as you know, what may need to be, as far as you know, use this disruption. Is it, you know, needing to put in more and more exact quotes? Is it, you know, just in the more confrontive ones? Or is it also going to be in any sort of situation where a different perspective is going to need that nuance reflected in the notes as well?   Katie Vernoy  15:27 What do you mean by that?   Curt Widhalm  15:28 So, you know, there's the clients that therapists use curse words to disrupt them. Yeah. There's also the other end of the spectrum where therapists may use more affectionate language to help to emphasize a point to that maybe seen as a boundary crossing of, you know, expressing some affection in a way that has some context sway, you know, hey, I really care for you. And I really want to see you be successful in this, do we need to then document that same nuance in that direction?   Katie Vernoy  16:06 From the description that you're providing there, I think the answer is the therapist, it depends. To me, when I express something that I think that therapists typically don't, you know, I tell my clients, I'm proud of them, I tell them, I care that care about them, or I care about what's going on with them, or whatever it is, I do show genuine human connection. I think that with one client, it may be completely documenting it out, not necessarily for the cya purposes, but for reminding myself what I'm doing. And, and and having that as part of the clinical record, because I think it's important. For other clients, if I slip up and say, hey, yeah, you and me both buddy, or Yes, my dear, or have a wonderful weekend, my dear, or something where I slip into a phrase that I might use with friends versus with my clients. And it is a client who may have a response to that that would be not clinically appropriate, or their, their response is clinically appropriate, but it would not be conducive, and it would need to have a conversation about it. I may document, you know, used informal language of care, we'll address it the next session, you know, to close out the session, I will address that at the next session and talk about the conversation of like, Hey, I was pretty casual at the end, I feel connected to you. But I wanted to make sure that we talk about our relationship. Like I think if there's a clinical reason, that or a personality reason why the client may take in something in a way that it was not intended or feel that it may be harmful. Yeah, I'm gonna document what I said and how I addressed it. And so I think it's, it's something where, depending on your relationship with the client, that context and what context may be needed, should a complaint or a concern or a clinical conversation comes down the pipe, and you need to remember kind of what was going on there? I think, yeah, I would document that for myself.   Curt Widhalm  18:06 As many of our listeners know, I sit on the California Association of Marriage and Family Therapists ethics committee, and not speaking for them, but a discussion that has come up at one of our meetings with one of the staff attorneys who also is on the ethics committee, talking about the way that opposing counsels would approach therapists and depositions specifically around their notes. And hearing you say, you know, use informal language of affection. I'm thinking of the way that that could be interpreted by somebody who's looking at your notes, who's not involved, and the kinds of questions that would come up. But what do you mean, why, why didn't you write with that exact language is? That, you know, this could be anything. My client remembered this as being something completely different than what you're saying now, that may lends towards needing to go even a step further than what you're talking about here.   Katie Vernoy  19:10 Sure. And I think that's part of the 'it depends,' I think, if it's a client that potentially is going to have that as a complaint, yeah, I'd write the exact phrase.   Curt Widhalm  19:19 How do you make a decision that about which clients are likely to make complaints versus those that are not?   Katie Vernoy  19:25 I think that's a good point. I think there are times when it comes from past history of whether it's kind of being litigious or other things. I think, for me, it's more my feeling in the moment, you know, and so this is more intuitive or instinctive. Do I need to be more descriptive in my notes or not, is a client that I, I think, may want to see their notes may or may have other things that they're doing with these notes, or if they would be potentially more confrontational or litigious, but you're right, I don't I don't think that there's a great way to make that assessment and maybe the the informal words have affection is not a good phrase to use. To me, I think it's something where if there is a concern that comes up in session that you feel like you want to document, you have to decide do you document it with euphemisms, clinical language? Or do you quote yourself? I don't know. I think there's, there's arguments both ways.   Curt Widhalm  20:21 Yeah, as you're talking, I'm thinking about the number of times that we may start down a path with clients that clients just kind of give indication that it's not the appropriate way of of going. That, you know, we may bring up an idea of, let's say, for, I don't know, working with anxiety or something where, you know, you might ask a question of, like, you know, have you ever, you know, considered doing this and the clients like, No, I'm not going to do that. Do you document every single one of those like, rejections that clients do? And in your notes?   Katie Vernoy  20:59 The 'No, I'm not gonna do this.' I think that's different than I tried it. And I felt like it was harmful. I think that was a bad idea. Why did you tell me to do that? I mean, there's different flavors to it. I think if it's a conversation of like, okay, what kind of coping strategies are you going to use? Or what kind of interventions feel right to you? To me, that's, that can be a higher level documentation. But if somebody says, "Hey, I was thinking about this thing all week, I didn't do it, because I think it's wrong. And this is, this is the thing, the mismatch I'm feeling in this relationship right now." Yeah, I would document that.   Curt Widhalm  21:34 Because I think that there is a way that as you point out, my practice being more with kids, that there's probably a lot more casual ways of bringing things up with kids and relating them, there might be even with some of the adult clients that I work with, you're making me think within this conversation of kind of the being able to describe in documents, why I might do things differently from case to case where a lot of these statutes are written for kind of the here's the standard for everybody. Yeah, I think if statutes had their way it would be everybody must do these things all the time here is very clearly what is okay. And very clearly what is not. Before the episode, Katie and I had looked at the California BBS's statutes and regulations relating to the practices of professional clinical counseling, marriage and family therapy, educational psychology, and clinical social work. This is a 300 page PDF that's available on the BBS website, we'll include a link to that in the show notes as well. Now through the magic of computers, we control F, and put in the words and put in the word notes, out over 300 pages in four different disciplines, notes came up 10 times in this document. Wow. And most of them were about the requirements of education, what needs to be in graduate programs, as far as areas to cover, students need to be taught how to take notes. And most of the remaining other ones where supervisors need to check the notes. So this clinical feedback loop piece of this is something that is left to just kind of the undefined standards of the profession. That seems to be what is being grasped at. And Katie had also made the recommendation of can you control F documentation in the same documents, and we ended up with about 70 hits, and most of them were, these are documents that need to be provided to the board for proof of your hours and this kind of stuff. So getting back to this citation. Yes, I can agree, handwritten illegible notes. Not gonna fly.   Katie Vernoy  24:05 Not gonna fly.   Curt Widhalm  24:07 The guidance in what the state has said as far as what needs to be in the notes. I'm, I'm still kind of wrestling with, did this therapist do something wrong in their documentation? If it comes down to needing to specifically look at what is the threshold of things that need to be documented? As I'm hearing you talk about it in this episode, you're saying it's kind of things outside of the norm, things that if we wouldn't do this with all of our clients, if there's something specific to an individual client, we should probably make note of that. So that way, anybody else who's reading it can understand our process of why this fits with this particular client or situation? Yes. Were you ever taught that?   Katie Vernoy  25:05 Was I ever taught that? I think I was. I don't know that I was taught that as a clinician, when we were looking at this and how I was thinking about an even wrote this in my notes in preparation is when I was working as a child care worker, aka, a residence counselor in a group home, anything that happened that was out of the norm, especially if there was an injury, or some sort of horrible thing that happened to a kid, we did a serious incident report, or an SIR. And so for me, that was always the case that I would write stuff up, if it happened. And the the client, that kid was having some sort of reaction to it, or they got hurt, I would write that up, and just the facts and what happened and how you resolved it. And so for me, when I moved up the ranks in being a clinician, there's always that in the back of my mind that if something goes down, that is different, that is potentially harmful, and/or could be perceived as harmful, because it was a mismatch or whatever. Write that stuff down and make sure that you talk about your rationale, what happened and how the client responded and any repairs. So to me, I don't know that that was specific to clinical training, certainly, as I was working as a supervisor, the clinical loop was present. But there's also all these liability issues. And I think especially working with kids and families that are very chaotic, or there's a lot of factors that are making things very challenging for the family, I would encourage my clinicians to document those things because of how chaotic it was. So their supervisors would know so that the clinicians would remember what happened. I think there's all of those pieces that that made it so I'm potentially a little bit more conservative in my note writing, meaning that I write more than other folks may because I feel like there is a need to understand, remember, and cya.   Curt Widhalm  27:11 From hearing from a lot of our listeners, past students, people who've consulted with me and other just general conversations. I think they your training might be more specific than what a lot of other people working in other agencies, maybe maybe not community mental health agencies, like I will group what you said in and assume that that is a largely kind of standard rule for a lot of community mental health. But for a lot of nonprofit agencies. I don't hear this kind of emphasis, I hear a lot more of the document as minimally as possible that this audience right here, listen to this. This citation is proof that that is bad direction from shows agencies that way, keep Katie is talking about is really covering your ass, not the agency's ass that this is the proof that boards can and do look at your notes. Yeah, they're going to find faults, if notes are not up to standards. And this goes back to your law and ethics professors of if things aren't written down, they did still happen. But now it's open to interpretation. Yeah. And yeah, your justification, days, months, years later is not necessarily going to be protection, because what is written in the note at the time, is what is going to be first and foremost evaluated.   Katie Vernoy  28:50 And I think the the big difference from what you're talking about with other kind of nonprofit agencies and agencies that have Medicaid billing, is I was also taught that my my progress notes the clinical documentation that I put together is a bill. And so there needs to be sufficient intervention to justify the minutes that I'm billing for. So the reverse was actually what I was taught all the way coming up, is your notes need to be longer for longer sessions, and you need to have sufficient documentation to prove that your time was worth what we're billing for it. So the other piece and you brought this up before we begin was this kind of what do we remember? Yes. And I think when I am on top of my game, and I get my notes write down right away, I find that I have some details, some richness, and it does help me to remember from week to week, what's happened when I'm not on my game and I start getting behind on my notes. I struggle with that. And I think that folks who are chronically overwhelmed, and I'm going to include a lot of the folks in community mental health but even practices that are very full Do get behind on their notes. And then how do we do this detail? And you talked about another issue with, potentially when you write the note and what's in it. So let's move to that part because I think that's important too, before we close up.   Curt Widhalm  30:14 Well, and I will forever credit Dr. Melissa McCaffrey Hall for this advice, that the number one reason that most people seem to be behind on their notes is that they don't end sessions on time. And this is phenomenal advice that I pass along to everybody, in that the reason that we do a 50 minute session or a 45 minute session is to leave yourself time to document this stuff correctly. Yeah. And I'm going back to talking about how attorneys might approach you in a deposition, they will ask you, when did you write this note? When? Why didn't you write it earlier? What do you remember the next day about anything? Like, can you remember what you had for lunch yesterday? And who served it to you? And what was the interaction process? And this is all showing proof of just how much your memory can and does have errors to it? And if that's the case, then you having errors in your notes from being written a day or a week or months later? Is very, not good practice. It is inviting liability.   Katie Vernoy  31:35 Yes, I think and I've been on the right, the note right after session and write the note a little bit later. I'm not gonna get myself too much more liability than saying that. But I do think that writing your notes from a state of fear doesn't feel good, either. So going back to the citation to finish up because I know we're getting short on time. I can see why they said what they said I can imagine a situation where it's appropriate. If it becomes statute that every time we use a word that doesn't seem quote unquote, professional, IE see the session from last week. I worry if that's in statute, because I think there are different ways we speak with different clients, there are different things that we do. And so to me, I don't I don't want this to become a statute where we have to do these things. I do worry that this is some overreach. And I also feel like there are some things that we can do to protect ourselves which is sufficiently document what has happened, do it as close to finishing the session as you can and recognize that part of your documentation is your clinical reminder of what's going on, as well as cya if somebody comes looking at those notes later.   Curt Widhalm  32:53 You can check out our show notes at MTSGpodcast.com. Follow our social media and take a moment and drop us a note your thoughts of what we're covering here, stories that you've heard, and anything else that you would like to have us cover and until next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  33:15 Thanks again to our sponsor, Dr. Tequilla Hill.   Curt Widhalm  33:18 Therapists, if you are tired of going in and out of the burnout cycle and you desire to optimize your wellness, Dr. Tequilla Hill has created and curated a wellness guide specifically with deep compassion for the dynamic personhood of the psychotherapist. Subscribe to Dr. Hills offerings at bit.ly/StayWellGuide that's bit.ly/StayWellGuide and you can find many of the inspiring offerings from Dr. Hill 17 years as a practice leader, supervisor, mentor, human systems consultant and wellness enthusiast.   Katie Vernoy  33:56 Once again, subscribed to Dr. Tequilla Hill's how to stay well while you work therapist wellness guide at bit.ly/StayWellGuide.   Curt Widhalm  34:06 Hey everyone Curt and Katie here. If you love our content and would like to bring conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more.   Katie Vernoy  34:29 If you don't think you can make a monthly contribution no worries we also have a buy me a coffee profile for one time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/MTSGpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.   Announcer  34:50 Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter and please don't forget to subscribe so you don't miss any of our episodes.

While Eric has satisfied his rocking sensibilities doing vocal and guitar with the Rock Band Alcatraz shakedown, he worked the circuit for some time performing his own tunes, primarily solo and acoustic. The new phase of his career has him buddied up with three players: Seth Murphy, cello and multi-instrumentalist, and John Ferguson, keys/bass/vocals, and Ben Caldwell, drums/vocals. We're so excited to have these amazing musicians on the stage!

When does somebody officially become a client of therapy? And what happens if, before that distinction is made, crises occur and the therapeutic relationship unravels? Our guest Neith shares her experience navigating this scenario, and Dr. Ben Caldwell explains why little of this is clear cut, but some of it is clearly bad. Plus, we introduce a new segment: Is It Bad Therapy?   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today's episode is sponsored by The Organized Therapist – Social Media for Therapists.   Introduction: 0:00 – 7:16 Part One: 7:16 – 44:14 Part Two: 44:14 – 1:25:45 Part Three: 1:25:45 – 1:27:52   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to Strays Hope for Life Rescue Burbank Public Library SimplePractice Learning Ben Caldwell Labs Psychotherapy Notes Duty to the Patient – When Does it Begin? When Does Therapy Begin? In Case of Emergency: The Professional Will SimplePractice Learning Professional Wills SimplePractice Professional Will Template

What Can Therapists Say About Celebrities? The ethics of public statements Curt and Katie chat about whether therapists should make public statements and diagnose public figures. This is our first continuing education eligible podcast, discussing the ethics of speaking out about the mental health of people in the public eye. We explore the origins of the Goldwater rule, a group of psychiatrists who purposefully broke it, and how masters level organizations address this concern. We also provide you with some ideas about how you can make this decision for yourself. In this podcast episode we look at the ethics of modern therapists diagnosing public figures For our first continuing education worthy podcast, we wanted to address something that is becoming more and more prevalent in our field: therapists speaking out about the mental health of public figures. What is the Goldwater Rule? The history of the Goldwater Rule The impact of DSM II (and the update to DSM III) The original intention of the rule versus the current interpretation of the Goldwater Rule Fears from the American Psychiatric Association that seems to have driven the development of (and on-going commitment to) this rule How the Goldwater Rule (and Similar Ethical Principles) Have Shifted Over Time Perspective from one of the original framers of the Goldwater Rule Moving from teleological to deontological interpretations How the internet and social media has changed the landscape The American Psychiatric Association expanding their commitment to the Goldwater Rule, stating reasons psychiatrists should not assess The Goldwater “Caveat” or “Principle” versus Goldwater “Rule” or even Goldwater “Doctrine” Beyond diagnosis to restricting any comment on the behavior or mental health of a public figure The stance on this ethic from American Psychological Association and the large Masters Level Organizations (AAMFT, ACA, NASW, and CAMFT, for example) The Dangerous Case of Donald Trump – the Public Diagnosis of an American President The group of psychiatrists who pushed back on the Goldwater Rule The Duty to Warn – does it apply here? What are the challenges of accurately diagnosing Trump? Where expertise is helpful (and how the public can water down diagnosis) Current Guidelines for Modern Therapists Whether diagnosis is required for a duty to warn The tactic of putting forward information without drawing conclusions (and why we don't like this strategy) Specific guidance from the professional organizations on what therapists can and cannot do Taking special care in how one decides what they say about an individual in public settings Using one's professional judgement and special care Cautions When Using Your Professional Judgment The potential harm of discussing diagnosis on social media Bias, cultural factors, and other information that could make an inaccurate or harmful diagnosis Mental health stigma and other concerns related to diagnostic language (ICD-10, DSM-V) Speaking outside of your professional expertise Questions to ask yourself before making a public statement 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/ Receive Continuing Education for this Episode of the Modern Therapist's Survival Guide Hey modern therapists, we're so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!  Once you've listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that's all completed - you'll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com. You can find this course here: What Can Therapists Say About Celebrities? The ethics of public statements - a continuing education podcourse Continuing Education Approvals: When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit. Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Fact Magazine The Goldwater Rule (Wikipedia) Debate Article: It is Ethical to Diagnose a Public Figure One has not Personally Examined The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President American Psychiatric Association – statement on Goldwater Rule Dr. Allen Dyer's website Dr. Ben Caldwell, Psychotherapy Notes: Ethically It's Fine to Diagnose Donald Trump For the full references list, please see the course on our learning platform. Relevant Episodes of MTSG Podcast: Therapy with an Audience Therapists Hater and Trolls Therapists Shaming Therapists Off Duty Therapist Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is a member of the California Association of Marriage and Family Therapists ethics committee, an Adjunct Professor at Pepperdine University, lecturer in Counseling Laws and Ethics at California State University Northridge, a former Law & Ethics Subject Matter Expert for the California Board of Behavioral Sciences, and former CFO of CAMFT. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, with a Master's degree in Clinical Psychology from California State University, Fullerton and a Bachelor's Degree in Psychology and Theater from Occidental College in Los Angeles, California. Katie has always loved leadership and began stepping into management positions soon after gaining her license in 2005. Katie's experience spans many leadership and management roles in the mental health field: program coordinator, director, clinical supervisor, hiring manager, recruiter, and former President of the California Association of Marriage and Family Therapists. Now in business for herself, Katie provides therapy, consultation, or business strategy to support leaders, visionaries, and helping professionals in pursuing their mission to help others. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: www.mtsgpodcast.com www.therapyreimagined.com www.moderntherapistcommunity.com Patreon Profile Buy Me A Coffee Profile https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group   Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated): Curt Widhalm 00:00 This episode of the Modern Therapist's Survival Guide is 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  00:49 Hey modern therapists, we're so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you've listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com register for your free profile, purchase this course pass the post test and complete the evaluation. Once that's all completed, you'll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals. Check out moderntherapistcommunity.com   Katie Vernoy  01:22 Once again hop over to moderntherapistcommunity.com for one CE once you've listened. Woo hoo!   Curt Widhalm  01:28 Welcome back modern therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is our first continuing education eligible podcast and we're gonna go a little bit long format today. Today we're going to be exploring an ethical issue around therapists making public statements. And this is becoming what would seemingly be more and more prevalent as more and more of us have access to things like social media outlets. But the underpinnings of a lot of this debate starts back in the 1960s with little story about Arizona Senator Barry Goldwater. Now Barry Goldwater was running for president in the 1964 election. And for those of you American history buffs, you probably know, he did not win. And this, this is partially blamed on the way that the Lyndon Johnson campaign framed Barry Goldwater, in response to Fact Magazine presented a special issue that was titled The unconscious of a conservative  a special issue on the mind of Barry Goldwater. This was in response to a play on the words of Barry Goldwater's book the conscience of a conservative so what fact magazine had done is they had sent out a survey to over 12,000, psychiatrists, of whom about 2400 responded, and this was asking these psychiatrist opinions of the mental health status of Senator Barry Goldwater. The results of the survey range a little bit all over the place. About 27% of the overall people responded, said that Mr. Goldwater was mentally fit, 23% said that they didn't know enough to make a judgement, and a whole lot said things like Mr. Goldwater is a megalomaniac, paranoid, grossly psychotic, and some even offered specific diagnoses, including schizophrenia and narcissistic personality disorder.   Katie Vernoy  03:49 Oh, my goodness, that sounds pretty familiar.   Curt Widhalm  03:54 Yeah, this has come up recently, in...   Katie Vernoy  03:58 Just a little. Just a little bit.   Curt Widhalm  04:01 And part of the point of today's episode is where some of this debate has been in the last several years as far as America, how the rules have gotten to where we are, and what this means for us at this point in time. Now, a lot has been said, and we will get into this a little bit later in the episode about some of the more recent publications and recent debates in the field, including books like The Dangerous Case of Donald Trump by Therapy Reimagined speaker Bandy X. Lee and some of her colleagues. We will be discussing her later, and kind of where our responses are as a profession and some recommendations at the end of the episode. So, getting back to Barry Goldwater,   Katie Vernoy  04:50 Must we? I'm joking, I'm joking.   Curt Widhalm  04:54 So Goldwater ended up suing fact magazine and the publishers for libel based on this and Goldwater ended up winning this. Now, in the cases, Goldwater was issued $1 as compensatory damages and $75,000 in punitory damages to the publisher of that magazine, Ralph Ginsberg. And this was upheld by United States Court of Appeals in the Second Circuit, and the Supreme Court's denied a petition to review it. So, Goldwater ended up prevailing, but at the time, feeling like they have a little egg on their face of all of these psychiatrists making public statements, the American Psychiatric Association said, this is something where this might erode the trust in our professionals, and therefore our profession. We can't have this. We have a sense of urgency that we need to address this, let's take nine years to make a rule.   Katie Vernoy  06:03 Nine years for a very important role. Well at least, we can't say that they didn't think it out, take time to really consider.   Curt Widhalm  06:11 I point out a little bit of the nine years because what happened at the time is, we were under the guidance of the Diagnostic and Statistical Manual of the American Psychiatric Association's Second edition. Now, this was during a building towards the DSM three, which was going to come out several years later in 1980. But for those of us who weren't practicing back in 1964, and answering questionnaires from Fact Magazine, there was a pretty fundamental difference between the DSM two and the DSM three. And that difference was the DSM two was largely based in psychodynamic and psychoanalytic theory, which led to a lot of conjecture and potential bias in evaluating clients. With the DSM three helps move us towards today's DSMs is created more of behavioral checklist observations. And so what many of these psychiatrist were conjecturing about Mr. Goldwater is assumptions about his upbringing, assumptions about the relationships that he was having, and the underpinnings of wherever they're believed psychosis and megalomania, diagnostics and observations about him would be based out of.   Katie Vernoy  07:40 so it really switched from being based in more of a clinician theoretical orientation to what we know more at this point with the DSM 3, 4, 5, 5TR that's coming out that it moves to more of observable and behavioral criteria. Am I hearing that right?   Curt Widhalm  07:59 You are hearing that absolutely correct. And so what the DSM three allowed is, if somebody's not getting out of bed, that's a feature of depression.   Katie Vernoy  08:12 Yes   Curt Widhalm  08:13 Not based in whatever the DSM two criteria were before. Overall, as far as protecting, you know, diagnostics, making inter-rater diagnostics, a little bit more consistent. This is generally seen as a good thing.   Katie Vernoy  08:29 Yeah.   Curt Widhalm  08:31 But some of the debates in the 60s and 70s, and has continued today is in the APA's interpretations of the Goldwater principle - I'm emphasizing principle here at this point  - is that there's some fear that if psychiatrists are making statements about political candidates, that if those candidates win, particularly executive offices within the US federal government, there may be fear that the federal government would reduce the reimbursement rates given to (particularly) psychiatrist for their services, under things like Medicare, and Medicaid.   Katie Vernoy  09:16 So it was -  there was money - money was talking here.   Curt Widhalm  09:19 Well, not necessarily any direct threats that I can find in my research about the setup of this, but there is the potential fear and who knows there may be a president that might punish particular agencies or sectors of the economy, if they are in fact elected. I don't know if that could potentially happen, but that's where the American Psychiatric Association's concerns seem to have been lying.   Katie Vernoy  09:47 And it seems like they may not have been too far off. So what was the original intention of the Goldwater principle then?   Curt Widhalm  09:58 So in some of our Research here and a lot of our conversation here right now so far as some history that is provided by the British Journal of Psychiatry article called "It is ethical to diagnose a public figure one has not personally examined". This is a debate written by John Gartner, Alex Lankford and Eileen O'Brien. Now in this, John Gardner had mentioned some personal communications that he had had with Dr. Allen Dyer, who was the last living member of the original APA ethics committee that drafted the APA Goldwater response in 1974.   Katie Vernoy  10:40 Wow   Curt Widhalm  10:41 This did lead me to looking at some more information that Allen Dyer has written and fortunately, Dr. Dyer has a blog, where he has written about the evolution of the so called Goldwater rule and ethical analysis.   Katie Vernoy  10:58 Can we put that in our show notes?   Curt Widhalm  11:00 We will include links and or references to everything that we can in our show notes. So this is from 2017 from this "Evolution of the so called Goldwater rule and ethical analysis." And from Dr. Dyer, I'm quoting here, "the first thing to appreciate about the so called Goldwater rule is that it is not a rule but rather a principle. The APA's code of ethics is the annotations applicable to psychiatry, of the AMA principle of medical ethics, which explicitly state that the principles are quote, 'not laws, but standards of conduct, which define the essentials of honorable behavior for the physician.' end quote - Much of the current discussion applies rule based legalistic thinking to a matter of professional judgment based on principle. In ethical theory, this would be a category mistake, attempting to transform a teleological end-based approach into a deontological or rule-based approach.   Katie Vernoy  12:07 Okay, ethics nerd, I was trying to follow you there. We've got teleological, and deontological. I think I'm gonna need a little bit of an explanation.   Curt Widhalm  12:18 Okay. So these are two different ways of looking at ethics and keeping this as kind of a shorter conversation because this isn't the point of the episode. But I think it helps to clarify what Dr. Dyer is saying here. Teleological is a type of consequentialist ethics. And what that means is that we need to look at the outcome of an action to determine if it was morally good or not. Whereas a deontological approach would be if there is any chance that an action could cause harm, you should not do that action.   Katie Vernoy  12:59 Okay. So if we're looking at deontological, it would be if something could be harmful, like client's in crisis in your office, need to be hospitalized? Do you drive them to the hospital or not? It sounds like a deontological deontological?   Curt Widhalm  13:18 deontologist,   Katie Vernoy  13:19 A deontologist, which doesn't sound like what it is, if a deontologist would say you should never have a client in your car, you should never drive your client to the hospital, you should never manage your client crisis alone.   Curt Widhalm  13:32 Yes, all of all of those lawyers and all of those insurance agents that would say, you know, oh, you got into an accident with with your client in the car, you are at fault for this. That is a deontological way of thinking.   Katie Vernoy  13:48 Okay, and then the teleological way would be that if you believe that you can be safe, you know this client needs to get to the hospital soon. You know, there's there's no transportation available, and it's going to be hours and hours. And this client is decompensating and needs to get to the hospital, but you have a strong relationship, you feel safe, you put them in your car, you get them over to the hospital, because the end justifies the means?   Curt Widhalm  14:15 Close and I guess maybe the the place of clarifying this is with the correct intent that if you reasonably believe that you could help this client get to the hospital and it was reasonably possible and something were bad to happen along the way - It's kind of more of the Good Samaritan approach that the intentions were correct. The the fallout of it ended up being maybe not ideal, but if there's the potential to cause good and as long as the intentions were good, you can morally judge that as good.   Katie Vernoy  14:53 Okay, but that still is sounding a little bit like the ends justify the means   Curt Widhalm  14:57 You You You are correct here -  In that this is what Dr. Dyer is saying -  this was -  he saying that this was written as a way of saying, use your judgment. Be, you know, predictably well. This, this subcommittee said, this is teleological. This is consequential. Have some professional judgment in doing this.   Katie Vernoy  15:21 Mm hmm.   Curt Widhalm  15:23 And what has happened over the last 40 plus years is it has been interpreted through an entirely different and competing moral viewpoint that everyone seems to be taking as well "just don't do this."   Katie Vernoy  15:38 Yeah. I see the complexity, though. Because if we're looking at maybe not exactly the ends justify the means, but something where we are relying on individual professionals to have a good assessment of their motives, to have a good assessment of what the consequence would be for public diagnosis, for example. Do we feel like we can trust our professionals to make that judgment? That the consequences are sufficiently positive and being able to work in that gray?   Curt Widhalm  16:14 And what Dr. Dyer is saying is that the APA says, No, those individual people can't make that decision.   Katie Vernoy  16:24 So we're looking at people making something very concrete, black and white, that actually has a lot of gray in it, and it's supposed to be professional judgment, not this is good, or this is bad.   Curt Widhalm  16:37 Yes. Now, Dr. Dyer goes on to say the second thing to appreciate is that the Goldwater caveat - called rule and understood by many psychiatrist as an absolute prohibition - is, in fact, embedded in an affirmative obligation of physicians to society, quote, "a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health." I take what Dr. Dyer is saying here, as the intention behind this was that psychiatrists should still be looking at improving the overall communities and public health that they work in, that there's an honor of being a medical professional to serving the greater good of society. And that this Goldwater caveat is that we maybe don't make diagnostics about people without evaluating them. But maybe when we feel that there is a sense of danger to somebody, we can use our professional - and in their case, medical - knowledge to be able to make communications about that.   Katie Vernoy  17:48 I'm not clear that that's what the Goldwater rule is being interpreted as now. Right. I mean, it seems like even saying anything has gotten to be taboo, according to the American Psychiatric Association.   Curt Widhalm  18:03 Oh, wait, there's more.   Katie Vernoy  18:05 Okay, okay. Keep going, keep going.   Curt Widhalm  18:09 Now, we also need to consider what the landscape of 1960s and 1970s world is as far as available information. I grew up in a part of the country at a point in my life, where, with an antenna and good weather, we could get maybe four television stations, the internet did not yet exist. Cell phones were a thing that was only imagined on the Jetsons that   Katie Vernoy  18:40 You and me both buddy, you and me both.   Curt Widhalm  18:43 This was several years after Mr. Goldwater was running for president. So the availability of information back at that time is much different than the landscape that we have today.   Katie Vernoy  18:54 Sure   Curt Widhalm  18:55 You know, I in my pocket normally carry a device that has more computing power than the first spaceships that went to the moon. Now, what I choose to do with it is make memes and send videos of cats to my wife. But I could also go and pull up videos of just about any public figure in a variety of different contexts that would allow for me as a mental health professional to at least say, yeah, what you're doing kind of looks "sus" as the kids who are using the language these days   Katie Vernoy  19:33 It's like "kind of looks what?" - suspect is that what you're saying is like for the old people in the audience, it's suspect that their your, your behavior looks suspect. All right?   Curt Widhalm  19:44 Yes. Now, in the intervening years, this is back to Dr. Dyer's blog, points out that the 2013 version of the principles and annotations preserves the original language of the 1973 version. But the 2015 APA commentary on ethics and practice takes a more administrative and specific tone. It preserves the affirmative ethical principle, better... of improving the community and betterment of public health through education and evidence based science. But says rather than offering opinions about a specific person, as the best means of facilitating public education, in some circumstances, such as academic scholarships, about figures of historical importance, exploration of psychiatric issues, for example, diagnostic conclusions. May be reasonably provided that it has sufficient evidence-base and is subject to peer review and academic scrutiny. It just means that you don't just go out as an individual and say, Here's my opinion. It needs to have a little bit of consensus here. But what the APA ethics committee did, instead, is started to reflect language that psychiatrists should not make any public statements about anybody no matter what. And this was really the beginnings of where the dangerous case of Donald Trump's how authored by Bandy X. Lee and colleagues ended up being a really big part of the debate here over the last now six years. And what the APA was seemingly trying to do is take the voice out of people saying, "hey, trust me, I'm a doctor. I know what I'm saying." And there were several questions and published across, you know, a number of different op eds, some that appeared in places like the New York Times that led to many of the professional organizations coming down more strictly on the emergence of the Goldwater rule. And this is where in March 2017, the American Psychiatric Association released a statement saying the APA remains committed to supporting the Goldwater rule.   Katie Vernoy  22:13 Ah   Curt Widhalm  22:14 And they gave three main points for the rationale of their opinion. Number one, when a psychiatrist comments about the behavior, symptoms, diagnosis, etc, of a public figure without consent, that psychiatrist has violated the principle that psychiatric evaluations be conducted with consent or authorization.   Katie Vernoy  22:35 So we're looking at consent as number one,   Curt Widhalm  22:38 Yes.   Katie Vernoy  22:38 Okay.   Curt Widhalm  22:40 Number two, offering a professional opinion on an individual that a psychiatrist has not examined, is a departure from established methods of examination, which require careful study of medical history, and firsthand examination of the patient. Such behavior compromises both the integrity of the psychiatrist and the profession.   Katie Vernoy  23:03 So that one sounds the most similar to the original intent, which is don't diagnose someone that you've not evaluated.   Curt Widhalm  23:10 Right,   Katie Vernoy  23:10 Right. Okay. And this is saying, don't do that, because it makes us look bad.   Curt Widhalm  23:18 Pretty much,   Katie Vernoy  23:19 Okay.   Curt Widhalm  23:20 And third, when psychiatrists offer medical opinions about an individual they have not examined, they have the potential to stigmatize those with mental illness.   Katie Vernoy  23:29 So we got there's no consent, it makes us look bad, and increases stigma.   Curt Widhalm  23:36 Yes.   Katie Vernoy  23:37 Okay.   Curt Widhalm  23:39 Now, turning this as maybe a question to you. You and I have both listened to a little bit of the news here in the last several years. What have you heard Donald Trump being diagnosed with?   Katie Vernoy  23:56 Malignant narcissism is one. He probably could be diagnosed with ADHD could potentially be diagnosed with psychopathy. I mean, like there's a lot of  - sociopathy, like there's - which I guess is malignant narcissism, but I've heard a lot of different suggestions about what's possible.   Curt Widhalm  24:17 And I've heard some people even suggesting things like dementia on top of that, just to be clear, these are things that Katie and I have heard, we're not actually   Katie Vernoy  24:28 We're not saying they're true. We're not diagnosing in public people!   Curt Widhalm  24:34 One of the op eds in the New York Times pointed out that in order for things like narcissism to be diagnosed, if you look in the DSM and particularly where we are today, the DSM five, that one of the features for diagnostics is that it has to be disturbing to the patient's themselves.   Katie Vernoy  24:58 Hmm.   Curt Widhalm  24:59 And therefore is actually an inaccurate use of a diagnostic, let alone the means to actually arrive there. Now, as I was mentioning earlier, there are lots of ways to get indirect observations of people these days. And maybe this calls into question the diagnosis or the diagnostic criteria of personality disorders where, hey, if one of the features of a personality disorder is that they're not bothered by the fact that they have that particular personality disorder, maybe that needs to be looked at in future DSMs. Maybe we'll talk to somebody someday about that. But in response to the APA reaffirming this   Katie Vernoy  25:47 for the American Psychiatric Association   Curt Widhalm  25:49 The American Psychiatric Association, in response to a op ed, published on New York times.com on March 7 2016, called "Should therapist analyze presidential candidates" on March 14 2016, the then president of the American Psychological Association - so taking this out of the medical realm and potentially a little bit more specific to providers of more traditional therapy - president of the American Psychological Association at the time, Dr. Susan H. McDaniel, wrote response to the article on whether therapists should analyze presidential candidates. And I'll read this in its entirety because it's about three paragraphs. "The American Psychological Association wholeheartedly agrees with Robert Klitzman PhD that neither psychiatrist nor psychologist should offer diagnoses of candidates, or any other living public figure they have never examined. Our association has declined requests from several reporters seeking referrals to psychologists who would make such speculations. Similar to the psychiatrist Goldwater rule, our Code of Ethics exhort psychologists to take precautions that any statements they make to the media are based on their professional knowledge, training or experience in accord with appropriate psychological literature and practice. And do not indicate that a professional relationship has been established with people in the public eye, including political candidates. When providing opinions of psychological characteristics, psychologists must conduct an examination adequate to support statements or conclusions. In other words, our ethical codes state that psychologists should not offer a diagnosis in the media of a living public figure they have not examined."   Katie Vernoy  27:40 So just diagnosis, it sounds like it also is going further into things that might be within the realm of psychology and not diagnosis. It was saying nothing could be in your professional opinion, unless you've done a an evaluation. And then there would be confidentiality issues. So the question that I have is - it just don't talk about public figures at all?   Curt Widhalm  28:06 That seems to be where both of the APAs are going with this language. Now, according to the Wikipedia article on the Goldwater rule, it is a citation needed statement on there. As you know, we're citing our references here. And I wasn't able to substantiate this claim that Dr. McDaniel received a lot of pushback from members of the American Psychological Association about her stance and interpretation of the American Psychological Association direction and intention with this, that apparently, many members of the American Psychological Association felt that this was too specific and restrictive. And that as long as they were framing it within the characteristics of hey, I haven't evaluated this guy, but based on these statements, and these misapplication of following through on his own things, yeah, this one presidential candidate seems to have this diagnosis. But of course, they were eventually talking about the opportunity to say this about Kanye West. Now, I recognize that most of our audience are probably not psychiatrists, and most of our audience are probably not psychologists. And so I want to create kind of some space as far as where do our other professional mental health associations take stances on these kinds of things. And that would be the American Counseling Association, the American Association for Marriage and Family Therapists, National Association for Social Workers. And Katie and my participation with the California Association of Marriage and Family Therapists,  while a state Organization, they have 30 plus 1000 members, we generally give them a say in national discussions as well. But before we jump to more of these masters levels organizations, Katie, what are you feeling as far as - can we be talking about people publicly?   Katie Vernoy  30:16 So what I'm hearing is that you can, it's pretty clear that you should not diagnose publicly, I think the the folks who wrote The Dangerous Case of Donald Trump would disagree. But most of the time, so far, what you've talked about APA and APA, are saying don't diagnose. It seems like there's an ongoing discussion around whether we can give opinion on behavior. How are the psychiatrists and other folks about how are we analyzing that piece about... Can we talk about people in public?   Curt Widhalm  30:52 So this is going back to that British Journal of Psychiatry. And back to the point made by John Gartner. He says that you don't have to diagnose to warn, in some cases, people may use public figures as a way of educating the public about diagnostic criteria, such as narcissistic personality disorder, for example, and let readers draw their own conclusions: 'Hey, I haven't evaluated this particular candidate. These kinds of behaviors are generally consistent with narcissistic personality disorder. Once again, I haven't evaluated this person, they're not a patient of mine. Make your own conclusions.' I don't necessarily like that as a full, you know, greenlight to go ahead and do this. I think that, as you pointed out at the beginning of the episode, that there's a lot of nuance to this conversation. And as professionals, we have to foresee some of the responsibility of saying, 'I'm not gonna draw the conclusions for you, but I'm drawing the conclusions for you,' is not really good discussion of public health. But what Gartner's argument is, is that in the bottom line is many people may feel the duty to warn, and a duty to warn does not require a multi axial diagnosis. And he uses the example of someone who's bringing a gun to your house, you only need to know that somebody is bringing a gun into your house.   Katie Vernoy  32:29 Yeah,   Curt Widhalm  32:29 A diagnosis is not needed.   Katie Vernoy  32:31 When the question that I heard posed with it, or I read posed within that debate article, is that - Do we need opinions from psychological experts or psychiatric experts at all? Can we just not view it as a public as a general public? Can we not just view behavior and make our own assumptions and psychiatrists or therapists providing that expert opinion does more harm than good and isn't required?   Curt Widhalm  33:05 It's a topic worth diving into, you know, part of where seeing the public really destigmatize mental health in a lot of ways - and we've seen this reflected in our practices and the need for mental health services over the last several years - is the public is a lot more open to talking about the challenges they face. But a lot of people misdiagnose without the robust background of training of how to properly assess people. And, you know, how many people are you going to see on social media that's, you know, complained about, oh, I'm O... I'm so OCD, I need to straighten out the books on my shelf. That's not really a diagnostic of obsessive compulsive disorder and tends to diminish what actual obsessive compulsive disorder is for those who properly have that condition. It's something where leaving this discussion out into the public really allows for things to be watered down in such a way that some of these diagnostics tend to lose all meaning. So to answer your question, I think that it's healthy to have professionals with a background to be able to offer this opinion, it's a matter of how it's done that is potentially there. But so far with the information that we're seeing from the American Psychiatric Association and the American Psychological Association, is that any professional opinion about any public figure seems to be forbidden.   Katie Vernoy  34:41 So we're stuck with the experts being silenced. But then the guidance around how to actually provide expert opinions to the public seems to be a little bit limiting, at least from the two APAs.   Curt Widhalm  34:56 Yes.   Katie Vernoy  34:56 What are the master's level folks saying?   Curt Widhalm  34:59 That is an excellent question and I'm glad that you're bringing it up. Looking at the four codes of the masters level organizations. This was summarized pretty well in September of 2016 on psychotherapynotes.com by Dr. Ben Caldwell. And I'll expand on some of this because some of these things have been updated even since this blog post. But starting with the American Association for Marriage and Family Therapy standard 3.11 simply requires that therapists exercise special care when making public their professional recommendations and opinions. There's no prohibition against diagnosing public figures according to AAMFT. Okay, the American Counseling Association as far as within their ethical code Standard C6C, says that counselors speaking with the media base their statements on appropriate counseling literature and practice to ensure that their statements are otherwise consistent with the ACA code of ethics, and to be clear about the nature of their relationship with those receiving the information. National Association of Social Workers - well, they talk about dishonesty and multiple standards. They also require social workers to protect client confidentiality when dealing with the media that standard 1.7K But they don't have any parallels to the Goldwater rule.   Katie Vernoy  36:38 Social workers really have no guidance at all, not very much anyway.   Curt Widhalm  36:43 CAMFT - This has been updated since Dr. Caldwell's blog here, but the CAMFT code of ethics 5.13 Public Statements, marriage and family therapist because of their ability to influence and alter the lives of others exercise caution when making public their professional recommendations, or their professional opinions, through testimony, social media and internet content, or other public statements. CAMFT also goes on to say 5.14 Limits of Professional Opinions, marriage and family therapists do not express professional opinions about an individual's psychological condition, unless they have treated or conducted an examination and assessment of the individual. Or unless they reveal the limits of the information upon which their professional opinions are based, with appropriate cautions as to the effects of such limited information upon their opinions. Now, how do you take this from the 4 master's level organizations?   Katie Vernoy  37:45 I mean, it's a little confusing to me. I think there's certainly caution that we need to take and not do this lightly, not pop off on our podcast, make sure that we're not just giving diagnosis willy nilly that we actually are cautious. Use our training, understand our training. And then also I hear- I think primarily from CAMFT but maybe from somebody other ones - that we need to make sure we put forward the limits that of information that we have, so I've not assessed this person or this is something I've not seen, but my statement is being based on this body of knowledge and this this information that I've been given. So it's a little more guidance, but it still is something where, you know, the rules... Ot just I mean, some of it feels like best judgment, which is a little bit more aligned to the the Goldwater principle. But it's it's still hard to know what's going to be in the best interest of society, of the our professions, of the individuals that are in the spot, the public, public eye that potentially are getting some of this stuff going on. Like it just feels really complex to make a decision around diagnosis or public statements.   Curt Widhalm  39:07 So in April of 2018, the American Counseling Association published an ethics update by Perry C Francis. Credited in counseling today, Perry Francis is a professor of counseling at Eastern Michigan University, and coordinator of the counseling and training clinic and the College of Education clinical suite, member of the American College Counseling Association, and he chaired the ethics revision task force that developed the 2014 ACA code of ethics. And summarizing many parts of the article, he also points to E5 of the ACA code of ethics which says, counselors take special care to provide proper diagnosis mental disorders, and dives into the discussion of what exactly is special care. And, in the description talks about that there's a list of behaviors and characteristics that make up not the entirety of a whole person. The DSM has been accused of being ethnocentric. And it's difficult to apply this to other cultures and contexts. Meanwhile, stakeholders like pharmaceutical companies welcome a growing list of diagnosable disorders and overall cautions that professionals who make real world statements might fail to take into account just the ramifications of what these statements might be saying, not only just to the public, but also to other businesses that work in mental health care. Therefore, as counselors according to Perry Francis, we need to take special care to ensure that any diagnosis is made using the most appropriate assessment techniques, including a well planned clinical interview and the most relevant instruments and tests. Part of taking that special care is taking into account the impact of culture on a client's life, including the fact that a client can live in multiple cultures. Perry Francis concludes this article by saying that the American Counseling Association has released a statement concerning publicly diagnosing the mental state of an individual. And it states in part, when publicly discussing public figures and others, professional counselors should avoid DSM and ICD related terms, especially the words diagnosis and disorder. Counselors should not attach a specific DSM or ICD diagnosis to any individual through messaging or statements in media outlets, or social media. Avoiding public statements that label an individual with a mental disorder is in the best interests of the public. This approach aligns with one of the counseling professions core professional values, as stated in the preamble of the ACA code of ethics, practicing in a competent and ethical manner.   Katie Vernoy  42:14 So that seems pretty clear to diagnosis.   Curt Widhalm  42:17 Yes,   Katie Vernoy  42:17 Right I mean, it's not about behavior. It's not saying this behavior as harmful like that's I mean, APA, both of the APAs seem to say like, Hey, whoa, whoa, whoa, like anything you say about a person, a public figure is too much, whereas the at least ACA is now saying, as long as it's not a diagnosis, you're good.   Curt Widhalm  42:38 That seems that seems to be where the stance is here.   Katie Vernoy  42:42 Okay. So that's what the professional associations are saying. I mean, I don't... like I feel like we still need to talk about how someone would make these decisions.   Curt Widhalm  42:55 Well, let's take this out of the research and the publications here so far. Let's talk about, you know, what our observations of the landscape of our field is. You and I both know, hundreds, if not 1000s, of therapists at this point, many of whom were connected to on social media. We have lots of friends who are professionals who talk on podcasts and are connected in the media, some who are on TV shows, providing therapy.   Katie Vernoy  43:29 Yes,   Curt Widhalm  43:30 We see lots of people in these spaces talking about lots of things.   Katie Vernoy  43:34 Yeah.   Curt Widhalm  43:34 What do you see?   Katie Vernoy  43:37 I mean, I see folks who are very open and talking about their own concerns. And so they're able to put forward their own mental health journey as an example. I see people talking about treatment between, you know, kind of how people treat each other and, and those types of things. I mean, I think the the treating someone on a TV show that feels like that's a, a demonstration of therapy with, hopefully, appropriate consents. And I don't I mean, besides our foray into having Bandy on the podcast, I've not seen someone, at least directly diagnose someone in public, I've seen people express concern about public figures or about the impact of public figures, but it feels a little bit more behavioral. And so kind of along the, this the second line, which is, you know, these behaviors are of concern, and this is why. But I don't know that I've seen a lot of the folks we know, kind of saying, like this person is a malignant narcissist. Like I don't necessarily see that -  although now that I just said it out loud. I think I probably have seen that as well. How about you? What are you seeing?   Curt Widhalm  44:48 Oh, I know a lot of our listeners are, you know, maybe have the same political ideologies as you and I. Maybe they're not. Maybe they make assumptions that they are. But what I do see is that especially as there becomes more advocacy within communities around a diagnosis - people coming from, for example, ADHD community, doing more to educate people about the things that go along with having ADHD that maybe extra, outside of the things listed within the DSM. Might see this same thing with any number of other diagnostic communities that come together. And what I see is also the inverse of some of these statements. And I particularly remember a time and seeing some discussions around Elon Musk making the claim that he was the first person with Asperger's to host Saturday Night Live. This is   Katie Vernoy  45:59 Yes,   Curt Widhalm  46:00 It's been some time in the past.   Katie Vernoy  46:01 Yeah.   Curt Widhalm  46:02 And many people have some opinions about this statement. And a lot of the commentary that I saw was professionals who also self identified - and I don't know, their diagnostic criteria -  of being part of the Autistic community ended up feeling that either or making statements on their own social media that, hey, Elon Musk isn't one of us. Doesn't belong on the spectrum. Now, these are professionals, I don't, you know, remember, and I don't I'm not pulling them up here. But I think it's just as important to caution saying the absence of a diagnosis without evaluating somebody is potentially just as damaging or dangerous as it is that saying somebody is at a certain diagnosis.   Katie Vernoy  46:56 Now that you say that, I think there's also been an impulse, maybe impulse is the wrong word, but there's been some of the you're not, you know, you aren't representative of us, like you talked about whether it's Elon Musk, or an original poster. And then there's also in comments, well, you definitely have this diagnosis, you definitely seem depressed, or you definitely seem X. Like people offering more diagnostic, you know, beyond the like, you should talk to your therapist about this, more of a diagnostic, what you're describing in this 50, you know, 50 word post suggest to me that you must be X diagnosis. And so to me, I think we are a little fast and loose in the more casual public spaces, like social media groups, and those types of things. But I think there is an element of the inverse diagnosis that's interesting. Because I hadn't thought about it that way. Like certainly saying, hey, this person has this diagnosis, that seems pretty clear. But saying this person with a self who self identified doesn't have a diagnosis, how is that harmful but how do you say, what did you think? Why do you think that's harmful?   Curt Widhalm  48:12 We haven't presented somebody with a proper assessment ourselves to publicly comment on what their diagnosis is. If  - We may not know their medical or psychological history it may be and not framing it, within the context of where you're basing that opinion is where these ethics codes are saying that that is unethical behavior. That you may only be making a snap judgment based on, you know, a few clips of a sketch comedy show. You may be incredibly biased based on the types of news outlets that you receive your information from. And particularly, you know, somebody like Elon Musk that doesn't have quite the number of televised appearances that somebody like Donald Trump might, that the limited amount of available information that you have ends up becoming where if they truly do have this diagnosis, you as a professional are making a statement that invalidates their experience. And one of the main principles of all of our codes of ethics is a stance of nonmaleficence not creating harm.   Katie Vernoy  49:33 Yeah. It's interesting because I think it's it's harder, I think, for some of our audience to be like, well, poor Donald Trump, poor Elon Musk, poor billionaires. Right. And I think, in truth, we actually need to pay attention to that because to me, they're, you know, although some people might disagree with me, they're humans too. And they, they could be harmed by the statements that are made. For most of us, I think maybe I'm putting myself too much in that. I think it's easier to, to look at this as a problem, when it's someone who is more traditionally oppressed. You know, if someone who legitimately, whether they claim it or not, has a mental health diagnosis, it doesn't prove them unfit for, for being in a public position, whether it's, you know, a government official or whatever. Like, if we, if we start making the case that they are problematic. Not only are we potentially breaking the Goldwater rule, but we're also potentially increasing stigma, as as the APA said, but we're also potentially harming the ability to have a more diverse representative pool in our legislation. We may be oppressing folks, because we've made this our job to try to protect society from folks who are mentally ill. And that feels really bad. I think the arguments against doing this in a more directed way to public figures. That's where it sits with me as appropriate. Like I, I was celebrating the The Dangerous Case of Donald Trump and I and I don't know that I would say like, Hey, that was a bad idea. But I think the precedent concerns me if we then use these types of stratagems to try to get folks either not elected or out of office.   Curt Widhalm  51:37 And bringing this back to earlier in the episode, the dangerous case of Donald Trump's pretty significant portion of that book is the arguments of the needing to step outside of the code of ethics as far as a duty to warn, that does not necessarily focus on the diagnostic criteria, but more so on behaviors that interpersonally end up feeling dangerous to people who have spent their career studying dangerous behaviors.   Katie Vernoy  52:11 Sure, and listening to Bandy speak in our conference, like she was talking about the the problem of violence. And there were specific, very public displays of incitement to violence or violence by Donald Trump that I think was potentially where she based her concern about and her duty to warn.   Curt Widhalm  52:32 And it also comes from a decade's long history of that being her particular area of study and specialty.   Katie Vernoy  52:40 Yeah.   Curt Widhalm  52:41 Which is quite a bit different in a number of ways of picking a celebrity and a random page in the DSM and going through some sort of BuzzFeed type evaluation and throwing your opinion out on the internet.   Katie Vernoy  52:59 Which is kind of what the original Goldwater thing was right? It was a magazine reaching out to a whole bunch of psychiatrists who were like, "Yeah, I think he's nuts.   Curt Widhalm  53:11 Pretty much   Katie Vernoy  53:12 It was, I mean, granted, it was a pool of folks. But it sounds like you described it as all over the place. And it wasn't something where they even necessarily individually, were thinking, oh, this is going to be public record. It was more like, oh, in the aggregate, this is kind of fun. I'm anonymously, putting forward my opinion about a candidate I don't like.   Curt Widhalm  53:34 And so this does bring to the overall discussion that making public statements as viewed by any of these professional organizations, does include even your own personal social media.   Katie Vernoy  53:48 Yeah.   Curt Widhalm  53:49 And there needs to be the caution. And this is really the emphatic point here. There needs to be the caution of how you're framing these statements. One of my Facebook memories said recently, was about the day that Donald Trump was inaugurated as the 45th President of the United States. And for listeners of the podcast, I think I've described before I was in a pretty serious bike accident about 10 years ago. And one of my social media posts from Inauguration Day was of the presidential limo driving down the streets of Washington, DC, solely in the bike lane. And my response, I mean, they had all the streets closed down his parade, it was not great. But yeah, my statement was, as a survivor of a pretty traumatic bike accidents, this administration is not off to a good start. Now, you obviously get the humor of this, you know, maybe even you know if you were to read too much into my statements - oh is is that trauma speaking is that, you know, that, and I'm talking about my own, you know, experiences and potential mental health here, but you got the humor out of it knowing me?   Katie Vernoy  55:13 Sure. Yes, I do.   Curt Widhalm  55:15 But it was not about Donald Trump, it was about the administration.   Katie Vernoy  55:19 Yeah.   Curt Widhalm  55:20 And there is a crafting that we need to consider in making any of these kinds of statements, we're all going to have opinions about many different people. And that is fine. Your responsibility as a professional is to know that every statement that you make, that goes outside of the very privacy of your own home, which does include things that you put on the internet, can be taken as fact, as a professional who's speaking. And that opens you up to ethical and legal liabilities.   Katie Vernoy  55:57 I think that's really strong. And I think I'd like to get even a little bit more specific on some ideas around this, because to me, there's an element of public figures that we've not talked about yet that I think is important to consider. I know -  and I'm sure you've had this happen too -  that I will meet someone for the first time. And they say, I feel like I know you, I listened to the podcast. And we are small potatoes compared to a President of the United States. I think there's an element to us feeling like we know public figures based on how they present to the public, and the things that they do. And I think the more time you spend in public, the more of your real self shows up, I think we discount that some people play a role, arguably people will have, the more time they spend in public, the more likely they are to show their real self. But there is a version of this where Trump's acting all the time, and it is playing a role in order to get what he wants. And does that suggest, narcissism maybe. But if it's all pretend, can we really diagnose him? You know, and I think with the the limitations of the knowledge that we have, I think we have to be very cautious about what we say. We don't know someone based on a small snippet of social media, or even sometimes, our long videos of their behavior. I think we do need to be cautious of saying, Well, we have enough information, we can make this diagnosis. We have a whole episode or several episodes on people making assumptions on the internet. So we can link to some of those in the show notes as well. And so to me, I think it comes back to what information do I actually have. Making sure I discussed the limits of the information. And then I think the third thing that is really important is what is my intent. And this is, you know - for all the DBT Folks, this is getting into wise mind - and I think for those of us who are advocates, it's determining is this strategic? Is this about trying to win an election? Like it was with the Goldwater stuff? Is it about a duty to warn, because society is going down rapidly and we need to call this out and, and name it, or anything else? Like what is the actual intention? Am I angry? Am I scared? How is that impacting my judgment? I think it's something where if we just speak from a place of seat-of-my-pants, this is what I'm seeing and it's scary. And it's awful, because this person is politically different from me, I think we get very, very in a very, very dangerous territory as a society.   Curt Widhalm  58:52 To conclude all of this - I think you're summarizing it very, very well - is that for many of our professional organizations that we may belong to, at the masters level, there is not a ethical code that necessarily forbids this.   Katie Vernoy  59:11 Yeah   Curt Widhalm  59:12 You need to really be cautious about framing the information upon how you're basing your opinions. And in general, I would stop well short of, you know, leaving the trail of breadcrumbs up to a diagnosis, if you do have personal and professional concerns about somebody who may be out there and expressing this, whether you put it on your social media, or what you think is your personal social media. Most professional organizations are still going to look at that as a professional statement. That you very carefully framed the context of where you're discussing these things from.   Katie Vernoy  59:54 Yeah   Curt Widhalm  59:54 And I think that in several of these articles that we've been citing here - and we willl put the references in our show notes at mtsgpodcast.com - that what has changed since 2016, when this debate really started and why we feel that it's still a relevant discussion today, is that some of these professional organizations have clamped down even harder in the last few years.   Katie Vernoy  1:00:24 Yeah.   Curt Widhalm  1:00:24 And some of the information that's available out there or pops up to the top of your search engines is not necessarily the most up-to-date information. It's important to understand the historical context that where professional organizations are today is not where they started back when the Goldwater principle was first suggested. Some of these articles now we're calling it the Goldwater doctrine, without necessarily putting it into any sort of ethical rigor to move things from a guiding principle to a absolute gag rule. So our recommendation is, for most of you it's not forbidden to make public commentary. But really, really make sure that you frame any sort of statements or exaspirations or social media posts in ways that really frame how you are coming to your conclusion and what your relationship (or lack there of) is to the person that you're talking about. We would love to hear your thoughts on this. You can let us know on our social media or in our Facebook group, the modern therapist group, you can find our Show Notes and references at mtsgpodcast.com. And stay tuned for more information on how to get continuing education for listening to this podcast. Until next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  1:02:02 Just a quick reminder, if you'd like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com purchase this course and pass the post test. A CE certificate will appear in your profile once you've successfully completed the steps.   Curt Widhalm  1:02:17 Once again, that's modern therapist community.com   Katie Vernoy  1:02:21 Thanks again to our sponsor Buying Time   Curt Widhalm  1:02:24 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  1:02:53 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.   Curt Widhalm  1:03:08 Hey everyone, Curt and Katie here. If you love this longer form content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more.   Katie Vernoy  1:03:33 If you don't think you can make a monthly contribution no worries we also have a Buy Me a Coffee profile for one time donations. Support us at whatever level that you can today it really helps us out. You can find us at patreon.com/MTSGpodcast or buy me a coffee.com/modern therapist. Thanks everyone.   Announcer  1:03:54 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.

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.

Grant Garmezy: Elevating Sculpted Glass to Narrative Work With a passion for hot sculpting animals in glass, Grant Garmezy perfected his ability to capture not only form, but expression and movement, elevating each piece from just sculpture into a narrative work of art. From his Dragon Ranch in Richmond, Virginia, the artist continues to draw inspiration from the environment of the American South. Says Garmezy: “Nature is truly perfect in its creation—impossible to reproduce. I do not strive to recreate the natural world exactly; instead, I try to capture the essence of the animal I am sculpting, not only in its physical features, but also its attitude and spirit.” Garmezy's work is created through the process of off-hand sculpting, meaning he sculpts the glass freehand while it is heated to about 2,000 degrees. Using an extremely hot torch and a variety of hand tools, the glass is manipulated without the use of molds. For that reason, each and every piece is truly unique. The artist works with at least one assistant, but most of the work requires the help of an entire team of skilled artists. Born on a farm outside Nashville, Tennessee, Garmezy began his artistic career as an apprentice to metal and jewelry fabricator, Ben Caldwell. In 2003, he traveled to Richmond, Virginia, to pursue a Bachelor's Degree in Fine Arts at Virginia Commonwealth University (VCU). While in the Craft/Material Studies program, he studied under Jack Wax, a furnace worker, and flameworker, Emilio Santini. Garmezy received the 10 Under 10 award from his alma mater, honoring 10 noteworthy and distinctive alumni of VCU who graduated in the past decade.   In 2008, Garmezy was awarded the International North Lands Creative Glass Residency in Scotland. While there, he was presented with the Benno Schotz Award through The Royal Scottish Academy for most promising young sculptor in the UK. In 2010, the artist served as teaching assistant for Karen Willenbrink and Jasen Johnsen at Pilchuck Glass School and the following year was awarded a position as an assistant at the new Chrysler Museum of Art Perry Glass Studio. During his time in Norfolk, he helped to break in the new studio and had a hand in shaping it into what it is today.  In July 2013, Garmezy was invited back to Norfolk as the featured artist for a Third Thursday performance at the Perry Glass Studio. At the conclusion of the evening, Grant surprised now wife Erin—and the entire audience—by taking a knee and proposing marriage to her. The special moment was very fitting to their relationship and is fondly remembered by all who were there to witness it. The husband-and-wife team returned to the Perry Glass Studio in September 2020 for the Visiting Artist Series, where they focused on a new series of works featuring reptiles and snakes coupled with sculpted flowers.  The pastoral environment of Garmezy's youth— specifically interactions with livestock, wildlife, and natural settings—manifests in collaborative sculptures with Erin, which are typically pairings of flora and fauna. Erin moved from blowing glass vessels at the furnace to sculpting glass plant life on a torch when she studied with VCU professor Santini, and later Robert Mickelsen and David Willis.  Having traveled as far as the Northlands of Scotland, and Seoul, South Korea, to demonstrate his craft, Garmezy has studied with Scott Darlington, Ross Richmond, Martin Janecky, Raven Skyriver, Marc Petrovic, Karen Willenbrink-Johnsen and Jasen Johnsen. He has been invited to exhibit his work all over the world, including Seoul, Edinburgh, Prague, Paris, and Istanbul. Upcoming 2022 workshops will take place at the Toledo Museum of Art, May 9 – 13 https://www.toledomuseum.org/master-class and at the Glass Furnace in Istanbul, May 30 – June 9 https://www.glassfurnace.org/intensives-workshops-2/ In 2020, Garmezy embarked on the most ambitious project of his career – hot sculpting 200 glass dragons for Kugler color company in Germany. Kugler hand-crafts a wide range of colored glass based on recipes passed on for generations. Garmezy and Kugler worked together with Hot Glass Color Supply to design a new color reference chart. A glass color chart is a reference that shows examples of what each glass color looks like. It is a resource for glass artists to help them choose the correct colors for their projects. As a sculptor, Garmezy always wished for a resource that showed more than one way the color can be used. The goal was to create a chart that demonstrated the bar color encased and blown, as well as powder color applied to the surface of the glass and sculpted.  Says Garmezy: “I created one dragon sculpture for each of the colors on the poster. It was important that each dragon head was a similar size and style, but each completely unique. This color chart will give both blowers and sculptors a good idea of the potential of each color. We chose the image of the dragon because dragon imagery can be found in cultures around the world, and its symbolism brings to mind good luck, fortune, wisdom and strength – things we wish for all glass artists out there.”  

Many roads in Manawatu remain cut off, phone lines are down and cellphone reception in some areas is patchy. Helicopters flew over isolated communities to assess the damage from the downpour that hit the already drenched region yesterday. In Te Reureu Valley, up to 30 people were cut off as bridges into the area were washed out. In Feilding, about a dozen people were evacuated because of flash flooding. Bryan chats to Ben Caldwell from Manawatu District Council.

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.  

Things are starting to come to a head in our penultimate episode for The Sandman Book Club! Brief Lives follows the story of Dream and Delirium as they search the world for Destruction, their missing brother. Meanwhile, the next volume (The World's End) brings us another anthology with hints at what to expect in the final two volumes of the series.  ----more---- Jessika: I feel like I'm very straight passing recently. So I went out and ordered by self some doc Martins, just work there. These are my doc Martins. I am bisexual. *laughs*  Hello! Welcome to Ten Cent Takes, the podcast where we seek to find Destruction one issue at a time. My name is Jessika Frasier, and I'm joined by my cohost, the fountain of facts, Mike Thompson.  Mike: Hello. Hello. Hello. Jessika: Hello, Mike. And if you, listener, are new around here, the purpose of this podcast is to study comic books in ways that are both fun and informative. We want to look at their coolest, weirdest and silliest moments, as well as examine how they're woven into the larger fabric of pop culture and history.  This episode, we're continuing on with the fourth episode of our book club as we discuss volume seven and eight of the Sandman series, if you haven't already listened to our previous episodes on the Sandman and want to catch up, which by the way, we highly recommend we're discussing two volumes at a time. So go check out episode 15 for volumes one and two episode 17 for volumes three and four, and episode 19 for volumes five and a six,  And if you're thinking "These guys are great. I would love to show my support for this amazing podcast, but how?" Well friends I'll tell you. It really helps us. If you rate and review us on the platform you're listening through, especially apple pod pass and pod chaser, it really helps with discoverability and in helping us reach other nerdlings that just might enjoy the show. Plus it gives us that validation boost that Mike and I both being generally anxious, so need. So show us some love wherever you listen, please. And thank you. You can also tell your friends how awesome we are so they can join in on this fun.  Mike: Yeah. Uh, I definitely thrive on words of affirmation as pointed out by Comic Book Couples Counseling in our last episode. Jessika: Yes, please give us all the affirmation. But before we jump into our main conversation about volume seven and eight of the same. what is one cool thing you've read or watched lately?  Mike: I recently learned that the Books of Magic, which is a bit of a spin-off to the Sandman and a bit of sequel and a bit of something totally original, is getting the omnibus treatment. So this was actually really exciting for me because I read all the trades when I was in high school and college. And I was disappointed at how it felt like the series ended halfway through the story. And then I learned way later that DC only collected the first 50 of like 75 total issues into trades, which is why the series felt like it ended the way it did, I guess. Didn't sell that well. And so DC stopped putting them out, but DC put out an omnibus late last year, and then they're going to release another one in a couple of months. And it's going to contain the rest of the series as well as all of the different tie in books. And I wound up getting it for over half off from Target during this big deal they had on books where it was like, buy two, get one free. And they also weirdly had it for over half off. So yeah, I snapped that fucker up. Jessika: Hey hey tar-get.  Mike: I know. Right. It was great. but yeah, we've been having a lot of rainstorms here in the bay area lately, and it's kind of the perfect weather to read an oversized book, featuring the adventures of Tim hunter, who is this British teenager who's due to become the most powerful magician in the current age of man and...It's a really good read still. It's one of those books from the nineties that was originally a mini series by Neil Gaiman, and then other authors picked it up and put their own spin on it, you know? And we saw that with Lucifer as well. the books of magic had a couple of different authors, but they had prolonged runs and then they had a rotating cast of artists meanwhile Lucifer had Mike Carey at the helm guiding everything for all 75 issues. And then Neil Gaiman wrote the original miniseries for the books of magic, but then, you can still feel his fingerprints all over it, which is really cool. Jessika: Yeah, that's neat.  Mike: Yeah. There's some cool little Easter eggs in it. Like I think I mentioned in last episode during the brain wrinkles about how we actually see Hamnet, who was in the Midsummer Night's Dream issue of Sandman show up in the Books of Magic as the page of Titania, the queen of fairies. Jessika: Yeah, totally validated me.  Mike: I remember, you and I talking about that and you were like, I don't know. Did he go with Titania? And I was sitting there going, I don't know, maybe . , you know, he could have it's left open-ended no, he went with Titania, so... Jessika: yeah.  Mike: yeah. Jessika: that.  Mike: But yeah. What about you? What have you been scoping out? Jessika: Well, my good friend and a listener Noel -hey- gave me a reprint of a one-shot Image comic called Aria: The Heavenly Creatures, which was written by  Brian Holguin, illustrated by Jay Anacleto with Brian Haberlin, colored by Drew Passata Raymond Lee and Brian Haeberlin and letter by Francis Taka Naga. And I, I wanted to call them all out because the illustration, this comic is absolutely phenomenal. It's gorgeous. It's just, it's a veritable work Bart on every page and it's done in a really soft and hazy almost Dreamlike way.  Mike: Hm. Jessika: And there aren't any harsh outlines it's detailed and very lifelike and all of the fabric just looks so like rich and realistic. Noel was telling me that the character Lady Kildare was actually in another longstanding series, but this one had the rights removed to use the character. I believe, I'm not sure why. but it was set in the smokestack that was Victorian London. Hence some of the reasons for the haze, the story follows Kildare, who is from the fairy realm as she stumbles upon and subsequently sets to saving a fallen angel who was being held active by a man who runs a sideshow.  And it gives off extreme queer vibes and has an absolutely strong, and bad-ass leading lady, which, you know, I'm absolutely here for. Mike: What.  Jessika: yeah. what? Who's heard of this?  Mike: nobody told me this. Jessika: what she's a feminist who would have known.  Mike: I can't believe you're telling me this now. It's like 20 episodes. We're all alive. Jessika: This is 21. I got ya.  Mike: I'm quitting! I'm quitting right now! How dare you? Jessika: You know what, Mike? Let's move on to our next topic. Our main topic.  Mike: that series does sound rad though. I haven't heard of it before, so I'm gonna have to check it out. Jessika: Yeah, you should. It's definitely, it's very interest.  Mike: All right. Now we can move on. Jessika: Okay, let's go. Oh, right. So we are moving on to volume seven and eight of the Sandman series. So volume seven is titled Brief Lives and was published 1992 and 93 and comprises volumes 41, through 49 of the Sandman series written of course, by Neil Gaiman and illustrated by Jill Thompson and Vince Locke. Mike: Yeah. And we've seen both of these artists before in the series, like Vince Locke helps with, the short story about the Wolf people.  Jessika: That's right.  Mike: and then Jill Thompson, Jill Thompson did the, the Chibi story that we saw  Jessika: Oh, that's right.  Mike: in the parliament of Rooks issue. Her chili style drawings of Death and Dream wound up becoming their own thing. It's called the Little Endless  Jessika: Aw.  Mike: and they did them as kind of like storybooks. Jessika: That's so cute.  Mike: Yeah.  Jessika: Oh, obviously I'm going to have to go down a Jill Thompson rabbit hole.  This volume in particular is chunked into chapters. So I'm going to break down the story in that way.  so we begin chapter one with an older man making a long arduous Trek to put flowers on a Memorial for Johannah Constantine. We find Orpheus living his endless life of being just a head, not ahead of the game, Just, a literal head. He's been there. for so long that he uses his current helper for the helper's grandfather, as the task of Orpheus's care has been passed down the familial line. We cut to Delirium who is lost on and living on the streets because she cannot find her realm and is obsessively talking about her quote unquote lost brother. She has what can probably be best described as an anxiety or panic attack after wandering into a club and mistaking a cute goth woman for being her sister, Death. Desire, swoops in and takes her to her realm, but refuses to help her in the search for their brother, but suggests that Delirium visit Despair in her realm And ask if she will help. Despair also refuses to assist, but we get a glance into the brother whose identity has been kept vague up to this point, which is Destruction. We get to see a brief interaction during the black plague where Despair and Destruction for both out admiring their work. Despair then ignores a mirror page, quote, unquote from her twin Desire who wanted to talk about her and their brother and the fact that Delirium is looking for him. Mike: Yeah. And I think this is the first time that we actually see Destruction as a person. Before that he showed up in the issue where we saw Orpheus his wedding, but he was like fully clad in armor and he had like a giant helm. So it was obscuring his face. Jessika: Yeah. And we didn't ever really get introduced necessarily. We just knew that he just was like, there. Mike: Yeah. I can't remember if they out and out named him, you know, it probably would help if I went back and re-read the issue right now, but I think they, identified him as part of the family  Jessika: Yeah. That's what I think it was vague.  Mike: because he has, he has a whole, he has a whole conversation with Orpheus, after, after Eurydice dies, where he kind of consoles him. I think, right, like I'm not misremembering. Jessika: I don't remember now that was too many issues ago,  Mike: Yeah. Jessika: But he's definitely there. He definitely was there and I, and I think it was just like vague as to his ties. Like he was family, but.  Mike: Yeah. And then when he's going through the town with Despair during the black plague, he's like very gregarious and like actually much more human seeming than honestly all of the other endless, he's one of those people where he's not going about his duty somberly but he's not like delighting in it either. He's just kind of like, you know, he's just a dude. Jessika: Yeah. Yeah. He like has a job and he's doing his job, but he's he still sees what effect that takes on others?  Mike: Yeah. He feels like a much more human member of the endless than most of his siblings. Jessika: Yeah, yeah. Say so. So chapter two brings us to Dream and his realm. Where he is once again, moping over a woman who has left him instead of dealing with the grief of his lost love interest, whom he'd only known for a scant couple months. He instead orders Lucien to have her quarters in the castle be dismantled and he's causing constant rain in the Dream realm, as well as in the Dreams of mortals and Delirium shows up and is at first identified as an intruder by the gargoyles outside of Dream's castle.  Mike: I mean, does it really surprise us? That Dream is just the mopiest moper whoever moped? I know that Neil Gaiman wanted the characters designed to be like a mix of him when he was in his late twenties, cause he was this tall kind of gangly guy, crossed with Robert Smith from The Cure. Which, I mean, like, it feels like something from a cure Song where it's like, my woman left me and so I'm, causing it to rain all over my realm  Jessika: Oh my gosh, causing it to flood.  Mike: It's very much that that kind of like new wave emo vibe that I keep getting from Dream. So, you know, spot on. Jessika: Oh, it totally is though. So Delirium shows up and is again, is at first identified as an intruder by the gargoyles outside of Dream's castle. And Dream invites Delirium inside and offers her a meal and then asks her what he can help with. And it took Delirium some time to get her request out and Dream being the super patient guy he is -just kidding, he's not- was starting to get frustrated, but Delirium finally got out her request or Dream to help her find their lost brother admitting that she had already asked Desire and Despair. Dream become suspicious that Desire had something to do with Delirium, getting that idea, but Desire swears that she had nothing to do with it and urges Dream to just kick her out and refuse to help. We get a flashback from when Delirium was still Delight and her own relationship with Destruction. When Dream returns, he ends up offering to help Delirium try to locate Destruction through some of Destruction's friends. When told of this, Lucien tries to coax him out of going, but Dream admits that he just needs something to take his mind off his current malady and could use the distraction. Dramatics. He also leaves on a literal, "this is straight forward, What could possibly go wrong?" note. Which why, why set yourself up in that way?  Anyway.  Mike: I thought that was great. Jessika: We begin chapter three with a man named Ernie CapEx, who has had a Dream where he is remembering the smell of wooly mammoths, recalling that he had lived for innumerable years, yet passing a construction zone. He is hit with an entire brick wall slash building itself that accidentally fell from overhead from an active, construction zone he was passing. As CapEx emerges from the rubble. He believed himself to have gotten out of the situation unscathed yet Death, comes, and collect him, pointing to his body, buried beneath the rebel and state that he got, what everybody gets a lifetime back. The waking world Dream has brought the leery into a travel agency in Dublin, looking for an acquaintance of Dreams after much back and forth with the woman working at the front desk. Dream finally sent the message about drinking wine in Babylon before Pharamond -now called Mr. Farrell- finally came to meet them. I love that while they were waiting in the lobby, Delirium was like making frogs, like actual animate frogs.  Mike: Yeah. And I think that was called out where Ferrell is sitting there and he's like, what are they doing? And the receptionist is like, they're making frogs. like she's making them appear out of thin air. It was. Jessika: So chaotic. During their meeting, Fairmont agrees to assist Dream after recalling our Dream and help them in the past, by suggesting a different profession, they asked Delirium about the list she had mentioned of their brother's friends, and she went and bought it and included the Lawyer, the Alderman, Etain of the Second Look and the Dancing Woman. we get a glimpse of a Etain who has had a Dream about a poem. She goes to write, but it escapes her. She also narrowly escaped from her apartment as it explodes from ignited gasoline.  Mike: Yeah. She, has like a moment where she figures out that something is wrong and just needs to get out like as soon as possible. Jessika: yeah, she had the forethought to grab her purse and then held it in front of her as she broke through the window with the force of her running body, shielding herself with purse. So bad-ass. And she was just in her underwear and a tank top at the time. So lucky for her She had her purse with her and he'd go off into Kmart, some clothes and shoes. We then pan to a man who looked suspiciously like Destruction with no facial hair. And he is trying to paint. His dog, Barnabas, comes to advise him that he is hearing an odd noise from inside a room where they find a round churning pool surrounded by framed portraits. He falls at the family room and states it is an early warning system.  Dream and Delirium fly on a plane in first-class and then are picked up by a chauffeur in a classic convertible on their way to see apex chapter four begins with an alderman who was nervously perceiving an out of season Northern lights display, knowing that is an negative omen. He does a ritual and changes itself into a bear with a human shadow bites off the human shadow and the shadow takes the man's clothes and his name and identity, and goes back into the world. The bear remains a bear and forgets he was anything else prior. Meanwhile, back in the waking world, Dream and Delirium are being driven around What looks like a suburban neighborhood. And Dream is clearly looking for something or someone they roll up to Bernie Cape axes house, where they're informed by a son that his father is dead. Dream gets really pushy with the chauffeur who insists that she needs to stop to rest for the night before they start driving the 12 to 14 hours, you know, like mortals need sleep and all Mike: What was the chauffeur's name again? Ruby, right? Jessika: it was Ruby. Mike: Yeah.  Jessika: Yup. Mike: Yeah. She was rad. I actually really liked that. She was, she was a. Just a cool character, but then she also like actively pushed back on Dream and she's like, I don't give a fuck who you are. I don't care that my boss is calling in a favor. This is not how this works. Jessika: Exactly. Exactly. It's like, yeah, she definitely had solid boundaries. It was awesome. So it was going to take 12 to 14 hours to get to their next destination, which per Deliriums list is Etain of the Second Look in Ohio. Dream, finally concedes to stop and they go to a motel to Russ for the night. And in the motel, we get background on Ruby, the chauffer, who is a polyglot and all around badass. As we said, Delirium is letting herself go in order to find another one of the characters on their lists. The scene cuts to an exotic nightclub where one of the dancers is sick prior to going. While looking in the mirror. One of the other dancers who was assisting the sick dancer sees Delirium, who verifies that she is the Dancing Lady that is on the list and tells her that they will see her soon. So Dream goes back to his own realm and speaks with Lucien asking for assistance and finding some of the information they need to find their brother. Dream also recollects a situation and conversation with Destruction and the Corinthian in the 17 hundreds. But at the time Dream didn't realize that Destruction was telling him that he was going to be leaving.  Mike: Yeah. And the Corinthian, this is the same Corinthian who we saw basically as the celebrity at the serial killer convention back in the Doll's House, right?  Jessika: Yeah. it was the Doll's House. Mike: Yeah. But it was before he had really gone off the deep end, but I really dug the character design where he's kind of dressed as a French dandy and he's still rocking sunglasses, like, but he's got, he's got like the giant puffy wig and I thought that was great. Jessika: yeah, it was a nice little, a nice little.  Mike: Yeah. Jessika: Back in the motel Dream returns to his body, to firefighters, trying to get him out. Ruby fell asleep with a lit cigarette and the motel burned down, killing Ruby in the process, or so we're made to believe.  Mike: Yeah, but at the same time, it's implied that someone or something is taking out all of the leads on Destruction. And they're not sure if the Endless themselves were being targeted as well. Jessika: Yeah, exactly. Exactly.  Mike: So there's that, there's that ominous tease. Jessika: Chapter five brings us to the search for the Dancing Lady. As well as some driving lessons for Delirium. So irresponsible.  Mike: which we should note, they bring Matthew the Raven in to teach Delirium how to drive and Matthew is basically having a panic attack the entire time, trying to teach her the rules of the road because teaching Delirium, the rules of anything is not going to work. Jessika: Yeah. Well, because she tried like, initially Dream was just like, yeah, go for it. And she's like all over the road, she's like swerving in and out of stuff. She's not on the correct side. And it was just a whole thing.  Mike: no, it was, it was very good watching Matthew, just panic. And he's like sitting there squawking and flapping his wings, like crazy. It was good. I loved it. Jessika: Oh, well. And before that, I mean, they had a... the reason the Matthew out called in was because they had a run in with highway patrol and that ended with the man being plagued with feeling like bugs were crawling on him, like forever. Forever. He always was just going to feel like that.  Mike: Yeah. That was like, and that was basically Delirium. Just does it as a hand wave thing, which you know, I have that as something to talk about later on. But. Yeah. It's the first instance where we see Delirium being just as casually cruel as the rest of her siblings. Jessika: Yeah. Yup. Without really realizing it, you know, it's almost like it's not even a thought, which is even worse.  Mike: Yeah. Jessika: So they get to the exotic dance club and Tiffany -whom Delirium had been using as a conduit- and Ishtar, who we find out as a former goddess of love. So she, at one point tells Tiffany that nobody comes to really see her dance just for TNA, but after Dream and Delirium and Matthew pay a visit with Dream, extracting nothing from who we find out is Destruction's former lover, but also warning her that she might be in danger. Ishtar goes out to the stage to dance and literally goes atomic dancing her true dance. The whole club explodes with a naked, Tiffany barely making it out alive. Desire, shows up and gives Tiffany their coat and talks about how Ishtar was thinking about her desire for Destruction up until her final moment. Mike: Yeah. Well, something that was interesting about Tiffany is that Ishtar, we've gotten glimpses of her, where Ishtar is like taking care of her. And it's very clear that she has some mental issues going on as well as possibly a drug addiction. She had a drug addiction, right? Cause at one point she was trying to eat some eggs and stuff that Ishtar made for her and then she wound up puking it up. And then she winds up stumbling out of the club and surviving while Desire gives her the jacket. And then I think that kind of becomes sort of like one of those revelatory moments that we always hear about with born again, Christians, which, you know, we see later on at the very end. Anyway. Moving on. Jessika: Well, chapter six brings us back to Destruction who is trying his hand at yet another artistic endeavor. And once again, producing lackluster results, he mentions to Barnabas that now is not the time for him to Dream or else he might give up too much. Back with Dream and Delirium Dream has had enough of his sister's bullshit and basically tells her that he's fucking back off to his own realm and she needs to go back to hers. He refuses to help her any further. Mike: he's really a Dick about it too. There's a very cold delivery to it. And it's very, again, it's very cruel, where he really talks down to her and treats her like a lesser rather than an equal. Jessika: Yeah. It would be one thing to put up a boundary, which I would absolutely respect if you said, you know what I, for XYZ reason, I really can't help you at this point. Here's what I can do for you. Or I can support you in this way, but it's not even like that. He's just like middle fingers in the air. Like here I go back to my realm, like Mike: Basically just fire both middle fingers off and go deuces I'm out! Jessika: Exactly. So Delirium is very upset obviously by this treatment from her brother and his response and sulks off to her own realm. And Dream is very salty when he gets back and tells him while at a stopped dancing, which, sorry, you're no fun, but stop stomping on everybody else's rose garden. He lets Pharamond know about Ruby's demise and then Dream creates a realm for bast to come and talk. And even though he's told everyone that he is no longer looking for his brother, that is the exact question he is going to ask a very flirty Bast. Mike: right. And this is because back in Season of the Mists, when all the different gods were vying for Hell, the gods of Egypt didn't exactly have a lot to offer, but Bast said, I do know where your brother is. Jessika: Which I didn't really put two and two together, obviously. Mike: No, I mean, well, I mean, here's the thing is like back then, like, you know, and that one they hinted at at where I think they had a curtains drawn over Destruction's portrait. This was something that was a very tangentially hinted at if even that much. But it's kind of interesting to see how Neil Gaiman clearly had an idea of what he wanted to do. Like, even that far back, like we're talking at this point years back.  Jessika: Yeah. Yeah. It's definitely the long game for the plot line.  Mike: which, anything that you read by him, He always has these small seeds that he plants that wind up growing into something bigger. Like if you read American gods, which is, a dense tome of a book, and I guess there's the, the director's cut version that they released a couple of years ago, which is even longer, there's a number of small things that he has his like kind of tangental side stories, and then they wind up building into something much bigger towards the end. Jessika: Oh, it's always so cool. It's such a good story teller.  Mike: Yeah. It's just, sometimes you sit there and view people's talent and you're like, that's not fair. Jessika: No, right? So when Dream appears back in the main part of his castle, Lucien lets him know that there is some trouble in the portrait gallery and when they get there, he discovers that one of the portrait has gone black. Dun dun dun! Mike: Yeah, like solid black, like that's, that's all there is.  Jessika: Solid black. Incommunicado. Death comes to see Dream and asks him what he did to Delirium. explained there so far failed by. And Death basically told him he needed to go make up with the sister.  Mike: Yeah. I mean, like, it's basically like a smack on the back of the head. Like she is like, talking about people tired of other people's bullshit. Death is about done with dreams at this point. I think. Jessika: Yeah. She's like stopping douche and just make up with her. Good Lord. And so Dream falls into Delirium's chaotic world, which is filled with color and random pictures and words. And you find her crying, having cut off all of her already short multicolored hair. He apologizes to her admitting the he had had ulterior motives for wanting to travel in the waking world. As there was a woman, he knew that he wanted to try to look up while they were in that world.  Mike: And it's implied that it's the woman that left him at the beginning who were not actually ever told who that is, right?  Jessika: No, she gets no name. She just, she's just a plot point. You know? I love that. Yeah. No, we never, we never see her. We never interact with her. She doesn't get a name. So... too bad or not feminist on this show.  Mike: What, what was the quote that Lisa gave us in the last episode? It was like, uh...  Jessika: Oh, which one? God, we are, she was talking about nothing. There's nothing better than a woman who was empty.  That was one of them.  Mike: Yeah, that was exactly what I was thinking of. Like what better purpose for a woman than to be empty and waiting for a man to fill her hole or something? I was like, ah, god damn it Lisa. Jessika: Yeah, exactly. Oh, yup. That's just a welcome to the patriarchy. Front row seat: Every woman. Or female identifying person. So dream tells Delirium that he will help her find their brother, but in earnest. chapter seven begins with Destruction trying out yet another fine art. And this time it's the culinary arts. He is somewhere in proximity to an actual town, as he goes and picks up supplies from there and feeds the dog, Barnabas some chocolate, which don't do that, do not do that to your actual dog.  This is a special, magical dog.  Mike: I'm still not sure if that was done intentionally to show that Barnabas was like something else or if it was because Neil Gaiman didn't have a dog and didn't know what you are supposed to and supposed to not feed them. Jessika: I hope it's the former. If it's the former, it's pretty cheeky. Let's just say.  Mike: But yeah, like I legit tensed up when I read that again. I'm like...  Jessika: I did too.  My dog was sitting right next to me and I literally out loud was Like. no, no, no, no.  So. Barnabas, is it on some chocolate as he and Destruction discuss Destruction's other artistic endeavors, like sculpting, which by the way, all of these have been done with varying degrees of mediocrity so far.  Mike: And Barnabas calls it out. Like, he is blunt and it's kinda great. Jessika: Yup. He's a, no nonsense kind of guy for sure. back with dream of Delirium dream, besides that they must get their older brother involved and notified destiny. They have to find his realm using amaze or labyrinth. And he is of course expecting their arrival. The only advice a destiny can offer dream is something that he had already realized, but doesn't seem to want to be true: That he had to see a certain "oracle." Destiny also told him that the woman he loves has never and will never love him. And you will see her one more time, but that you will not like the outcome. Delirium sees Dream's distress and comes to his aid. Speaking very coherently. And with her eyes the same color when bustin, she said that she was able to do that if she wanted, but that it hurt to do it for very long and that she felt like she needed to step up for him when he was down.  Mike: I kind of love that. I thought it was great. I thought it also showed that she's actually a better quote unquote "person" than he is in a lot of ways because she did that kind of like naturally, without anyone telling her she had to. Jessika: Yeah, it was very, it was instantaneous and it was very selfless. We then get to jump into Destiny's recollection of a story in his book of destruction, calling a family meeting, where he says he's leaving and that he does not want to be found and is no longer going to be associated with the family. Each family member reacts a little bit differently to the news, but Delirium seems to be the most visually upset. So the Oracle in question turns out to be Orpheus. So Dream ends up going there, to Orpheus's island, and in exchange for destruction's location. Dream now owes Orpheus a boon. So they've very easily traversed to destruction's location by boat, where they meet Barnabas and the formal eternal being himself. Destruction meets them with literal open arms and invites them inside with beast that he has made himself, which by the way, they were just sticks about that. They didn't even want It that  Mike: It looked really good too. Like it looked like a really good meal.  Jessika: It looked like the one thing he was actually able to do well,  Mike: Yeah. Jessika: like he finally figured it out. Hey, I can cook.  Mike: Well, I mean, speaking of someone who, you know, bakes enthusiastically people generally don't care so much about how your food looks as much as they do about how it tastes. Jessika: Yeah, exactly. So chapter eight brings us to Destruction's decision. He speaks with Delirium and Dream about the reason he had left family and the fact that he was going to exit existence s Barnabas to stay with Delirium and watch over her.  Mike: Yeah. And then he reveals during this conversation that the reason that so many people that knew him have been dying was because of certain safeguards I think is how we phrased it. which, I mean, it's fine. I guess it also kind of, it drives home that the endless are not actually people and they don't feel things like guilt or shame, but I don't know. I was kind of hoping the first time that I read this, that we would get some third agent involved. Someone who is actively trying to hunt down destruction or something like that, but we didn't get it. Jessika: Nope.  Mike: It kind of got hand-waved away.  Jessika: Yeah. Yep. Just all right. Well that was because I didn't want anybody to find me, so I just gotta to make sure nobody finds me regardless of, you know, who gets in my way. And if  Mike: Yeah.  Jessika: trying, it's gonna  Mike: Cool. Cool bro. Cool. Jessika: Yeah. Pretty rough. Destruction torches the portraits and the gallery. He shrinks his sword and pool, which was rad by the way. And he puts them in, he puts them on a stick in a polka-dot handkerchief and walks literally into the stars.  Mike: Yeah. It's that like hobo stick from turn of the century artwork. Whereas the people who were just wandering the rails and stuff and they have a stick and then they have their belongings in, you know, in this little kind of sack tied to the end. Jessika: Yeah. You could tell, he was like, oh, this is what this is supposed to look like. You could tell it was like an affectation, which was kind of adorable. He's been trying this whole time to be someone else, You know, and, and even when he left, he was trying to be someone else. So it's like, man, I hope you find yourself out there.  Mike: Well, yeah, it... he's been trying to be human and this is another affectation that he's put on. To seem human. Jessika: Dream then tells Delirium that he has to go see his son. Oh. And also that dream needed to kill Orpheus.  Mike: That was such a great cliffhanger moment. Jessika: I know. I actually, I literally gasped. It's like, whoa. We begin chapter nine back to Orpheus's home island where after a bit of back and forth re dream allows Delirium to accompany him, to see his son. She says her chaotic hello, and then Death double-checks with Orpheus that this is what I wanted. They have a very meaningful conversation about their relationship and life and change. And then Dream kills  Orpheus. Dream meets up with Delirium outside where Despair has entered the scene. She shows regret and not going with delirium to find and ultimately see destruction for one final time. Delirium pieces out with Barnabas and Despair meets up with Desire who should be happy as it had accomplished what it wanted to have happen... to have Dream spill the blood of one of the family, but she is somehow still lacking proper fulfillment from the situation. Dream returns to his own realm and is unusually empathetic to everyone around them, wanting to know how people are and speaking with soft vendor, standing, leaving every person he interacts with in a state of poodle. He visits Adros who was one of the Island's caretakers and asks him to bury Orpheus in an unmarked grave. He also starts making plans to let people know that they are no longer in danger and generally thinking about the well-being of others. And that is that they're no longer in danger of being harmed by Destruction's safeguards. Dream washes his hands of the blood of his son, literally. And he remembers a flashback advice given after the Death of Eurydice. Throughout this volume, different characters have told dream in different ways that he is changing, evolving as a person, but he fought this notion up until the end of this chapter, where he seems to have made peace with his decision and accepting the fact that maybe has the capacity for change after all. So, Mike, what did you think about this volume? And do you have a favorite story or event? Mike: Yeah. I'm of two minds on this. Like the plot itself feels like this very necessary one. And it's one that moves the story of Dream and his siblings forward in a pretty meaningful way. But I also found myself continuing to realize that the Endless are these very alien beings who just happened to look human. And oftentimes they're not very kind to each other or to anyone else. And I don't really think I like most of them to be honest. I keep thinking about that moment in the club where Desire basically forces two women to fall in love and then reveals it's going to lead to obsession and stalking and I think maybe a murder. And there's just this casual cruelty that they generally seem to possess, like even Delirium. Like we talked about how she gets irritated with the highway patrolman. And then was like, you're going to think that you have bugs crawling onto your skin for the rest of your life. We see that at the end of this volume, like how it's played out. And it's really rough. He's like in a sanitarium. And, that said I will say, I think Delirium is the most human of the endless, except maybe Death, because she feels all the same things that we do. And it's somehow driven her to her current state. Like we never actually see, I don't think what caused her to go from Delight to Delirium.  Jessika: Oh, interesting. Okay.  Mike: I think it's one of those things that, that game and kind of teases out, but then just leaves us to, let us wonder about afterwards.  Jessika: Well, damn Mike: Yeah. And that said, I think my favorite thing about this volume was honestly, was Barnabas. Like I really enjoyed how he had that brutal honesty and was really funny. Whenever destruction would ask him to critique whatever piece of art he just attempted and then he agrees to go with delirium as I don't quite know how to describe this new role for him, I guess like a sanity check dog, as opposed to a seeing eye dog. Jessika: Yeah. Like maybe an emotional support dog.  Mike: Yeah. Like he, he's a cosmic emotional support dog, I guess.   Jessika: Yeah. You gotta ramp it up and you've got like cosmic powers. You have to, like, there has to be a safeguard for that kind of a, it takes a special service dog.  Mike: Yeah. But I felt like he was the best character throughout the whole story. He's funny. And he's weird. And he's also the companion that we all want our dogs to be. I'm not going to lie. Like I'm probably projecting onto him, but I've recently left a job that was incredibly stressful and was actually causing me to start having anxiety attacks. And my dog, Iggy, would clue into when I was freaking out and he would just hop into my lap and calm me down. don't think we deserve dogs and Barnabas is kind of the manifestation of why that's the case.  Jessika: Yeah.  Mike: And on that note, I know that Jill Thompson, who was the main artists for this volume based Barnabas on a real life dog who belonged to a neighbor who she said was quote, "unkind to the animal." And so she decided to like memorialize them in a comic, which kind of adds that extra emotional punch to it.  Jessika: yeah, which I'm sorry. Are we obsessed with Jill Thompson answer? Yes, we are.  Mike: A hundred percent. Jessika: Jill hit us up.  Mike: What about you? Was there anything that really stuck out to you? Jessika: I was really struck with the part where delirium is at dinner and asks. "Have you got any little milk chocolate people, about three inches, high men and women. I'd like some of them filled with raspberries and cream." She makes them kiss throughout the scene. And after a dream and delirium have left, there is one frame of the last two chocolate people, a man and a woman, which is described as such: "touched by her fingers, the two surviving chocolate people populate desperately losing themselves in a melting frenzy of lust spending. The last of their brief borrowed lives in a spasm of raspberry cream and fear." Something about the fact that delirium was both animating and then eating little candy people is just so intense and horrifying.  Mike: Yup. Jessika: And for how much of a throwaway frame it was, it really said a lot about Delirium in just that one situation, you know, even bringing it back to what you had mentioned, just that casual, like she's created a life and she doesn't even care what happens to it? She's just going to destroy it. She'll just leave it to just melt. It doesn't matter to her.  Mike: Yeah. And I mean, that's, I think part of the thing with the Endless is that they're older than gods and galaxies. At some point, when you were these beings that kind of surpass already cosmic things, I don't know, maybe. you just have that perspective where you're like, Hm, you're less than an ant and it's not because I don't like you... It's just, Hmm. Jessika: Yeah, totally. Well. We're bringing it back to the art. Do you have a favorite panel or illustration that caught your eye? Mike: Yeah. The scene where destruction is talking with dream and delirium under that starry sky, like right before he pieces out. It's one of those things where every panel feels like this legit work of art. And in the moment when he actually pieces out, it just feels simultaneously strange and surreal and totally ordinary. And I loved it. It's now one of the sequences that I think about when I think about Sandman, like I've got a couple of moments from, different stories that I've talked about in the past. Like in Men of Good Fortune and there's that three panel sequence with Hob Gadling and his face. And then, this is another one. it felt like there were a bunch of different emotions wrapped up in the entire scene. And I really liked how I just, it left me feeling satisfied at the end, which, you know, you want good art to do. And then it's not exactly a favorite art moment. But one detail that I really liked was how after Orpheus dies, which by the way, the moment that he dies is kind of cool because we don't actually see what dream did, but we see the symbol of death. And then, Orpheus is dead. But one detail that I've really liked was how after Orpheus dies and dream has blood dripping from his hands, there's a trail of red flowers, blooming where the blood hits the ground. Jessika: Yeah. That's really sweet. It was those same red flowers that he had that Orpheus had been sending up to Johanna, Constantine's memorial Mike: Yeah. Yeah. so I'm curious, like what about you? What was your favorite art moment? Jessika: Well, I actually have a tie, so you're just gonna have to hear both.  Mike: that's kind of funny because normally I'm the one where I'm like, I have two, maybe three. Jessika: I couldn't decide this time, usually very decisive, but you know. Sandman's got me like... so in chapter five they visit the exotic dance club and the illustration was super neat. They didn't have any heavy outlines. It was lit differently, you know, the, the drawing style and it just had like shapes, comprising most of the forms, which was neat. And it was a good way to show the distorting light that neon and other lights. You know, give off the appearance. And it also gives the vibe for the place they were in. The customers are also not looking at details and the reader won't get any, you know, the stage lights were also different from the backstage lighting, but the line work was the same, which was also an interesting choice. It made it feel like the club was just a world of its own, with its own visual rules.  Mike: Yeah. And the moment where Ishtar takes the stage and she kind of goes nuclear, the art style is very distinct and the way that she's drawn compared to everything else, it's like, she's no longer a concrete form. It's kind of like, she is the idea of a woman in the midst of a very real world, which I thought was a really cool way to do it. Jessika: Yeah. I think so too. Yeah, I think so.  Mike: Yeah.  Jessika: And my other favorite art moment is when Dream goes into Delirium's round  Mike: Mm.  Jessika: it's so colorful and it's a chaotic and it's hard to know where to look, to take everything in. And I found myself kind of looking at the pages far away and then up close because the little details come out when you're close, but the distance lets you see the whole big chaotic picture. So it was really neat to portray like a really neat way to portray that vibe.  Mike: Yeah.  Jessika: so Mike, do you have any final thoughts about this volume before we move on?  Mike: Yeah, I was kind of entertained at how dream threw a giant tantrum because his latest girlfriend bounced and it sort of just drove home how he's still very much a mediocre white guy in his thirties. But, but I also, I will say I did appreciate how this volume brought closure to Orpheus's story and, and how we saw some genuine emotion and regrets from Morpheus at the end of it. There's that moment where after he's having that, recollection of telling Orpheus to live, you can see him in his, I guess his throne or his personal chair or whatever it was. And he looks really sorrowful and that's, I think, the first time that we've seen. Express any true emotion other than anger? Jessika: Yeah. Yeah.  Mike: No. Jessika: Well, let's move along to volume eight and this is titled Worlds End. And was originally published in single magazine farm as the Sandman issues, 51 through 56 in 1993, written as always by our boy, Neil Gaiman illustrated by Brian Talbot, Alex Stevens, John Watkiss, Michael Zuli, Michael Alfred, Shaya Anson Pensa and Gary Amarro. This volume is another anthology. The first story is titled the tale of two cities, and it begins with a car accident where a man named Brant Tucker was behind the wheel with the car's owner, Charlene Mooney in the passenger seat. A large black-horned animal, bigger than a car was in the middle of the road, causing him to veer off and hit a tree Brant bulls Charlene from the wreckage and carries her to find help, winding up at a place called the World's End Inn. Where there are many very curious characters, similarly waiting out the storm, but this isn't a snowstorm like brand had initially thought it is a reality storm, a centaur who is touted to be a prolific healer, tends to Charlene and after drinking a very comforting honey flavored liquid Brant falls into a short coma of 15 hours and awakens to find everyone around a table, trading stories. One of the men at the table, Mr. Geharris goes on to tell a story about a man who enjoyed wandering around the city until the night that he fell or more accurately rode a train into the dreams of his city. After catching a glimpse of a silver gleaming path during his daily lunchtime walk, the man spaces out at work and leaves late missing his usual train. The train he catches is not the right one at all, as Dream as the only other passenger. And it doesn't make the usual stops instead, quickly zipping to an unknown destination when he arrives, all of the landmarks are familiar, but not quite recognizable. He comes upon another older man who tells him his theory that this is the dream of a city. He finds his way out through a familiar doorway where he was later able to read out the tail to Mr. Harris stating that he's not afraid of the dreams of the cities. He's more worried about what might happen if they wake up and decide to take over.  Mike: Yeah. And that last bit, gives, everything kind of this weird Lovecraftian kind of vibe where it's painting cities to kind of seem like they are these eldritch beings that we just happened to be living in. And I kind of dug that Jessika: Yeah. Well, I don't know. I am of the opinion that a city is a living, breathing organism in a way. I mean, there are definite veins and arteries of traffic and, there's different inner workings that make the whole thing rent. I don't know. It just, it feels alive.  Mike: what was that like the mortal engine series, like Peter Jackson produced a movie. That they based on the books about how after effectively, like a giant world war cities become these mobile entities and they wind up like roaming the world and harvesting smaller towns and villages for resources. Jessika: Oh, I Like, that.  Mike: it's a cool idea. It's one where I, I haven't read the book. I've only, I've only seen the trailers, but it looked cool. I don't know. I think it did not actually get that great a review. So I'm waiting for it to come to Netflix before I watch it Jessika: yeah. Fair. So moving on to the second story, which is titled Cluracan's Tale, and it's told by its namesake who is similarly waiting out the store. And this is the very same thorough can who was the brother to Nuala the quote unquote gift given to dream by the Fey after all the underworld drama?  Mike: right in season of the miss. Jessika: Yeah, exactly. His story takes place in the land of Fae where Cluracan is being told by her majesty the queen that he must act as an ambassador on her behalf and intervene in a dealing in Australia of the Plains. Evidently he had been planning to visit Nuala, but would have to set that aside to go on a mission for the queen. She gives him some instructional scrolls, which he was like, yeah, cool. I'll read those later and sets on his way. He's guided to the palace where he meets the psychopomp, who is basically trying to gain power of all the realms tax people and make himself wealthy and powerful. don't know if that sounds familiar.  Mike: Neil Gaiman, continuing to be oddly prescient. Jessika: Man. Cluracan bursts out an uncontrollable prediction, which lands him in jail with iron cuffs and chains. He falls into the dream realm where he sees Nuala. And when he awakes Dream is there and undoes his chains and lets him out as a favor to Nuala. Once out Cluracan spreads rumors throughout the town about the psychopomp causing the town to riot the psychopomp and his adviser. Hide out in the crypt where he is mocking. The former leaders Cluracan comes to face the psychopomp, but before he's able to do. One of the dead bodies comes back the life and fucks up the oily little man by sending them both out of a stained glass window from way high up. Cluracan was on his way back to give his queen the news when he was caught in the storm and absolutely admits to embellishing his story. Mike: Which I mean, that's kind of in keeping with Cluracan's character. He's very much the grandiose storyteller. Jessika: Yeah, exactly. So the next story is called Hob's Leviathan and is told by a young person who goes only by the name, Jim, while Brant and Charlene have come from June, 1993, Jim and the rest of the ship's crew came from September, 1914.  Mike: I actually really liked that detail because it shows the fluid nature of time throughout all of these stories that we're reading. Jessika: Yeah. Yeah. Not only time, but other realms, like, you know, we had reality budding up against the Fey realm and budding up against wherever the hell centaurs come from and all that good stuff, Jim had worked on several other ships and had finally started working on the Sea Witch. The captain reluctantly took on a passenger who we find out to be Hob Gadling during their merchant voyage and also find a stowaway. The stowaway is named Gunga Din, who told a very sexist story about how all women cheat and along the way they encounter a sea serpent. When Jim asks Bob, why nobody is talking about the sea serpent, Hob states that some things just go unsaid and who would believe that story anyway, and then reveals that he knows that Jim is actually a girl in the end. Jim says that there is only so much more time that this disguise will work, but for now they can still be called Jim. Mike: Yeah. And Gunga Din I think that's a Rudyard Kipling poem from like the late 1900s... Jessika: Oh, hence the sexism  Mike: yeah. I mean, I don't remember the details about that. I think we read that in junior year English for high school. but Rudyard Kipling stuff it has that, unmistakable whiff of colonialism. Jessika: Yeah. Colonialism is a thing. Mike: Yeah. Jessika: Golden Boy is the title of our next story and starts with Brant being a very sleepy guy. He wakens to a sandwich and miraculously hot coffee that had been left for him starts looking around the inn. He runs into another guest who states he is a seeker and follower quote, unquote, and tells the story of the one he follows. In another reality, we follow the growth of a boy named Prez Rickard who becomes the 19-year-old president of the United States with a pension for fixing broken timepieces. Now, Mike, off recording, we've talked about Prez before, I know this is a passion of yours. Would you like to give us some background on the character.  Mike: Oh man. Pres. Okay. yeah, we haven't actually talked about them on this show before, and we probably should at some point, but I, but the funny thing is we did talk about him when we were spinning up the podcast that eventually morphed into Ten Cent Takes. So there's like a last episode out there with some of this info. Prez was this comic that DC did back in the early 1970s. It was following the passage of the 26th amendment, which lowered the voting age. And basically the idea was what would happen if a followup amendment allowed teenagers to get elected to office. And the core concept was there's a kid named Prez who is named so because his mom wants him to be president one day, he becomes this local hero after getting all the clocks in his town to run on time and winds up, getting elected president after kind of thwarting, a convoluted scheme by the shady political fixer named boss smiley and Boss Smiley is a weird guy. Like I think, I think if I remember him, he's like a human person, but then he's got like a smiley face button for a face.  Jessika: Yeah. It's weird.  Mike: the problem is, is it's been a while since I read the original issues and I may be mixing it up with what's in here. And then also the followup reboot they did back in 2015, which we'll talk about that in a minute. But the seventies comic only lasted for four issues and it had some really wild stories. Like one of my favorites is he fights a legless vampire on a skateboard and he goes toe to toe with this distant descendant of George Washington, who was leading an extremist militia group. He survives it and assassination attempt on him after he comes out as pro gun control. And I need to show you that comic cover with the vampire, because he's got like, he's got a werewolf as an assistant, just like a torso and then...  Jessika: Sounds a lot like terror. Shout out to DG Chichester.  Mike: Oh man. All right. Take a look at this. Jessika: No, it's on a wheelie cart.  Mike: Uh, yeah. Jessika: I was not. Oh no, there, there, are problems.  Mike: Yeah. Jessika: Oh no. Okay. Let me just paint a picture for everyone. So we have the DC logo in the corner. It says in the middle of the cover Vampire in the wWite House! Prez: First Teen President 20 cents number for March. It's got the comics code authority, of course, which we love. So the door is being opened by what looks like, uh, some militia men, as well as a native American person. Who's very little stereotypically drawn, Mike: I believe that's character name is Eagle free.  Jessika: Oh no, I'm  Mike: Hold on.  Jessika: not loving it.  Mike: Yeah, I mean, it was, it was the early 1970s. They, uh, they weren't very politically correct.  Jessika: can't see my head shaking. It's shaking. I don't love it. Mike: It looks like the Native American mascot that you see when a team is named the Indians. Jessika: Yes, exactly. It's a little rough. you saying "We're too late, that creature's found the president!" and just as... he says Prez who, by the way, is wearing a red sweater, which has the presidential logo with Prez USA around it. So that's already funny. He seems to be in the oval office. Papers are flying everywhere and there's half a vampire on a rolly cart who by the looks of it has flown in and is now trying to bite his neck or strangle him or bite his shoulder and strangle him is what it looks like. Not entirely sure what he's going to do here. So Yeah. Mike: And that's like the final issue of Prez as well, I believe. Jessika: It would escalate into vampirism and be like, oh, where do we go from here?  Pres and a vampire.  Mike: Yeah. pres everything that I love about comics and the press books are why I collect where you just find these weird, strange, silly moments, and then you can bust it out to show to people. And they just want to know all about it. And then you guys get to talk about it for awhile. Jessika: it's the concept itself is so laughable that even if it were an option to like elect an 18 year old, like most of us would be like, I remember what I was 18. This sounds like an awful idea. This sounds like a terrible idea.  Mike: I remember what I was like when I was 30. Good Lord. I wouldn't want me when I was 30 as president. Jessika: That's what I'm saying? Yeah. I'm 35. I'm oh, Hey. I'm just now of presidential age. So nobody vote for me. Nobody vote for me. I don't want that job, but I thought my job was stressful.  Mike: Yeah. Jessika: I have like seven employees. Like I don't, I don't want to have like the country as my, as my dealings with that's a lot.  Mike: Yeah. But the other thing is that in 2015, DC did a mini series revival slash reboot of Prez. Where instead of Prez Rickard... Rickard still shows up and he's kind of like this wildly congressmen, and he's a lot of fun, the idea it's updated for the modern age, where basically you can vote via Twitter. And... Jessika: Oh, no.  Mike: and this girl who goes viral because of like a humiliating video at our fast food job, winds up getting elected president. And it's very funny and very smart. And I can't remember who wrote it, but Ben Caldwell did the art who has this wonderful style. That's kind of a mix of cartoony and then more traditional. And it it's really good. And it's also very affordable. You can find it very easily for not much money. In fact it might be on Hoopla.  Jessika: Ooh, we love Hoopla.  Mike: Yeah, let's see if it's on Hoopla. Jessika: Hey everyone. I would like to take this time to remind everyone to support your local library, to support your local comic book. You're a local small bookstore, small artists.  Mike: We are recording this on small business Saturday. Jessika: We are  Mike: So  Jessika: that's right.  Mike: press volume, one from 2015, by Mark Russell and Ben Caldwell and Mark Morales is available on Hoopla. Highly recommend it. It's a great read. Jessika: Yes. Well, thank you. So back within, the story, so that was a nice background on Prez, but back to what happened within this anthology story. So press has many trials where he's tempted by that character Boss Smiley that you had mentioned, but he declined each time wanting to work for his people instead of selling out so that he could receive the rewards offered by the creepy smiling guy. Even after his fiancé is killed and he's injured by a shooter, he still does not give into temptation after finishing his second term of office and denying want change laws so he could continue through a third, Prez hit the road and beyond some Elvis level sightings, he disappeared into the sunset. When Prez died, despite the lack of news on the subject, collectively the nation knew the tragedy that had befallen them. When Death came to retrieve Prez, he was led to gold gates in the clouds and was met by Boss Smiley. Who explains that there are other Americas, other realities that are unknown to most when Prez explains that he wants to leave to the afterlife of broken watches he was told about. Boss smiley says he will not let him leave that he has to stay with the boss. Dream shows up and puts the kibosh on Boss Smiley's plan, taking Prez out of the situation and literally disappearing in front of the boss's angry visage. Dream explains that Death was the one to call attention to this plight and that he had her the thank for his rescue. Before dream sends him off to the real afterlife, Prez gives dream a pocket watch. And the narrator mentioned that he could be out there spreading his good word or waiting to hop back into reality, but we may never know.  Mike: Yeah. And I really liked that one because it was, the Neil Gaiman spin on a classic obscure character. But I liked the idea of. this person who was in the DC universe, like, you know, a real in quotes character becoming an urban legend. And by that becoming a dream of a nation. And I liked the idea of Morpheus stepping in and being like, nah, he's, he's mine. Jessika: Yeah. Yeah. exactly. So our next story is called Cerements and begins of course, back at the World's End In. And the storyteller for this tale is named Petrefax an apprentice and Stacy has a true story about another member of the party he has with his master BlackRock. Both are from necropolis. We begin in a glass where clap Roth is teaching ways to get rid of a body and quizzes at daydreaming Petrefax Petrefax is assigned by black broth to go see an air burial that was scheduled. The party members of this gathering tell their own stories of the lore of death and the ceremony surrounding it. There was a tale about a prior city that was not showing enough respect for it that ended up being destroyed and reestablished and another that followed the search for hidden place in the city that holds a book that knows many things about death and the departed Brent becomes convinced that the end is actually just them in death, but one of the other people at the end states that they can explain the Inn and magic.  Mike: yeah, and I don't think we've seen Necropolis before now, but I know it shows up later on in the series. Jessika: this is the first time that I had. The final story is called world's end, which shows the storm breaking and the different patrons departing to their respective homes and realms. Well sort of Charlene decided that she didn't really care for her reality anyway, and wants to stay on working at the Inn. Although Brant absolutely tries to talk her into going back with him in vain. Petrefax decided that he hadn't seen enough realms and decides to leave and go venturing with Chiron the centaur. When Brant gets back, the car is in one piece without a scratch on it. And it is registered in his name. All signs of Charlene's existence have been erased from the reality in which he lives with Brant being the only person on earth to remember Charlene.  Mike: Yeah. And then it's revealed that he was telling the story to a bartender. And that basically when he got to their final destination, he called his work and said, I'm not coming back. Like everything has changed. And then he stays out there and, yeah, it was just, it was kinda, it was one of those ones that ended in a way that was kinda weirdly bittersweet it felt a little sad, even though most everybody got what they wanted. Jessika: Yeah. Yeah. I agree. Well, Mike, was there a scene or event in this volume that stood out to you?  Mike: I mean, there's a lot, actually, this is one of the volumes that I really do. Like, but the one that I always really find myself going back to is the story about Prez, which, you know, I mean, based on our prior conversation, probably shouldn't surprise anyone. I really loved how Gaiman created something that was very true to the character, but also was a totally different spin at the same time. And it really felt fun and thoughtful. And I enjoyed how biblical it felt in a lot of ways with Prez being this kind of Christ-like figure. And then Boss Smiley being the adversary. Like they even have the moment where Boss Smiley is trying to tempt him on top of a mountain. Yeah, like I just, I think that is one of my favorite of the Sandman short stories. Jessika: Yeah. That doesn't surprise me about you.  Absolutely.  Mike: What about you? Jessika: No, I really liked the part where Charlene went on a rampage about how there weren't any women in their stories except to further the plot line or be decoration.  Mike: Yeah.  Jessika: It was like, yes, girl.  Mike: I mean, even with the one about Prez it's like he has a fiancé who gets shot and that's about it.  Jessika: Yep, totally fridged.  Mike: Yup. Jessika: Yeah. And it also, I also appreciated Gaiman for actually taking the time to point this out in the narratives.  Mike: Yeah. Jessika: I mean, it would have been nice if there actually had been women in the narratives instead of him just pointing it out. You know, something to think about. Mike: Yeah. Jessika: But that is one of the things that I like about this series in general, while there are some really, really violent things that do happen to women. There are female characters who take charge and step up and act as main characters and have more of a presence. Is it the whole series? No, but I do feel that this is at least trying to be somewhat inclusive. You know, in the way cis male author. And do so. What was your favorite art moment in this. Mike: I think it was the funeral procession that we see towards the end, it's shown across several two page spreads and it's really striking and knowing what I know, it's really interesting with all the foreshadowing that the wake provides us with, but the way that it's presented, we don't know what's g

What does it mean if a therapist suddenly changes their behavior? In this episode, Katie shares her experiences with two therapists who made significant adjustments and left her (and Ben and Carrie) confused about what happened. Plus, Dr. Ben Caldwell returns with fantastic metaphors about ethical gray areas and how therapists can adjust their boundaries and clinical style in a compassionate way.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community.   Introduction: 0:00 – 5:43 Part One: 5:43 – 42:32 Part Two: 42:32 – 1:25:40 Part Three: 1:25:40 – 1:30:33   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to Alzheimer's Association Embracing Our Core Competencies: How Would It Change the Practice of Therapy? Sentio Institute Undergraduate Internship (Note: For California residents only) A User's Guide to the 7 Criteria for ‘Good Therapy' Ben Caldwell Labs SimplePractice Learning

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 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.    

An Incomplete List of Everything Wrong with Therapist Education An interview with Diane Gehart, LMFT, on what works in therapy and where the field is headed. Curt and Katie talk with Diane about the overwhelming amount of information new therapists must learn in school and how this impacts their confidence. We also explore how the field is moving towards synthesizing theories and how this will impact future 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.   Interview with Diane Gehart, LMFT Diane Gehart, Ph.D. is Professor in the Marriage and Family Therapy and Counseling Programs at California State University, Northridge and has a private practice in Agoura Hills, California. She has authored several professional books including Mindfulness for Chocolate Lovers: A Lighthearted Way to Stress Less and Savor More Each Day, Mindfulness and Acceptance in Couple and Family Therapy Mastering Competencies in Family Therapy, Theory and Treatment Planning in Counseling and Psychotherapy. In this episode we talk about: Who Diane Gehart is and what she has (and continues) to contribute to the field. Diane discusses what is wrong with therapist education and how it impacts newer therapists. How we can help students feel more confident when they enter the field, while still providing a good education. The abundance of theories students need to learn in graduate school and how the future of the field will be synthesis of theories. How the synthesis of theories will impact testing for licensure. Diane discusses how focusing on client outcomes and finding quality training can support confidence in new clinicians. How cultural considerations can be included in the synthesis of theories. Using the client's reality/perspective to make therapy work, rather than focusing on interventions. Explore how different parts of the field (e.g., clinicians, researchers, educators) contribute to what is wrong with therapist education. The need for synthesized information to be more widely available to make more competent therapists. Balancing helping clinicians to feel more confident while also encouraging them to be self-motivated to learn. What are the best things clinicians can do right now to improve their confidence? Our Generous Sponsors: Healthcasters The Healthcasters is a podcasting course and community designed for therapists in private practice and therapists turned coaches + consultants that's supported the successful launch of over 270 podcasts. Wanted to tell you guys a little bit what's included in the Healthcasters podcasting course. It includes simple step by step videos to take your podcast from idea to one that generates income when it launches. Also includes cheatsheets and templates Melvin uses for the Selling The Couch podcast whether its scripts to reach out to guests or templates to let guests know a podcast is live.  We recently released the Podcast Episode Tracker.  This simple sheet helps you keep your podcast episodes organized whether you want to reference them later or re-purpose the content in the future.  You can also choose to upgrade after purchasing the course to a community of over 250 other therapist podcasts.  This also includes monthly group and 1 on 1 coaching calls with Melvin.  You can learn more about Healthcasters at sellingthecouch.com/jointhehealthcasters (enter the promo code "therapyreimagined" at checkout for $100 off the listed price). 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! Diane Gehart Therapy That Works Mastering Competencies Mindfulness at Our Schools Diane on YouTube   Relevant Episodes: You DO NOT Have to be a Thought Leader Reigniting Therapy How to BE a Therapist Unlearning Very Bad Therapy Showing Up for Your 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. 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 the Modern Therapist Survival Guide is brought to you by The Healthcasters.   Katie Vernoy  00:04 The Healthcasters is a podcasting course and community designed for therapists and private practice and therapists turn coaches and consultants that supported the successful launch of over 270 podcasts. Learn more about The Healthcasters at sellingthecouch.com/jointhehealthcasters and enter the promo code therapyreimagined at checkout for $100 off the listed price.   Curt Widhalm  00:26 Listen at the end of the episode for more information about The Healthcasters.   Curt Widhalm  00:29 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  00:45 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 things that we do the places our field is where it's going. And we are once again joined by one of our therapy reimagined 2021 speakers Dr. Diane Gehart LMFT talking about the future of psychotherapy. And this is something where we're really excited to always look forward of where we're going. And for our longtime listeners know that we kind of try to push the envelope here with the things that we do on the podcast with our conference. It's always wonderful to have like minded people, and not making lots of stupid jokes start this because Diane's my boss over at State University, Northridge. So thank you for joining us today. Thank you so much for having me.   Katie Vernoy  01:44 We're so excited to have you here. And we start each of our interviews with this question. Who are you? And what are you putting out into the world?     Diane Gehart  01:53 Wow, wow, that is a that's a big question. I'm going to try to keep it simple though. I'm Diane Gehart. I am a licensed marriage Family Therapist I have been a professor of family therapy for I'm coming up on my 25th year of teaching full time, I currently run the family therapy program at CSUN. And Curt is our amazing law & ethics instructors. So it's really a pleasure to be here. And yeah, and   Curt Widhalm  02:22 I'm just jumping in. I'm going to point out to one of our listeners, Dr. Ben Caldwell, She didn't mention you. Okay, go ahead. Okay, okay. Okay,   Diane Gehart  02:32 but you teach too la & ethics classes for me, and Ben only teaches one,   Curt Widhalm  02:36 so I'm twice as good, as bad, as valuable, as valuable to me.   Diane Gehart  02:45 Let me tell you, you two are the best of the best. And so we absolutely have the best law and ethics classes of any MFT program in the United States, I'm really sure of that. So yes, in addition to hiring some of the best faculty in the world, I do a lot of writing in the area around mental health theories. I've written textbooks, And I believe I'm the only person who's written mental health textbooks on both family therapy and counseling theories, which are actually two different worlds, if you're in the mental health world, that I'm really passionate about theories, and how therapists learn. I've done a lot of work around trying to create better ways for people to learn how to become therapists using competencies and simulation and all sorts of new things. So that's something a bit about me and what I do, what I put out in the world,   Curt Widhalm  03:32 As an educator that has been around for quite a while. Very loaded question to start out with here. But what's what's wrong with therapist education?   Diane Gehart  03:45 Wow, wow, wow. Yeah, it is, it is a big question. And I have, I've really been privileged, I think in my career, too. And I've had people say, Diane, how do you end up at the forefront of everything, and I really have been blessed and lucky. I did a lot of training early in my career. And it's really been fascinating to watch the evolution of what has happened over the last 20-30 years in the field. Because when I started my first degree with a master's degree in counseling, and you know, we learned about eight theories, evidence based treatment was not a thing, we hardly learned, we didn't learn about the brain and my grad program whatsoever. We even have a psycho forum class, you know, it was pretty much pick a theory that you like, learn it, you know, and when you graduated, you knew you'd go to all the conferences on this and you're done. You felt competent. We didn't have imposter syndrome back then. I mean, it was really different. And when I went to my MFT doctoral program, you know, again, it was about eight theories, I had to learn they overlap a lot with the counseling ones, pick one, get good at it, you know, and, you know, enjoy your career. So that's pretty much what it was like when I started and so I just finished Writing a state of the art, you know, master's program and family therapy that, you know, meets the national COAMFTE standards that meets California licensing standards. And that meets the needs of the stakeholders, the employers in which is LA County Mental Health preseason. So I've made everyone really happy. And there are about 25 different theories, some traditional, some evidence based that my students are learning. And it is amazing because my students are exceptionally well trained, not just because occurred, but we have an amazing faculty, it's an amazing curriculum. And when they leave, they are so confused, they have imposter syndrome. They they don't know where to start, and they're totally lost. And I sit here and I watch this because I know what it was like, where I started and what that look like. And now I'm looking at where students are today. And it's this cannot continue. It's kind of where I'm at. It's it's really, it's this bizarre thing where in some ways students are getting more information than ever, but they feel less and less competent. So it's this weird paradox. The way we have just we've been doing what we've been doing for years, and we just keep adding on adding on adding on. But there's no synthesis, there's no integration. And it's overwhelming students, especially at the Masters level,   Curt Widhalm  06:22 Katie, and I talk about problems in therapist training and education, we have been for several years here. And I've heard forever back to when we were students about you know, therapists need more training. And I've never heard it kind of putting the terms that you are putting it in here now of maybe, we're throwing too much at people. And that's what's leading to a lot of this problem as it's developing. What is possible as far as fixing this direction that we're going like, what can actually be done? You're familiar with all of these standards, you have, you know, a million different bosses, maybe not directly, but a bunch of people's requirements that you have to be what is actually possible to kind of change the momentum to helping people feel more confident entering into our fields, while still being well educated.   Diane Gehart  07:20 And that is the $10 million dollar question, because what we have is we have, we have licensing boards. And I think our licensing process needs to be totally overhauled. It just so happens I'm in a position in my career where because I've been thinking about retiring, moving to another state, I have to take the national MFT exam. I'm taking it actually on July 21, this summer. And I ended up having to learn all about the national MFT exam, which has such ancient theories in it that like, they actually have been taking those theories out of my textbook, and I'm like, Oh, my God, because I'm running a class on laugh your way to licensure. And I have just been shocked and slightly horrified at how much old information like if they really want you to learn symbolic experience, because they're great questions. It's really easy to write, you know, exam questions around symbolic experience with doing that anymore. Just newsflash both. So it's like surreal. It is like this trip back into the past when you look at our licensing exams, and then you have, so they're one piece of the puzzle. And yeah, kind of like educational programs have to prepare folks for licensure, but we have very little influence on what is on that exam. So that's one huge, very difficult piece of the puzzle to influence, you know, and then we have the accreditation standards, which I mean, they move very slowly, we have more influence on that, because they they're more stakeholders are able to give their you know, two cents. But still, it's a very slow process to move that. And then quite frankly, I've discovered as someone who directs a marriage family therapy program, it's hard to get faculty who trained up, you know, when I tell people you need to teach these newer theories, I get this deer on the head, like, but I don't know that theory. And I'm like, well bring yourself up. And this is a whole new, you know, situation. So the problem is we have these huge systems that are very hard to shift and change, that are very rooted in the past. And they are not evolving at the rate that practitioners need to be evolving. So it's really a very difficult thing to do. And I'll tell you, I'll be I'll be honest, I don't feel like it's going to be my role in the world. I know that someone else fix those systems. I mean, my solution has been as I page this other course that I've created, that it's synthesis, I think the answer is going to be synthesis because if you remember back to some of your You know, grad studies courses are two reasons the EU and you're listening to this new theory new, like, a lot like XYZ theory, a lot like, you know that that the theory will be honest to god truth is, and I'm going to say like it is yes, there's a lot more overlap than distinction between these theories. And we have to start boiling down the core concepts in the basic brain works very simple methods that are, it's, it's not even integration. I mean, we're past integration that was a couple decades ago, this is synthesis, we have to really extract from what we the knowledge base that we have, and put it into a very simple framework that a human being can use, because what we have now is almost impossible, the way we train our students and license people to the way they're supposed to be updating themselves. It's not, the pieces don't fit together nicely, we're gonna we have to synthesize this knowledge base in a much more coherent way.   Katie Vernoy  11:02 With this synthesize knowledge base, it seems like it would come down to very common interventions, I'm thinking kind of the kind of the common elements of therapy, and to me, it seems like that would be very helpful. And it would also mean that folks would then have to study differently for these licensing exams. Because we're very attached to these intricate theories with the titles that they have for the same thing, you know, they've renamed it save slightly tweaked it. And so to me, it seems like there would be a lot of pushback. So for the therapist, you're describing something that is very empowering, I learned what therapy is and what we commonly see as effective. And what we see on the educational side is bureaucracy and ego and hubris, holding into these very distinct theories that, you know, it just seems like well, I, you know, to keep my job I have to publish. And so now I'm going to create a theory. And now everybody's going to have to learn this theory. And I'm now committed to this theory, and I'm not going to let it go.   Diane Gehart  12:11 So, you know, I actually think there's a lot of different layers here. So I, I actually think I'm working right now on developing, I just call it therapy that works, because if you call it anything else, any theoretical term, we are so divisive. in this field, you're postmodern your system is or your, you know, your psychodynamic or your CBT. And that's, and then you're these little cancer all fighting with each other. And it's just like, it doesn't need to be like that I actually think you should be using every theory is, you know, what we're dealing with all of human suffering in this world, you know, and it is you need every bit of wisdom you can find. And so I think we've created a lot of artificial tensions and wars that are not actually helping us serve our clients, by, you know, dividing up into these little camps is kind of what it feels like to me. And, and so, you know, when I first started writing my textbooks, I was very deliberate in how I approached this because I wasn't a camp I really was, I'm, you know, in the postmodern world, that's, you know, kind of was my camp. And it was interesting, one of the parts of the postmodern world is this concept of appreciative inquiry, where you learn and use curiosity and really appreciating what's good about the others. And I very intentionally when I started writing, my textbook said, I am going to approach every single theory that I have, and I had biases, I absolutely did. With appreciative inquiry, somehow, these ideas were important enough to really stand out. And I'm going to figure out what it is about each single one, you know, and as I did that, I was really surprised, honestly, the how I found something really wise in each of these approaches over the years, and so on, begin to see a lot of these connections. And so I think, learning to appreciate those, but now we have so many, it's like you're lost, unless you're lucky like me, and you've had 30 years to slowly piece together the knowledge base of the field. For those who are coming into this. It's just one on all overwhelming, I think for everybody. So when it's, you know, I actually think we're at a place where we can, you know, create structures. It's more like a method where you take out even most of that theoretical language, because there actually is a skeleton underneath it all I can't quite describe but I think in a podcast, but there is a skeleton, I call it, it's like that you can begin to see. And every single theory kind of maps on top of this basic skeleton and when you approach it that way, you begin to see those connections. And so it's much easier to make sense of the many sources of wisdom and knowledge. We have in this field   Curt Widhalm  15:01 almost kind of common factors of building from there that there's many factors that we use, regardless of what we do. And the rest is kind of the seasonings on in the structure of a plate of food here. Looking at this from where we can come from kind of this basic place, you know, taking this from the idealistic, you know, and how should we be trained? Like, okay, that's gonna be, you know, decades in the making of getting a bunch of disagreeable people to agree on changing all of these systems. What can therapists do for themselves to not get sucked into all of those traps, and all of those arguments to follow a good individual training path that they can feel confident and not constantly be worried about? What I don't know, and falling into imposter syndrome?     Diane Gehart  15:59 Well, you know, I think, finding a very solid, broad method of working, that really serves your clients that really notice whether or not you're making a difference, like therapy should have results actually relatively quickly in treatment, you know, and so I think really focusing not just do like the theory, are you having a good time? Do you feel good about yourself? But like, are, are things changing for your clients, and to really focus on outcomes is one piece and then to, you know, really be thoughtful about what you get yourself trained in? And to learn to really be conscious about learning skill sets and making sure they work? Because the truth is, you know, looking at the common factors, right, you know, any therapy model out there just about can deliver decent outcomes. And the questions is, are you able to do that? And how do you put yourself in a position to do that well, and consistently.   Katie Vernoy  17:10 So there's an assessment piece, but this other angle that I'm looking at, because when we go to common factors, it seems like it's very, very clear, they're very broad, they're so broad that that I think that it's, you know, it's something that also can be a little bit confusing to just when it's so broad, right?   Diane Gehart  17:27 Yes, yeah, common factors is too broad to be useful in the room at this point in history.   Katie Vernoy  17:32 But when you were talking about the skeleton, and that all of these theories kind of fall on this same skeleton, and, and for me, and I guess this is just for my head, when I think about kind of things that are very systemic can also be impacting the skeleton. And so if we're looking at whether it's systemic bias or oppression, when we're looking at those types of things, I'm wondering if if, in creating the actual skeleton of what works and and separating out the language, if that's a way to decrease bias, or if it's already baked in? And if oppression is already baked? In?   Diane Gehart  18:08 Yes, yeah. I mean, in my in my system that I've been developing, therapy that works, I don't have a better name. Because whatever I come up with, I know someone's gonna hate it for some reason. But yeah, so I, you know, there's way to analyze what happens behaviorally, emotionally, cognitively, and then at the societal level. And so to put that piece in as the fourth kind of level when you whenever you're analyzing or assessing what's going on with a client, but is that kind of answering what your I think it is?     Katie Vernoy  18:37 I mean, I think for me, it's it's something where so much of our history as a profession has been guided by   Curt Widhalm  18:45 hierarchy, structural sort of differences.   Katie Vernoy  18:50 You can continue talking, Curt, I was agree.   Curt Widhalm  18:54 It's this fundamental shift of really empowering clients to be in control of some of this process to it's shifting that hierarchical power that, you know, we can spend, you know, hours and hours talking about the roles of transference and countertransference. And what's left unsaid and to boil it back to and you should totally trademark therapy that works. And then be argued with like the, you know, 3% of cases where it didn't. But it's embracing where mental health field has really common as far as who dictates when therapy works. Yeah. Yeah, I don't know. We're awkwardly not stating a question. That's just more of Yes.   Diane Gehart  19:46 Yeah, and if you look at what really works, and there's a ton of research behind this is you have to work within the clients reality. It has to work for them. I mean, it does have to be the client. I talked to When I when I, when I teach this approach I talk about like entering the client's reality, it's like their holodeck, and you've got to go into their holodeck into their reality to understand what is going to work from where they're standing. It's one of the things I've been realizing is in this class that I'm teaching therapy that works. I'm like, if it's forcing me to identify what I actually do in the room, and I realized, what I've done is I literally turn theories inside out. And that I literally take this because the theories are written from the, like a therapist looking at a client, that's how the theories are written. But if you really want them to work, well, you have to take the theory and like flip it inside out. And you have to apply it from within the clients construction of the world is the client under see sees it, and then it works like magic. But if you're trying to it's like squinting, fitting for the square peg in a round hole, right, that's kind of what we've been doing. And if the client will go with our reality, that's great. But if they don't, which many of them don't, then it just worked so much smoother, if you can take the knowledge we have, and have it like, enter into the clients make sense within the clients world. And it's like, I can only describe it as like flipping it inside out.   Katie Vernoy  21:19 I think that's so important, because with a lot of theories, and maybe this is, you know, getting back into the awkward space, but it seems like a lot of theories assume we know. And there's that kind of paternalistic, we know what's best for the client. And what you're describing is really getting into the, to the space into the holodeck of the client, and really understanding from their perspective. But to do that, we have to come from a very humble and curious place, and be able to really see from their perspective, which requires so much sitting back and and active exploration versus doing interventions on clients.   Diane Gehart  22:01 Absolutely. Yeah, absolutely. Doing interventions on clients is the least efficient way to go about this work. It just really is. I really believe, I guess what we're describing here is, you know, obviously, I'm trained, you know, in collaborative therapy, it's one of my specialty, and it is really still my home base. But it is so fascinating to me, if you just slow down like you described and become curious about, wow, your client makes sense of life interprets life, just asking those questions, having a client put that into words, because most of us don't put it into words in our own head, we're not aware of it. So someone asks us and we begin to like put all those pieces together. I really think over 80% of what I do is just that. And you know, there are other interventions that are important. You know, my favorite one to point out to everyone is the research is like exposure is the treatment for OCD folks. Like that's all that works, right. So there are places where you need to be much more intentional about that. But it is fascinating how just slowing down being curious, entering and really under as you come to understand how the client makes sense of their life. So many things just unravel and problems get resolved or shift in pretty magical ways. So that the work of the end is like sweeping up, you know, a little bit of math on the floor, and what it feels like it's the leftovers, but it's so clear what you need to do.   Curt Widhalm  23:30 And a lot of this seems to be driven by the really siloed parts of our worlds, the researchers who, as Katie pointed out earlier, need to keep their jobs by publishing research and things get really boiled down there. And then the research has to inform the education so that the education is based on something and then students and new therapists get thrown out into the real world. And then they experience what you're talking about, which is like, Oh, that's only like 20% of what's actually going on in the room. Is there ways to make these parts of the field less siloed, to where the researchers actually know what it's like to sit across from people who are more complex than one diagnoses and who talk about things more than very specific symptoms of that diagnoses? To actually being able to see what the rest of complex human behavior is like.       Diane Gehart  24:30 Wow, I mean, unfortunately, as over the years I've been in the field, it's become more and more siloed in the beginning, in the beginning when I was really old. And the last century is my kids are like you were alive in the century. Yeah, I was alive. Yep.   Curt Widhalm  24:46 Yep. Yep. I had a client recently as a middle schooler, who referred to the 90s as the late 1900s. And I was   Katie Vernoy  24:58 Oh dear,   Diane Gehart  24:59 yeah. Yeah. So in the last century, it was possible to be a scholar practitioner, like it was this hyphenated thing. It was foundational, especially for doctoral programs as the model, they were all supposed to be teaching us Lalalalala. But in the last 1020 years, we really said that's not possible anymore. Because if you're going to do a clinical trial, ie the skill set it takes to run a clinical trial, you know, which is what samsa and NIH and that's like the gold standard to do that is a full time job. And that skill set is so different and is so advanced, if they don't have time to be a practitioner, and to do quality research in the 21st century, what's expected and so it's pulling us further and further apart actually is, is kind of where we're going. Now, I do think research really has moved the food field forward in important ways. And we really need to stay connected with the evidence base, like when I went to school, it was really considered ethical. And I guess Kurt can correct me if I'm wrong on this, it ethical to use whatever theory you thought would be great, or whatever your theory of choice was to breed OCD, I don't think that's ethical anymore, because the research is so clear about what works and what doesn't. And so, so that really puts us in, I think, in a somewhat difficult, you know, spot with that sort of thing. And so, again, we have to take all of that knowledge, kind of getting back to your question, Kurt is in Reese, as well as a theory need to be synthesized, the research needs to be synthesized. And it really can be it really, it really can be I do believe I have taken a whole DSM. I've created this table, I don't know, it's probably six, eight pages long. But and I have synthesize what the research says works for each of the different diagnoses. I mean, this should be widely available. I know I'm going to work on a book. But still, I mean, we we need to get boiled down to relatively simple, you know, structures and information. And so we have to the synthesis of research, the synthesis of our theories, I also think a huge missing gaping hole in the whole field of psychotherapy is there's a lot of motivational research on like how to just set a goal and achieve it, which we don't even have trickling into our programs, you know, or flowing into the work that we do, which is another very important actually stream of knowledge that I think we need more of in our field.   Curt Widhalm  27:39 And to answer the ethics question that you're asking here is parts of the ethics that most people don't even bother to read is the preambles, which is basically like we do our things based on science. And it's being able to distill and synthesize what the science is that, again, speaks back to what you were talking about earlier, of not overwhelming people and being able to help people in a competency based way of being able to take this education and be able to implement it with people, as clients as explorers as being able to have those timely interventions rather than just kind of like coming in overwhelmed feeling like I have to do something that needs to be justified in this note. And so I'm going to throw an intervention whether or not it fits and hope that nobody audit says,   Diane Gehart  28:41 Yeah, that is not that's not a good place for us to be, I think, as a profession, I'd say we too.   Katie Vernoy  28:49 Yeah, when I'm listening to this, I like the idea of distilling things down to synthesizing them into competency based steps, those types of things. I also recognize that there's an evidence base that we want to pay attention to, I guess the the place I get held up a little bit, and this is something where I think there's a an important tension, I think it's gone too far, one direction, and I probably was being educated in a similar time where there was a theories. And so it seems very doable to me. And I'm not, I'm not facing the 20 theories, right. So I fully recognize my bias. But there is an importance for therapists to also make some of the decisions on their own. And and I worry that if we distill these things down too far, that therapists will be doing things they don't necessarily have the background with the evidence base and why they're doing what they're doing. And that, to me, potentially, is problematic if the the research base has its own issues, right. I mean, I don't know if I'm asking an intelligent question here. But I think when we're when we're trying to simplify something down to teach people how to do a thing. I think there still is value and Having an understanding of the theoretical underpinnings and the the broad complexity of what's behind it all? And so how do I guess I guess the question is, how do you hold that tension? If obsoleting this new this Yeah, education that doesn't seem to exist? Yes.   Diane Gehart  30:16 Well, you know, I would say that I'm with you on that, because I'm a total theory nerd. And I can read theory forever. And I love theory. And so and I do think knowing, you know, reading, I encourage when people are saying, My, my license, or course I said, If you have time, I want you to I give them a reading list of like, 10 bucks. I'm like, No, the voices know that. Understand that. So I definitely think understanding the philosophy, but I think, and especially at the coral level, yes, we can throw them 20 theories, I'm good with that. They've got whatever 120 units, and they need to know the difference between Milan systemic strategic and MRI. But at the Masters level, you know, understanding strategic structural hyphenated, you know, together, as one basic theory is going in, you can, you know, and to understand those two, really, most people in practice, use both of them together, you know, but on the licensing exam, because it's easier to write questions, we have people like memorizing and these tiny little boxes. And so we need to find, like a happy middle ground, because yes, you'll, you'll always be reading lots of theory in this field, there's no way to get I don't think, in my opinion, and you should be reading lots of research, too. But it's creating structures, that it's where it's humanly possible for people to take in that information. It's almost it's ironic that at a time in history, where everyone's attention span is shorter, and shorter, and smaller and smaller, we are throwing more and more and more at people. And it none of it sticking in a meaningful way. And so we have to find, I think we really need to start distinguishing between the master's and doctoral level of training, and what is learned at each level. But, you know, I, here I am with 30 years of experience in training, and I have been training trainers for like, 20 years, right. And I'm looking at what is on the list of to know, for the licensing exam, which you know, you do that early in your career, and you kind of forget about it, but having to go back and do it has been so educational. I'm like, this is insane. This is I look at the knowledge statement. And I'm like, This isn't like humanly possible. This is awful. And I am even telling some of my students like 10% of the stuff like you would have to study so many hours to be able to analyze any research study they possibly could put in front of you. It's not worth it missed those, you just need to get a 70%. Like, don't even worry about it. So we it's like it's like throwing we're throwing everything, you know, at these poor folks taking exams and expecting them to memorize far more than is we know, based on our new neurobiology is really reasonable to be expecting.   Curt Widhalm  32:54 Where can people practically go from here, when it comes to getting better and working with our clients?   Diane Gehart  33:02 Well, I do think you need to really think about and you know, your individual journey as a clinician and getting to how you want to move forward, because there are options, there are different options. But in general, I think, learning one really solid theory, well, that really makes sense. And that you can actually get training in you know, I talked to some people who claim that there's a therapist, I'm like, which could you training, and they're like, Oh, I read some books, I'm like, that that's not training folks. You need to really invest in a program that will be, you know, intense in depth where you learn some skills. And so there are definitely a number of them out there. But I think really making sure and just focusing on that not getting distracted by everyone else telling you what else you should be doing or my bet what might be better, like pick one stick with it, do it well master that and look for results.   Katie Vernoy  34:01 So there's a lot that you were talking about that was either in development or that you've already created and and so I'm sure that people would want to get in touch with you and talk through these things with you. So where can people find you?   Diane Gehart  34:15 Well, I have started what I call the Institute for therapy that works and so you can find it at therapythatworksInstitute.com or Dianegehart.com, I do have a course you know where I actually teach this method, it's the best word I can come up with the moment for trying to really find a way of working that synthesizes uses everything you know, you can pick whatever other theories you want to use, but to really create a holistic structure from beginning to end that really grounds folks and what they're doing so I'm very excited about that. And it's funny because that's the I have one side of this one project that's synthesizing every now all the knowledge and it's really funny. On the other hand, I do have this laugh, your way to license your course that is going to teach you all the different silos that you need to know. And it's a very kind of bizarre, actually as the instructor of both courses. One is how many little teeny tiny theories Can I teach you? And then where's the master theory? So, I offer both options.   Curt Widhalm  35:14 We will include links to those in our show notes. You can find those at MTSGpodcast.com. And you can check out the therapy reimagined conference where Dr. Gehart will be helping us out and talking about the future of therapy there. You can find out more information about that and all the latest up to date news at therapyreimaginedconference.com or follow us on our social media. And until next time, I'm Curt Widhalm with Katie Vernoy and Dr. Diane Gehart.   Katie Vernoy  35:45 Thanks again to our sponsor, The Healthcasters   Curt Widhalm  35:48 I wanted to tell you guys a little bit of what's included in The Healthcasters podcasting course it includes simple step by step videos to take your podcast from idea to one that generates income when it launches also includes cheat sheets and templates Dr. Melvin Varghese uses for the selling the couch podcast, whether it's scripts to reach out to guests templates to let guests know that podcast is live. The recently released the podcast episode tracker the simple sheet helps keep your podcast episodes organized, whether you want to reference them later or repurpose them for content in the future. You can also choose to upgrade the purchase of course the community of over 250 other therapists podcasts. This includes a monthly group one on one coaching calls with Melvin and you can learn more about The Healthcasters, it's selling the couch comm join The Healthcasters   Katie Vernoy  36:38 Enter the promo code therapyreimagined at checkout for $100 off the listed price at sellingthecouch.com/jointhehealthcasters.   Curt Widhalm  36:48 Thank you for listening to the modern therapists 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 State of the Profession in a COVID World Curt and Katie chat about the current state of the Mental Health Profession. We give our opinion on a recent report from SimplePractice, looking at what they included as well as what we think is missing. We explore how COVID has impacted burnout rates and give action steps professionals can take to support each other as we continue to move forward as a field. We also talk about barriers in our field and what is coming next. This is the Modern Therapist Consumer Guide, a series of special episodes to help modern therapists navigate products and services specifically designed for therapists and their clients. We dig deeply into the companies, the people, and the products and services so you can make smart decisions in building your practice and serving your clients. In this episode we talk about: 0:53: What do Curt and Katie think about the report? And how do demographics and length of time in the field impact how long clinicians stay in the profession? 2:27: Who feels burned out the most and what are action steps professionals can take to help each other with this problem? 7:44: How do financial burdens and parental burnout impact a clinician's ability to work in this field? 10:50: How do insurance regulations create barriers for clinicians and clients? 15:38: How has COVID impacted use of technology in the field and accessibility to care? 18:55: Who are the therapists in the field and who are they working with (demographics)? 23:18: How do social justice issues impact burnout rates? 24:56: What comes next for our profession? 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 www.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.   GreenOak Accounting At GreenOak Accounting, they believe that every private practice should be profitable. They've worked with hundreds of practice owners across the country to help them gain financial peace of mind and assist them with making smart financial decisions. GreenOak Accounting specializes in working with therapists in private practice, and they have helped hundreds of therapists across the country reach their financial goals.  They offer a number of monthly service options that can be catered to a practice's needs - from basic bookkeeping to premium CFO services. Other specialized services include Profit First Support, compensation planning, and customized KPI Dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice, and offer unsurpassed support along the way.  If you're interested in scheduling a complimentary consultation, please visit their website at www.GreenOakAccounting.com/consultation to learn more.   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! State of the Mental Health Profession: Impact of COVID-19 Teletherapy Good Enough Therapy For A Crisis…and Beyond!   Relevant Episodes: Fixing Mental Healthcare in America Structuring Self-Care Quarantine Self-Care for Therapists Why Therapists Quit Why Therapists Quit Part 2   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/ 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 simple practice 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 episode is also sponsored by GreenOak Accounting.   Curt Widhalm  00:26 At GreenOak accounting, they believe that every private practice should be profitable. They've worked with hundreds of practice owners across the country to help them gain Financial Peace of mind and assist them with making smart financial decisions.   Katie Vernoy  00:38 If you're interested in speaking with a member of their team, visit their website at greenoakaccounting.com today.   Announcer  00:46 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  01:01 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, therapists related, and today's episode we are going to be discussing from our friends over at SimplePractice, they came out with a report called the state of the mental health profession, impact of COVID-19. And they had done a survey of a lot of mental health professionals from all across the United States. And this was published here in the first part of 2021. There's about 2500 respondents on this, and we are going to go through and talk about some of their findings, some of our reactions to this, and maybe kind of look at the way that Katie and I do the way that our profession goes forward. So Katie, what are your first thoughts on what you're finding out of this report? We'll also link to this in our show notes at mtsgpodcast.com but Katie, what are your thoughts on this?   Katie Vernoy  02:06 I think a lot of the report feels very common sense, I think there's a lot that we know, intrinsically or or instinctively, maybe that's a better word that is really showing up in this report. But I think it does have some good data that shows us things more concretely, to me, there's there's definitely things that are of concern, that I feel like we probably want to address, maybe not in this episode. But like as a society as a profession. We want to address these things. And one of them is the differential way that demographics and length of time in the profession impact clinicians, because to me, there's a sense that when folks have been in the profession longer, and they actually stay in the profession, I think there's a different way that we approach it versus the time stirring, which we're new in the profession and have a little bit less control. I feel like that's a little vague, but but maybe we can dig in. And I can point out some of those thoughts. I think it's it's something where we need as the two of us being experienced clinicians who have chosen to stay in the profession for this length of time, may want to reflect on why our newer colleagues or colleagues of color and color colleagues with other types of marginalized identities are having some different struggles than we are.   Curt Widhalm  03:29 So one of the first sections of this report is specifically diving in on this is who feels burnout the most. And this was broken down into aged categories with percentages of people who've always or often have feelings of burnout, those who rarely have it and those who report no such feelings and really stark differences in some age groups here 27% of those aged 35 and under reported always feeling burnt out. And these numbers go down in the higher categorical areas based on age 20% of 36 to 45 year olds 18% to 46 to 55 year olds, 13% of 56 to 65 and only 6% of those age 66 or older. And to me there's, you know what you're talking about here of oftentimes, younger therapists don't have as much control over what their practice is, as you're mentioning that your pre license you're working in agencies, you might not have as much of an opportunity to have control over your case loads when you see people how you see people that oftentimes being in this profession longer ends up affording us either the ability to shape our practices or private practices in the way that we want from moving up into supervisory or managerial positions that give us more control over our day to day. We also in this I think are missing that there. Usually a lot of survivorship bias that comes into questions like this. And this was something that we had originally first talks about in the very first therapy reimagined conference that you had I did our presentation on that, when it comes to Later career therapists and the research that's done on them, the people who are going to burn out and leave the field have long already burnt out in the field. And so the survivorship bias here might also be that those people who have a longer career have given me in some of those older age categories, have either a learned how to deal with the stresses better, might have easier abilities to control their schedule, but also just might be more naturally inclined to handling the kinds of stresses that come because those people who are feeling beartown, to those younger categories, might be the ones that have already left the field by the time to get to those older age categories.   Katie Vernoy  06:03 Another thing that I'm thinking about too, is that this is really broken down by age, but not necessarily time in the profession. And as therapy is a great second, third, fourth career and oftentimes can be a retirement career, folks who have had other careers have different financial situations, may be less likely to be burned out in later, later ages, because they have designed it that way. They have that financial buffer that someone starting in the career in their 20s and 30s, may not have and and they also have some of the skill sets from working in potentially high intensity professions like corporate careers, and that kind of stuff, where they can then turn to those skill sets to help manage those things. So to me, it's, it's something where I agree survivorship biases here, I think there's also differential experiences when people enter the field at different ages, because I think that there's different things that you bring to the table.   Curt Widhalm  07:02 So one of the takeaways here, one of the action steps when it comes to using this kind of data is, if you're a younger therapists, feel free to reach out for some help. And if you have some capacity as an older therapist, as a supervisor, as a manager, you might notice this kind of stuff a little bit more being a risk factor with some of the younger therapists that you might be working with, if it's within your capacity to kind of check in with some of these early career therapists, younger therapists a little bit more to see how they're doing. This might be something that helps to alleviate and normalize some of the ways that we react to burnout rather than it just being kind of a well, we've all dealt with it at some point. Good luck kids sort of aspect.   Katie Vernoy  07:50 Yeah. I think the other piece, and this is something where it sounds like one in five respondents under 35 wouldn't choose their profession if they could start over. And so that potentially means that they are more likely to leave the profession, or they won't be the word of mouth to say, hey, being a therapist is cool. In our series of fixing mental health care in America, we referenced the RAND report and those types of things, where we're looking at what is needed in society. And we need more therapists, we need more mental health providers. And so as a manager, as a supervisor, as a professor, as someone who is potentially in a position to mentor or steward someone into the profession, or to succeed in the profession, you know, like help them out, it's our profession could really go the way of the dodo bird, if we don't have enough people that are actually entering the field.   Curt Widhalm  08:45 And there's things in this report that speak to this. And there's some things that Katie and I have discussed with a number of our episodes here before but the financial burdens on younger therapists these days are much higher than they have been in the last 40 years and costs of getting degrees is eight to 10 times higher than it was for people who got the same kinds of degrees in the 80s. Here's our annual shout out to saving psychotherapy by Dr. Ben Caldwell.   Katie Vernoy  09:18 But I think it's more than annual at this point.   Curt Widhalm  09:23 But something that is in this report is also the parental burnout that is likely going to be associated with younger therapists that younger therapists are going to tend to have younger kids, but we've talked about this in one of our previous episodes about just kind of the therapist, partner responsibilities sorts of things, but younger therapists tend to have younger kids biological demographically, that it's a lot harder to parent a infant to three year olds than it is going to be to parent a later teenager, when it comes to just self sufficiency sort of things. And those are going to be harder to parent than adults, kids who have launched out of the house and are fully independent on their own. And this is likely a contributing factor to part of this report from simple practice here just about how much this parental burnout is contributing to people trying to balance the work that they do find the right space to be able to work from home and have kids in the other room, and how it affects their ability to work with clients.   Katie Vernoy  10:36 And I think that oftentimes, and we've seen this in the larger society, is we do have a very feminized field. And we have another conversation to have about that. But a lot of women end up doing or, or a female identified folks end up doing parenting, that they end up being the ones that take that responsibility on. And so many folks who were required to do the parenting ended up either decreasing or leaving their work in order to do that during the pandemic. And oftentimes, it's very hard to kind of go back from that, whether it's with, you know, with a private practice, you can kind of add clients and stuff like that. But I think with within our field, it's not as easy just to kind of pop in and out of jobs. Because there there are different kind of parameters that people are looking at. And work gaps oftentimes are very feared because of the impacts on clients. And so to me, I feel like being able to really understand who therapists are, and how life and society are impacting them is very important, because we want to support people, all people with all situations being able to be therapists, because if we don't, we don't have the lived experience that a lot of our clients need.   Curt Widhalm  11:51 Shifting to chapter two of this report on talking about the state of insurance, and looking at insurance regulations and barriers in the insurance system that's making it stressful and expensive for clinicians to take insurance. There's a number of quotes that are listed in here. Things like current insurance, reimbursement and time spent with billing are driving people away from accepting insurance. And I fully resonate with that kind of stuff. Currently, insurance reimbursements and time spent with billing are driving people away from accepting insurance. I know I can resonate with that you take insurance, you might have a little bit more of a background into this year.   Katie Vernoy  12:37 I think for insurance, there is a double edged sword to it a little bit because there is the reimbursement and time spent that's that's awful, right. In some places it is improving, I think there is room for negotiation, different states have different insurance, reimbursement rates that actually are more aligned with cost of living California is pretty awful. But I think other states kind of do better with that. The thing that I'm really seeing related to insurance, and I don't know that it's necessarily addressed in this report, but I think you and I've talked about potentially doing another episode on this is that there are large provider networks slash group providers that are negotiating directly with insurance companies and bringing on therapists to kind of take away all of that. But that means that that can increase availability of insurance. for insurance providers, I think there's a lot of folks who are worried that if they don't take insurance, that they won't be able to have a full caseload, there's access issues. And yet, with the state of the insurance right now, at least as I perceive it, it just isn't sustainable to do a full insurance practice on your own in some areas. Because there's there is all that oversight, there is the negotiation that you want to continue to do with insurance companies to get your rates increased. There's a lot of chasing things down. And if you don't want to have a biller that can be onerous, and create a lot of that busy work that is inane and exhausting. And so to me, I feel like I think we're going to be seeing a shift and how clients access therapy when they want to use insurance. And I think that providers who are in private practice may end up at best having a hybrid practice, at worst may not really be able to be competitive, and consistent with other types of therapists that are providing insurance or that are using insurance because of some of these systems that some of these kind of things are that are being built up about it. But I know you and I have talked about doing a whole other episode on kind of the future of and the commoditization of therapy and kind of large companies taking over the healthcare space, including therapy. So I'll leave that there. But I think that there has been for me anyway, there's been a big need to be able to provide insurance because people were struggling financially. I think that's not necessarily really the case in the economy didn't really have the tank that people thought it was going to. But it is a lot more work for a lot less pay. And so I think there's going to be a mismatch unless clients start going to these bigger providers that are willing to take on all of the burden and have therapists do that just do the therapy. So more to discuss there. But I think insurance is still going to be a big player in mental health. It's just whether or not kind of you and me as private practitioners are going to be involved in that at all.   Curt Widhalm  15:30 I think geographically, this has a long known place in our fields that appear in large, wealthy urban areas, there's less of a pressure to take insurance. And as a state of the profession report points out said places where it might be more rural, specifically pointed in this report is like the Midwest, where it's significantly more clinicians who would have to be on insurance panels. And the numbers here in the report say that 75% of clinicians who responded to the survey in the Midwest are on an insurance panel, compared to a national average of 64%. So regionally, this is going to affect some people more than others. And those people who are on insurance panels are also the ones who were reporting that they're taking more clients than they feel that they can handle right now. 30% compared to only 19% of those who do not accept insurance. So just putting some numbers to what you're talking about here. We do have a episode coming out here in the next couple of months that we'll be talking about some of this stuff like Katie previewed here as well. Chapter Three, state of technology. I think most of us are going to be doing at least some telehealth continuing on.   Katie Vernoy  16:47 Yeah, we'll link to CAMFT, the California Association of Marriage and Family Therapists did a similar report and talked about, you know, kind of telehealth and that shift and the pandemic. And the majority of providers were not doing telehealth prior to the pandemic, you know, or not doing a significant amount of telehealth, and now the majority of providers are going to keep telehealth. And so I think that's actually great. I was doing telehealth prior, I think you were too maybe a little bit of telehealth as well. And it's nice to have a hybrid practice. And so, in the simple practice report, it says only 2% are not going to continue offering telehealth and I know that there are definitely therapists who absolutely hate it, I see you Ofra. And I also know that there are people who absolutely adore it and want to do 100% telehealth because they don't want the overhead of an office. And so we talked about this and post pandemic practice. But I think that there is a lot of access, convenience, different types of therapy you can do with telehealth that may be very accessible for folks, or beneficial for folks so that you can kind of keep a practice that has a little bit more opportunity for you. I guess.   Curt Widhalm  17:59 One of the things that simple practice report points out that we haven't talked about yet is the infrastructure problem of good internet. And this being a issue across the country of being able to have good enough internet to have regular, good quality video Sessions is a problem that many people face. And while this is definitely a necessity for reaching clients in those areas that a lot of these telehealth laws are designed to help those who can't be reached by clinicians that there's too few mental health workers who are there. It's a necessity, and really to continue to build and provide on our national mental health system, telehealth is going to have to be a cornerstone of it. But it goes hand in hand with the ability to have good internet in those places. We're no better if those people cell phone coverage. If it sucks, and you're only hearing every fifth word, it's more frustrating to be on it than it is to not really be a part of the conversation at all. And the same thing is gonna be happening with our our telehealth here that we're reliant on getting good internet to people in those places in the first place. And some of the clinicians responding to this report are facing that on the delivery end to that further places a burden on those clinicians and a further frustration for them.   Katie Vernoy  19:30 Yeah, I think we did talk about this a little bit in the conversation with the RAND folks and I, I feel like the call to action in this regard is maybe identifying and understanding any kind of laws or infrastructure around internet so that we can actually provide better coverage for mental health care, because I think that would that would make a huge difference. So before we close up, I do want to circle back to something a little bit earlier in the report, because I think it is important to look at and it's it's something that I think was very resonant for me. And it also, I think I have a personal response to it because of the way that my practice is evolving. And, you know, I am currently a hybrid practice but may not continue to take insurance, which then would would impact this for me, but looking at who are therapists, demographically, when we look at 66, and older 95% are white clinicians, 3% are other and 2% are black, when we go down to 35, or under, so people who are aged 35 and under, it's still inordinately more white people, it is 77%. But now we're up to 7% black therapist, 4% Asian therapists, 4% Hispanic therapists and 7% other therapists, and there is an increase in diversity with newer therapists. This is exciting. And I hope that trend continues. Because I think that there's a need to have more lived experience opportunities for clients and folks that can, you know, people will go to therapy, if they see that therapist look like them. I think the thing that I'm I'm looking at, as well is in this next part, it says that 53% of white clinicians reported not working with any underserved populations. And so there's a few things that I'm drawing from this one is white people are generally working with rich white people. I think. And I guess it doesn't talk about in this section, it doesn't talk about demographics. But I'm also thinking about income potential because of reimbursement rates from insurance, I'm thinking about access. And you know, if we have so few therapists that are black, Asian, Hispanic, or I guess it says other specialty, so I don't know if that what that means on this report. But I think if we don't, if we don't support our younger clinicians, with that have a larger, you know, it's a more diverse population of therapists. Access for some of these underserved populations and simple practice lists them as low income or unsecured clients, LGBTQ population, Medicaid recipients, populations with disabilities, and veterans. If we don't address both the access issues, as well as the diversity issues, I think mental health stays broken.   Curt Widhalm  22:36 As you're talking about this, I'm looking at some of these comparisons here. And well, not quite to the same extremes, I'm seeing some very similar trends with Asian therapists, as white therapists have not working with as many of the underserved populations, black and Hispanic therapists seem to have similar numbers to each other. Just by comparison here, and looking at traditionally where the demographics of these two different groups come from that we've known historically, that way therapists, as you pointed out, tend to come from wealthier backgrounds to start with. And this gets maybe even into some of the model minority influences that has led to Asian therapists into some of the same similar trends, I don't know that would be kind of the area where I would want to research more into this to see if that's where that trend comes from. But speaking to black and Hispanic therapists, what we do know as far as trends go, is that a lot of white therapists enter into this field because they had a good experience with therapy, typically as a child or as a young adults that led them into this fields, whereas a lot of the research that's emerging about black and Hispanic therapists is that they're entering into this field because they didn't have those good experiences, and are more likely to be returning back to working with the communities that would be underserved in the first place. And so the motivations for entering into the profession are quite different. Just from the get go on this. Yeah. As I'm also hearing you talk, one of the thoughts that I had is going back to the burnout question, and especially around age groups. This is also a year with a tremendous amount of social justice action, which tends to be things that younger people are involved with in the first place. And before anybody shoots us off an email or complains on social media to us. I'm not saying that older people don't but statistically, yes, younger people are the ones who are more involved in these social justice movements, which has been a huge emotional piece of this last Last year for a lot of the world, but especially here in the United States. And so if you add the social justice burden on top of everything else that we've already discussed, I can see how that's potentially another factor that can be explained in this report or that isn't specifically called out in this report.   Katie Vernoy  25:21 I agree. I think there's so much that younger therapists clinicians of color, especially have been facing in the past year given, especially the racial injustices that have been increased or spotlighted this year. And so I think that has to go hand in hand with some of these other types of burnout that people were experiencing. And so call to action here, I think is take care of each other. I don't know. I mean, it seems like this is a pretty systemic issue.   Curt Widhalm  25:58 There is a summary at the end of this report. Now, what comes next. And this is even where some practices wording on this. And the challenge with kind of this institutional support is not really been clear of what it is. You know, I see Dr. Caldwell floated here directly, but I just know from a lot of our conversations with him that a lot of this whole section has his fingerprints all over it.   Katie Vernoy  26:29 Thanks, Ben.   Curt Widhalm  26:30 Yeah, there's, there's no quoting here, there's no way to put the industry on pause. People are always going to need mental health care. We can't tell people stop coming to therapy. Well, we just reorganize what we do. Yeah. And we do, as a field end up placing so much emphasis on individual responsibility for things like self care. And self care has been hard, especially if you're in one of those groups that we've been talking about the you know, do you have kids, it's not like you can like, keep the babysitter an extra couple of hours during the pandemic here. Like if you're overworked, seeing a bunch of clients and having the parental responsibilities in the background and the educational responsibilities of teaching them from online school and all of that kind of stuff. Back to Caldwell does, but that, as far as getting some structural fixes, means having laws, policies and practices insured, fair and timely reimbursements, things that make telehealth care easier, and enables providers to lead more balanced lives. I will point back to the presentation that we did right before the pandemic, at the foundations of connection conference in Hawaii, about some of the structural self care things too. And if you're in a place of influence within your organization, or even if this just means for yourself, of being able to really help create systems around nice closures to your workday, having a balanced flow throughout your work week. These are things that can be applied on both the micro and the macro levels. But just Dr. Caldwell suggesting here. We do need some systemic influential changes when it comes to things like insurance, and our ability to continue to practice here.   Katie Vernoy  28:27 So I'm looking forward to kind of continuing the conversation on what's next. I think that there's a lot of innovative things that are exciting, and they're innovative, things that are terrifying, that are coming about that may impact some of these areas for good or for ill. And I think that there are opportunities for advocacy that may come out of the huge mental health need that we're seeing at this time. And so if you haven't started listening to our series on fixing mental healthcare in America, I would suggest that we'll link to it in the show notes. We'll also put the structural self care, or I think it's structuring self care. I don't know what the podcast title is, but we'll put some links to some of the relevant episodes, as well as this report and the camp's report in the show notes. But really, what this is saying is, this is hard. We know it's hard. We're gonna keep doing therapy because people need therapy. But let's see if we can find ways to support ourselves but also fix the system.   Curt Widhalm  29:30 You can find our show notes at mtsgpodcast.com, follow us on our social media. And till next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  29:38 Thanks again to our sponsor, simple practice.   Curt Widhalm  29:41 Simple practice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use simple practice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform.   Katie Vernoy  29:59 Get your first two months of simple practice 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 a simple practice I will give 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  30:20 This episode is also sponsored by green oak accounting.   Katie Vernoy  30:24 Green oak accounting specializes in working with therapists and private practice and they have helped hundreds of therapists across the country reach their financial goals. They offer a number of monthly service options that can be catered to a practices needs, from basic bookkeeping to premium CFO services. Other specialized services include profit, first support, compensation planning, and customized KPI dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice and offer unsurpassed support along the way.   Curt Widhalm  30:55 If you're interested in scheduling a complimentary consultation, please visit their website at greenoakaccounting.com/consultation to learn more.   Announcer  31:05 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 could also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

At Least 3 Reasons Continuing Education Sucks Curt and Katie chat about why continuing education is usually pretty ineffective. We dig into a listener question related to repackaged, introductory level, uninspiring presentations. We look at the systemic concerns related to CE standards as well as the difficulty balancing high quality education with affordability. We explore research that shows that continuing education (especially when it is solely didactic) does not impact client outcomes. We also share ideas to improve continuing education for the next generation of 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: The problems with continuing education rules and what that means for the types of education modern therapists often can find The ways in which presenters repackage others' material Continuing education is not proven to improve client outcomes CE standards that limit the innovation and interactive capability How most CE is very general and appropriate for all levels of clinicians (not solely intermediate to advanced therapists) The type of didactic training that might be impactful or effective (but may not be CE worthy) The problem with not having practical applications involved in presentations Learning, practicing and then doing Why effective continuing education is expensive and whether they make a difference in being better therapists Deliberate practice and the effectiveness of spending time outside of session (and training) practicing skills Practice-based evidence (measuring how well our clients are doing) and why this is the strongest way to do better work The importance of giving accurate feedback to CE providers The acknowledgement and acceptance within the system that CE doesn't really work – and the push back and reasons why people within the system don't want to fix it Assessing competence and engagement in training (pros and cons) The balance between accessibility and accountability The shelf-life of graduate education and the need for continuing education Our vision related to continuing education and learning 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 www.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. GreenOak Accounting At GreenOak Accounting, they believe that every private practice should be profitable. They've worked with hundreds of practice owners across the country to help them gain financial peace of mind and assist them with making smart financial decisions. GreenOak Accounting specializes in working with therapists in private practice, and they have helped hundreds of therapists across the country reach their financial goals.  They offer a number of monthly service options that can be catered to a practice's needs - from basic bookkeeping to premium CFO services. Other specialized services include Profit First Support, compensation planning, and customized KPI Dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice, and offer unsurpassed support along the way.  If you're interested in scheduling a complimentary consultation, please visit their website at www.GreenOakAccounting.com/consultation to learn more.   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! The Cycle of Excellence by Tony Rousmaniere Dr. Joy DeGruy Why TED Talks don't change people's behaviors: Tom Asacker at TEDxCambridge 2014 Scott Miller, PhD: Deliberate Practice Dr. Ben Caldwell, LMFT – Ben Caldwell Labs Articles: Impact of Formal Continuing Medical Education Does Professional Training Make a Therapist More Effective?   Relevant Episodes: All Deliberate Practice episodes Be a Better Therapist Finding Your Blind Spots The Fight to Save Psychotherapy   Connect with us! Our Facebook Group – The Modern Therapists Group 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. Katie is also 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/  

Au sommaire de cette spéciale sorties bouquins : -Retour sur RICHARD FLEISCHER I & II parus chez MAREST EDITEUR, le volume 1 s'intitule SURVIVRE A HOLLYWOOD, c'est l'autobiographie de feu Richard Fleischer, le deuxième, RICHARD FLEISCHER UNE ŒUVRE, est signé Nicolas Tellop ;-Rencontre avec Nicolas Tellop ;-Chronique du nouveau volume, signé Ogroff, de la COLLECTION KARNAGE des EDITIONS ZONE 52 : ACID COP (attention, un jeu-concours pour gagner un exemplaire du livre et un poster se cache dans l'émission) ;-Evocation de PREZ de Ben Caldwell et Mark Russel édité par URBAN COMICS ;-Evocation du dernier opus en date de la COLLECTION CONTRECHAMP, aux EDITIONS VENDEMIAIRE : MONTY PYTHON SACRE GRAAL ! DE TERRY GILLIAM ET TERRY JONES par Justine Breton ;-Entretien avec Justine Breton. Bonne écoute à toutes et à tous !

This episode is about optimism. Hosted by SCI-Arc History + Theory coordinator Marrikka Trotter, the show considers how optimism factors critically in architecture, film, community-building, liberation movements, nation-building, and mining. We will speak with Ben Caldwell, arts educator, independent filmmaker, and founding member of the radical 1970s film movement LA Rebellion; Sandy Hilal, Palestinian architect and founder of Decolonizing Architecture and Art Research Collective; and Emily King, founder of new search engine for mining, Prospector, and CEO of Global Venture Consulting.

In this episode, our guest Maryellen shares her bad experience with a Dialectical Behavior Therapy (DBT) specialist. But was it bad therapy? Was it therapy at all? Dr. Ben Caldwell joins us to share his thoughts on loosely regulated mental health services, and we explore the unfortunately relevant ethics of having sessions with clients while visiting the Dunkin’ Donuts drive-thru and getting tattooed.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community.   Introduction: 0:00 – 5:39 Part One: 5:39 – 45:56 Part Two: 45:56 – 1:27:36 Part Three: 1:27:36 – 1:32:04   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to Fluffy Butt Rescue Rehab Riviera: An investigation into the Southern California rehab industry SimplePractice Learning Ben Caldwell Labs

Noteworthy Documentation An interview with Dr. Ben Caldwell, LMFT about some basic documentation information as well as updates relevant to the 21st Century Cures Act. Curt and Katie talk with Ben about what to consider when writing your notes including what to include and what should not be included. We look at who can see your progress notes as well as other considerations related to records requests and confidentiality.        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 Education and 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 Users 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: Documentation as our favorite thing ever Excitement about Ben breaking the record on number of interviews on this podcast What needs to go into your documentation Accurate, adequate, and timely Standard of care How much information to put into your notes Who is the audience for your documentation Who might request records The importance documentation in continuity of care Where to put client quotes The difference between progress and process or psychotherapy notes What can be subpoenaed (including psychotherapy notes) How much information you include based on what is advisable to protect self The benefit of doing documentation for yourself as well as for treatment efficacy The 21st Century Cures Act – Open Notes (deadline now extended through April 2021) Optional certification process that requires clients to have access to all the information in their chart without charging them) Most mental health providers have no changes required from this change Most private practice EHRs are not on these systems Hospitals may have this requirement, but individual practitioners are not responsible for the mechanism to provide documentation to clients How to make sure you’re ready for clients to see your documentation The communication is going on for people who are required to comply with this open notes mandate, including how to access information and who to contact with questions In most states, clients have a fundamental right to request their records Confidentiality and access to records for family members, especially parents of minor children Conversations to have at the beginning of treatment in these situations regarding what will be included in the chart (and what will not be put into the chart) What not to include in your chart (specifically written reports from child abuse reports) A debate of who owns the record – who can see them is different from who owns them Our Generous Sponsors: GreenOak Accounting If you love dreaming about growing your practice, but you feel a disconnect between where you are now and where you want to be, check out GreenOak Accounting. You went to school to become a therapist, not an accountant! Your time is much better spent doing what you love–and not crunching numbers. That’s where GreenOak Accounting comes in! They specialize in working with private practices just like yours, so you can reclaim precious hours each week! They can help with all your accounting needs like bookkeeping, budgeting, forecasting, payroll and even assist with implementing Profit First. If you are interested in freeing up your schedule for more clients, or just getting back time for yourself, go to greenoakaccounting.com to schedule a free, no obligation consultation today. You can also check out our podcast, Therapy for Your Money, hosted by GreenOak Accounting owner Julie Herres. CPH & Associates CPH & Associates is an insurance company that specializes in professional liability insurance for mental health professionals. We currently insure over 100,000 mental health professionals throughout the United States. We can insure you throughout your professional career starting with your student practicum, through your post masters internship, and on to practicing with your professional license. With up-to-date legal resources and exceptional customer service, CPH protects your career against a grievance from a regulatory board, claim, or lawsuit. Because our business is specialized, we are able to focus on your liability needs in a way that bigger companies are not. We are able to serve a large client base while maintaining a small-office approach. With options to add General Liability, Cyber Liability, and coverage for your LLC or corporation, a policy with CPH is tailored specifically to meet your liability needs. Policy holders are encouraged to take advantage of our Attorney Avoiding Liability Helpline, providing two free hours of attorney consultation per year for situations with a client that could result in a claim or lawsuit. With our online application and renewal process, real-time online policy change capabilities and knowledgeable customer service, we continue to keep our customers’ needs a priority! Get a quote and apply online to receive proof of coverage within minutes at cphins.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 21st Century Cures Act Open Notes Org article related to the Cures Act Simple Practice Learning Course: HIPAA in the age of COVID-19 Psychotherapynotes.com   Relevant Episodes: Episodes with Dr. Ben Caldwell – The Fight to Save Psychotherapy Defining the Therapy Movement COVID-19 Legal and Ethical Updates Dr. Maelisa Hall: Make Your Paperwork Meaningful Nicol Stolar-Peterson: CYA for Court Barbara Griswold: Busting Insurance Myths   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 Past 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/

Dr. Christine King experienced three concussions when she was a child. The symptoms of her brain injury were misunderstood and later assumed to be the result of childhood sexual abuse, sending Christine on a pathologized path that took decades for her to undo. We hear her story and also speak with Dr. Ben Caldwell about how therapists can attune to client symptoms, make good referrals, and avoid misdiagnoses when they lack relevant knowledge beyond their scope of practice. Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Introduction: 0:00 – 12:27 Part One: 12:27 – 44:34 Part Two: 44:34 – 1:20:53 Part Three:  1:20:53 – 1:27:13 Very Bad Therapy: Website / Facebook / Tell Us Your Story Ben Fineman Counseling - Therapy for Young Professionals  (Benjamin Michael Fineman - Registered Associate MFT #119754 - Supervised by Curt Widhalm, LMFT #47333) Show Notes: Donate to Bideawee Animal Shelter What Didn't Happen: A memoir Multicultural Orientation Deliberate Practice Online Training Deliberate Practice Institute Website SimplePractice Learning

Ben Caldwell

Rage and Client Self-Harm An interview with Angela Caldwell, LMFT on cutting and non-suicidal self-injury. Curt and Katie talk with Angela about the causes of self-harm, the mistakes therapists make in addressing self-harm as well as how to identify reasons behind this harmful coping mechanism and how to identify when suicidality is a risk. We also look at how rage within nice families can lead to self-injury. 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 Angela Caldwell, LMFT Angela Caldwell is a licensed Marriage and Family Therapist and Family Coach. She is the Founder and Director of the Self-Injury Institute, where her practice focuses on the treatment of self-injury from a family systems perspective, as well as the Caldwell Family Institute, where she offers out-of-the-box coaching for families that are looking for something other than therapy to help them reach their growth potential. Angela is currently on the adjunct faculty for the MFT graduate program at California State University Northridge, where she teaches family systems theories and couples therapy. She has been teaching graduate students for over a decade at four different universities, and previously taught assessment for a large majority of her teaching career. She was selected by Antioch University to design a curriculum for a new Counselor Assessment class, and has offered consultation on assessments for the last eight years. Angela has served in MFT leadership for much of her career, including holding executive offices in CAMFT and AAMFT. She has worked side by side with Ben Caldwell and other leaders on various advocacy efforts in California, most notably on the passage of SB 1172, which banned reparative therapy for minors in 2012. In this episode we talk about: Angela’s perspective on family systems and champions of families and dinner tables The mistakes in treatment planning and way of being related to self-injury What not to do when clients disclose self-harm The intrusive nature of liability-focused treatment planning and interventions in the room The need to render cutting irrelevant The role of the family treatment for addressing self-injury Non-suicidal self-injury versus suicidal self-injury (the difference is intent) “It’s important for therapists to be able to talk about suicide – to use the word suicide with the same emphasis that we use the word hamburger.” Angela Caldwell, LMFT It’s important to be direct in asking about intent “I’m cautious to link self-injury with suicide in such a short, abrupt way.” Angela Caldwell, LMFT Rage in families who are too nice leading to self-injury The profiles in non-suicidal self-injury: peer-based and rage-based Social media self-injury and mental illness competitions How rage is often misunderstood – looking at how rage and anger are very different Rage is animalistic and limbic Self-injury is rage (when anger is not useful) when you do not want to be a burden Rage comes with tactile stimulus seeking, seeking destruction Discovery is mortifying The problem with group treatment for cutting The contagion factor – Barent Walsh Co-rumination – looking at adolescent female relationships Family Therapy as the most effective treatment for non- Rewrite the family constitution around anger and anger expression Family assertiveness training, teaching families how to disagree and hurt each other’s feelings Angela’s strategy to provoke fights within the families that she sees and conducts repair Our Generous Sponsors: Hushmail Hushmail and Hush Secure Forms take the guesswork out of secure communications by providing encrypted email, web forms, and e-signatures all in one package. During a time when limiting contact is necessary to protect our clients’ health, using secure email and web forms to communicate is more important than ever. Now’s the perfect time to move your paper forms and PDFs to HIPAA-compliant, digital forms that your clients can easily fill out. You can send them through secure email or put them on your website. Hush Secure Forms makes emailing securely with your clients and using HIPAA-compliant web forms very easy. You can start with one of their form templates and customize it to reflect your practice or use their drag-and-drop form builder to build beautiful forms from scratch. No need for extra services to get your forms signed; Hushmail provides email, web forms, and e-signatures that work seamlessly together in one package to get the job done. Great for contact forms, health histories, client experience surveys, referrals, and screenings. Among other popular forms, Hushmail’s template directory includes a COVID-19 screening questionnaire and several screening forms such as the PHQ-9 depression screening and the GAD-7 anxiety screening, which calculate a score upon completion. And as a Modern Therapist Survival Guide Listener, you get a 10 percent lifetime discount. Just go to hushmail.com/therapyreimagined and sign up for the Hushmail for Healthcare plan that suits your practice. Hushmail has a plan for everyone! Kelly & Miranda – ZynnyMe Do you ever wish there was someone who could really tell you what the right path is for YOU in private practice so you could avoid wasting time and energy and get to what you love- helping clients? Kelly & Miranda of ZynnyMe are two therapists who just that!  They don't get you cookie-cutter solutions that work for some people- instead they teach you a process that works for everybody.  Kelly & Miranda of ZynnyMe have been helping therapists from across the country and around the world grow, revamp, and launch profitable private practices that really help people- while also making sure therapists' lives stay in balance. Their award-winning and multiple time sell-out Business School Bootcamp for Therapists is the largest private practice resource on the planet and will transform your life and business whether you are 20+ years in, or you are starting from scratch. They have the largest collection of free private practice resources for therapists - go to ZynnyMe.com today and sign up for their free Marketing Masterclass COVID edition and get access to 10+ hours of free training AND a free community for therapists that is NOT on Facebook!  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! Self-injury Institute Caldwell Family Institute Barent Walsh, PhD  Relevant Episodes: Preventing Client Suicide When Clients Die 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, the 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. Katie is also Past 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/

Faith Without Borders with Rev. Kelvin Sauls hosts the second installment in av10-week series entitled: "Intersectional Convergence: Organizing & Mobilizing for Inclusivity, Equality & Equity." Guests: California Senator Holly Mitchell, Tasha Hunter and Ben Caldwell from LA COMMONS and The Leimert Park Art Walk. Our mission at Faith Without Borders is to engage in the education and mobilization of multi-racial and multi-religious trans-national movements for social equity and planetary justice glocally. Looking forward to your presence and participation with us! #faithwithoutborders

“Wear a Mask” as a Therapy Directive Curt and Katie chat about COVID, science, and critical thinking in an anti-intellectual, post-truth era. We look at what therapists’ responsibilities are to the greater good, whether we should tell our clients to wear masks, and how to help clients navigate very challenging decisions that must balance mental versus physical health as well as individual versus societal needs. 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: Should we tell our clients to wear masks? How do we help our clients navigate the complex decisions related to risk Client autonomy, transparency of goals, decreasing therapist bias How science and the greater good come into the equation Is there a duty to warn? Or duty to protect? Imminence, privacy issues Should we try to change behavior around wearing masks in public? How we address risky behavior with clients The impact of the presenting problem on deciding what we do Our responsibility to society, to our communities versus our clients Psychoeducation and alternate facts The process of making decisions around health and safety Sorting through and gaining agreement on what is truth Therapists needing to be informed and be able to sort through expert information The importance of critical thinking and the scientific method Anti-science, anti-intellectualism, and cognitive dissonance How to meet your client where they are while also not colluding with unhealthy beliefs Helping our clients to navigate the current challenges to balance physical vs mental health needs, individual vs societal needs The responsibility to bring up healthy decisions for our clients through psychoeducation The complexity of decision-making during these times Our Generous Sponsors: Hushmail Hushmail and Hush Secure Forms take the guesswork out of secure communications by providing encrypted email, web forms, and e-signatures all in one package. During a time when limiting contact is necessary to protect our clients’ health, using secure email and web forms to communicate is more important than ever. Now’s the perfect time to move your paper forms and PDFs to HIPAA-compliant, digital forms that your clients can easily fill out. You can send them through secure email or put them on your website. Hush Secure Forms makes emailing securely with your clients and using HIPAA-compliant web forms very easy. You can start with one of their form templates and customize it to reflect your practice or use their drag-and-drop form builder to build beautiful forms from scratch. No need for extra services to get your forms signed; Hushmail provides email, web forms, and e-signatures that work seamlessly together in one package to get the job done. Great for contact forms, health histories, client experience surveys, referrals, and screenings. Among other popular forms, Hushmail’s template directory includes a COVID-19 screening questionnaire and several screening forms such as the PHQ-9 depression screening and the GAD-7 anxiety screening, which calculate a score upon completion. And as a Modern Therapist Survival Guide Listener, you get a 10 percent lifetime discount. Just go to hushmail.com/therapyreimagined and sign up for the Hushmail for Healthcare plan that suits your practice. Hushmail has a plan for everyone!   Kelly & Miranda – ZynnyMe Do you ever wish there was someone who could really tell you what the right path is for YOU in private practice so you could avoid wasting time and energy and get to what you love- helping clients? Kelly & Miranda of ZynnyMe are two therapists who just that!  They don't get you cookie-cutter solutions that work for some people- instead they teach you a process that works for everybody.  Kelly & Miranda of ZynnyMe have been helping therapists from across the country and around the world grow, revamp, and launch profitable private practices that really help people- while also making sure therapists' lives stay in balance. Their award-winning and multiple time sell-out Business School Bootcamp for Therapists is the largest private practice resource on the planet and will transform your life and business whether you are 20+ years in, or you are starting from scratch. They have the largest collection of free private practice resources for therapists - go to ZynnyMe.com today and sign up for their free Marketing Masterclass COVID edition and get access to 10+ hours of free training AND a free community for therapists that is NOT on Facebook!    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! Dr. Ben Caldwell – friend of the show WHO - World Health Organization - COVID-19 information CDC - Centers for Disease Control - COVID-19 Information Article: Wearing of face masks can trigger trauma for some   Therapy Reimagined 2020: Therapy Reimagined 2020 Conference Therapy Reimagined 2020 Call for Sponsors   Relevant Episodes: Returning to the Office Is Therapy an Opiate of the Masses?   Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2020 (and TR2019 Virtual Conference)   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, the 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. Katie is also 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/

Today on Scatter Chatter, hosts Will93 and Jussray interview community advocate and music taste maker DJ Qwess about community issues effecting Socal and future plans for his Elevate Culture movement. Tune in to Scatter Chatter every Monday for all things pop culture and more!

"We did a land trust study to break out real numbers so we wouldn't be dreaming!" In the face of cultural displacement, gentrification, and brimstone, PSYCHOTIC BUMP SCHOOL welcomes legendary artist/filmmaker/businessman BEN CALDWELL who joins DJ ROME to discuss the economic impact of Black culture upon the historic LEIMERT PARK community in WEST LOS ANGELES.

For this edition of PSYCHOTIC BUMP SCHOOL, DJ ROME continues to cover national and local stories impacting U.S. citizens during a global pandemic. Acclaimed actress/producer JOY SUDDUTH chimes in from the East Coast to share the story of her stage and screen career which now includes key roles on hit TV dramas such as "Power" and "Criminal Minds." Soon after property near the historic Vision Theatre in Los Angeles went ablaze, we had a chance to catch up to legendary artist/filmmaker BEN CALDWELL for his take on the implication of this fire and the ongoing cultural significance of the historic Leimert Park community. Lastly, three amazing comic book creators check in for their take on the world of comics in the midst of COVID-19-SHEQUETA L. SMITH, CHRISTIE SHINN, and MADELEINE HOLLY ROSING. An incredibly full show, so press PLAY and enjoy.

For this edition of PSYCHOTIC BUMP SCHOOL, DJ ROME continues to cover national and local stories impacting U.S. citizens during a global pandemic. Acclaimed actress/producer JOY SUDDUTH chimes in from the East Coast to share the story of her stage and screen career which now includes key roles on hit TV dramas such as "Power" and "Criminal Minds." Soon after property near the historic Vision Theatre in Los Angeles went ablaze, we had a chance to catch up to legendary artist/filmmaker BEN CALDWELL for his take on the implication of this fire and the ongoing cultural significance of the historic Leimert Park community. Lastly, three amazing comic book creators check in for their take on the world of comics in the midst of COVID-19-SHEQUETA L. SMITH, CHRISTIE SHINN, and MADELEINE HOLLY ROSING. An incredibly full show, so press PLAY and enjoy.

"We did a land trust study to break out real numbers so we wouldn't be dreaming!" In the face of cultural displacement, gentrification, and brimstone, PSYCHOTIC BUMP SCHOOL welcomes legendary artist/filmmaker/businessman BEN CALDWELL who joins DJ ROME to discuss the economic impact of Black culture upon the historic LEIMERT PARK community in WEST LOS ANGELES.

An interview with Dr. Ben Caldwell about the rapidly changing directives during the COVID-19 pandemic. Curt and Katie interview Ben about telehealth, HIPAA, and all of the efforts of continuity of care during quarantine, shelter-in-place orders. We look at legal, ethical, and clinical responsibilities during these uncertain times.          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 Benjamin Caldwell, PsyD, LMFT Benjamin Caldwell, PsyD is a California Licensed Marriage and Family Therapist (#42723) and the Education and Director for SimplePractice Learning. He currently serves as adjunct faculty for California Statue 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 Users 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: How to identify what to do and how to respond to all the changing instructions from officials about practicing therapy during these times The debate around telehealth versus in person treatment The legal and ethical responsibilities therapists hold regarding continuity of care Client opt-in and preference, fears about client abandonment The myth that you are required to keep seeing clients no matter what The moral aspect of choices made during treatment, especially during uncertain times like these Clinical considerations for clients who are not appropriate for telehealth The importance of identifying and managing all types of risks during these times The fallacy that you can now practice across state lines without any restrictions The possibilities for seeing clients who have returned home to other states, the reasonable argument for continuity of care Advice for implementing telehealth quickly, including choosing a HIPAA compliant platform The benefits of complying with telehealth training requirements Misinformation that can confuse folks within the Facebook Therapist Groups The challenges that licensing boards are facing related to testing and licensing delays and related laws or regulations Professional wills – basic requirements and legal/ethical responsibilities Connecting with clients, human to human related to illness and emergency The growing importance of communication in this new era of health awareness The requirements for “essential workers” Our Generous Sponsor: GreenOak Accounting You went to school to become a therapist, not an accountant! Your time is much better spent doing what you love–helping people–and not crunching numbers. That’s where GreenOak Accounting comes in! They specialize in increasing the profit of private practices just like yours, so you can reclaim precious hours each week! If you are interested in freeing up your schedule for more clients, or just to get some time back for yourself, if you’re behind on your books or ready to implement Profit First, or need someone on your financial team who really understands private practice and can help your business grow, go to greenoakaccounting.com to schedule a 100% free no-obligation consultation today or sign up for 5 days of profit-boosting emails. 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! Saving Psychotherapy by Dr. Ben Caldwell SimplePractice Platform (has a telehealth add-on option) SimplePractice free template for a Professional Will SimplePractice Learning (SPL) SPL telehealth legal and ethical training (free for a limited time) SPL HIPAA for Mental Health Professionals course SPL Telehealth Getting Started course SPL California Telehealth Law course   Therapy Reimagined 2020 Conference: Speakers!! Therapy Reimagined 2020 Call for Sponsors   Relevant Episodes: Ben’s previous episode: The Fight to Save Psychotherapy   Connect with us! Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2020 (and TR2019 Virtual Conference)   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, the 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. Katie is also 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/

An urgent conversation about the role of therapists in doing the most public good during the coronavirus outbreak. Pat Wiita, MD and Farah Zerehi, MS explore the science, needed actions, and social justice implications of the pandemic, and Ben Caldwell, PsyD discusses what you need to know about shifting your practice to telehealth services. Please share this episode anywhere you feel it might make an impact. If you have expertise or information related to the pandemic that you feel is important to share with the psychotherapy community, email us at vbtpodcast@gmail.com. Note: A previous version of this episode contained information about Zoom being HIPAA compliant. This is only true for the Zoom for Healthcare option ($200/month), not the free and low-tier paid options.

An interview with Carrie Wiita and Ben Fineman, MFT Trainees and the co-hosts of the Very Bad Therapy podcast. Curt and Katie interview Ben and Carrie about their experience as graduate students and mental health advocates. We look at the short-falls of the educational system as well as the mythologies that stagnate the profession. We talk about how to improve therapy and the training we receive. 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 therapists must develop a personal brand to market their practices. 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 Carrie Wiita and Ben Fineman, Marriage and Family Therapist Trainees and Co-Hosts of the Very Bad Therapy podcast Very Bad Therapy gives voice to the stores that begin with an exasperated "You would not believe what happened with my therapist." Weekly episodes explore real-life stories of very bad therapy experiences as hosts Caroline Wiita and Ben Fineman seek to learn from diverse guests and experts in the field who help shed light on how things could have gone better. Supported by scientific research and a mission to bring out the best in psychotherapy through discussion of its worst moments, Very Bad Therapy is a corrective emotional experience for clinicians and clients alike.   In this episode we talk about: How Curt is responsible for Carrie and Ben meeting (and how proud he is of that fact) What is missing in therapist education and how to look at the profession of therapy critically What we are told when we enter into the field and what the reality actually is How going to grad school and listening to MTSG Podcast can be super confusing The research that says therapists do not get better with experience The mythologies in the profession that stop us from being curious The disappointment in the status quo and the failure to move into the cutting edge The stagnation of the field when we have the same people talking about the same things The inconsistency of the faculty and their ability/desire to teach graduate students in therapy Problems with graduate programs related to the bureaucracy and misinformation Ben Caldwell’s Saving Psychotherapy (of course) Feedback on the Very Bad Therapy podcast (and how Carrie and Ben have taken it in) The importance of research, grounding in laws, ethics, clinical excellence, when challenging the status quo The willingness to make mistakes publicly and be transparent with accountability to normalize mistakes and reinforce that we are not perfect and cannot be perfect as therapists The role of defensiveness in very bad therapy The problem of perfectionism in the field Minimizing risk and maximizing “joining” or developing the therapeutic relationship How harmful the communication between therapists can be The impact of bias on the work How to improve your training   Our Generous Sponsor: Reasons Eating Disorder Reasons Eating Disorder Center in Los Angeles, CA provides comprehensive, personalized and gender-inclusive treatment programs for ages 12 and older. Reasons’ programs are designed to address the complexities of eating disorders and their intersection with anxiety, trauma, OCD, and substance abuse by providing each patient with a multidisciplinary team of professionals to assist in their process of healing. We offer our patients hope rooted in the belief that they are capable of living an authentic life of meaning and connectedness. Reasons Eating Disorder Center is an innovative program founded on the belief that healing is a fundamental aspect of eating disorder treatment. We believe that eating disorders are rooted in and driven by anxiety and profound disruptions to the sufferers’ sense of self. We offer our patients hope, rooted in the belief that they are capable of living an authentic life of meaning and connectedness. Our goal is to create a culture that nurtures the integration of body and mind through the daily practice and continual reinforcing of the balancing ideas of Doing and Being. Reasons offers highly personalized, gender-inclusive treatment for adults and adolescents. Our levels of care include Inpatient, residential, partial hospitalization, intensive outpatient and independent living. Reasons is located in the greater Los Angeles area and accepts most insurances. Please visit http://www.reasdonsedc.com for more information, or call our admissions team at 844 572-2766.   Relevant Resources: We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below are 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 podcast Very Bad Therapy Facebook page vbtpodcast@gmail.com Dr. Ben Caldwell, LMFT: Saving Psychotherapy NPR Podcast: Hidden Brain   Relevant Episodes: Defining the Therapy Movement   Deliberate Practice episodes: Be a Better Therapist Finding Your Blindspots   Connect with us: The Modern Therapists Group on Facebook Get Notified About Therapy Reimagined 2020 (and TR2019 Virtual Conference) Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, the 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: http://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 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: http://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 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/

Live Podcast: Curt and Katie are live at Therapy Reimagined 2019. We talk about what the #therapymovement aspires to accomplish. We talk about the broken educational system, the need for a livable wage, the ways we can improve our profession, and stronger ways that we can show up for our clients.            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: The origin story of the #therapymovement What needs to be changed in our profession The conversations we are having and need to continue having Conversations with #moderntherapists about education and therapist-ways-of-being How continuing education needs to shift to support the actual job The difference between what graduate programs teach and what the work actually looks like What do we do to improve the profession? The importance of a livable wage #postthepay The threat on our scope of practice if we don’t have adequate numbers The need to improve the quality of the therapists that come out of the educational system The importance of getting new voices into the conversation Looking at what therapy has been versus what therapy can be How to step into leadership in this #therapymovement The way to effect change, both in our office and the world The importance of being present to help keep our clients alive Now what?   Our Generous Sponsors: SimplePractice SimplePractice is a HIPAA compliant, fully integrated EHR for health and wellness professionals in private practice. It consistently ranks as the “#1 Most Popular Mental Health Software” on Capterra, and has collected over $2.8 billion in revenue for its customers. SimplePractice offers features like paperless intakes, automated billing for self-pay and insurance, free appointment reminders, secure messaging, telehealth, and more. Learn more by going to www.simplepractice.com/therapyreimagined. You can also sign up and receive a special promotion of getting 3 months of SimplePractice for the price of 1 (equivalent to a $50 credit). Please note, this offer is valid for new customers only and does not include product add-ons. This is episode is also sponsored by Simplified SEO. Thank you to our generous sponsor, Simplified SEO Consulting. Do you have a beautiful website that just doesn’t rank very well on Google?  Simplified SEO Consulting can help!  Jessica Tappana, LCSW and a team of SEO Specialists focus exclusively on helping mental health professionals improve their website rankings on Google so you can get in front of more clients!  Jessica’s team goes in depth to edit your website in a way search engines will respond to, while also encouraging you to maintain your own voice and branding. Simplified SEO Consulting offers both SEO training for motivated practice owners who want to learn to manage their own SEO as well as "done for you" services for therapists who are too busy and are ready to hire someone to invest the time into getting their website ranking. Simplified SEO Consulting is offering a FREE 7-day SEO e-mail series to help you learn the basic components that can help you get your website to the top of search engines!  If you're interested in learning more about search engine optimization, you can head over to www.simplifiedseoconsulting.com/moderntherapist to sign up!   Resources mentioned: We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Dr. Ben Caldwell, LMFT Caroline Wiita Amoret Kaufman LMFT Very Bad Therapy Podcast Scott Miller’s work Sage Mendez-McLeish, MA   Relevant Episodes: Ben Caldwell’s episode: The Fight to Save Psychotherapy   Connect with us! Our Facebook Group – The Modern Therapists Group   Our consultation services: The Fifty-Minute Hour   Who we are: Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, 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. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. 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/

Dr. Ben Caldwell is part of the faculty at California State Northridge, an author of five books, and the chair of the Legislative and Advocacy Committee for the California division of AAMFT.In a discussion about advocacy and his thoughts on the MFT profession, Eli and Ben talk about his origin story as an MFT and how he started his work in advocacy. He expresses why advocacy should be important to students and young professionals, and discusses how MFTs can help change the stigma of going to therapy. Lastly, he talks about the biggest changes and trends in the field.

Curt and Katie talk about generational differences in therapists, looking at perceptions (and misperceptions) about Millennials We look at how these differences impact therapy workplaces, supervision, and the future of our field.     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: Whether or not Curt is a Millennial Looking at how millennials show up as employees and entrepreneurs Generational differences in therapists Common complaint of millennials being entitled Living life now versus earning your stripes and waiting on retirement The Four-Hour Work Week Curt’s theory that Millennials have perfected the dream of the Gen X-ers The impact of technology on growing up in different generations Looking at the impact of the recession on the perspective on how to navigate work The “young upstart” mythology that gets under Boomers’ skin Gaining confidence earlier due to the access to immense amounts of data that wasn’t around when X-ers and Boomers were growing up Teaching as equals versus teaching as a superior, looking at collaborative learning The difference between therapy as work and other professions The further we remove the therapist from having creativity and ownership from the work, the less value they will get from the work. The importance of real application of concepts in our education The tension of enough structured guidance versus enough collaboration/empowerment Avoiding the helicoptering (supervision, management, etc.) How technology is impacting the work The importance of grounding innovation in laws, ethics, and clinical excellence How coaching might impact our profession, whether there is harm with people jumping to coaching without credentials or training Instagram Therapists Different goals for different generations, namely the scourge of selling out Whether or not Gen X-ers have actually sold old How things have changed in marketing and how that has impacted newer therapists When you can claim “expert” status How strong entrepreneurs can potentially harm the profession   Our Generous Sponsors: SimplePractice Trusted by over 40,000 customers, SimplePractice creates software and services for health and wellness professionals. Its EHR empowers practices to run their businesses more efficiently, streamlining administrative tasks, enabling regulatory compliance, and improving documentation. Learn more by going to www.simplepractice.com/therapyreimagined . You can also sign up and receive a special promotion of getting 3 months of SimplePractice for the price of 1. Please note, this offer is valid for new customers only.    Become a Group Guru Learn how to fill a group in private practice without coffee dates or networking events, even if no one in your community knows your name yet and you have no idea where to start.  Free trainings and resources (like a free 5-day group jump start guide with your step-by-step plan to creating the group your ideal clients are ready to enroll in today) at www.becomeagroupguru.com.   Resources mentioned: We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. The Four Hour Work Week by Tim Ferriss Saving Psychotherapy by Ben Caldwell   Relevant Episodes: Is CBT Crap? All Kinds of Burnout The Dividing Line Between Coaching and Therapy The Brand Called You   Connect with us! Our Facebook Group – The Modern Therapists Group Therapy Reimagined 2019   Our consultation services: The Fifty-Minute Hour   Who we are: Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, 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. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. 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/    

Therapists are not supposed to tackle their clients*. But what are the ethical limitations in trying to prevent a potential suicide attempt? Today's guest Katherine recounts her experience with a caring clinician who went to extreme lengths to protect her safety, and Dr. Ben Caldwell shares his expertise to help us understand how therapists should manage delicate yet ambiguous situations with clients. *Unless perhaps the client is attempting to physically harm someone else in the room. Perhaps. Show Notes: Dissociative Identity Disorder (Multiple Personality Disorder) Bellah v. Greenson Dr. Ben Caldwell's Website Saving Psychotherapy: How Therapists Can Bring the Talking Cure Back from the Brink SimplePractice Learning Suicide Prevention, Assessment, and Intervention (6 hours CE) Very Bad Website / Facebook / Instagram

Here we are, the supposed final episode of season one, and boy is it a doozy! Listen to Head Lopper creator, Andrew MacLean talk about his development as a creator, and his approach to craft, afterward, Jason and Kent have a creative catch-up about juggling projects, moving on, and collaborating. In the recommended resource, hear Jason sell the pants off Ben Caldwell's book, Action Cartooning. PLUS: Hear the ad for listener Milo Neuman's comic: Dimitra of the Silver Mask!Brought to you by PanelxPanel MagazineSubscribe via: iTunes | Google | Stitcher | RSSFollow the Show: Twitter | InstagramContact: Letters@TMBCWorkshop.comFollow Kent: Facebook | Twitter | InstagramFollow Jason: Twitter | InstagramMore TMBC Podcasts

Sara Schulting-Kranz joins us to talk about her transformation from married mother of three, who one day discovered “my husband is gay,” to life coach helping and leading people on journeys of their own transformation in the Grand Canyon and in the Sierras. Sara talks about the power of nature to heal and the amazing life changes she and her clients have gone through on such incredible treks. She also talks about what it was like to help blind para-olympian Shawn Cheshire hike the Grand Canyon rim-to-rim. Check her out at www.liveboldlycoaching.com. This episode is sponsored by Ben Caldwell Labs. Ben Caldwell labs provides exam prep, continuing education, advocacy and more. Ben Caldwell labs is building a more empowered, more effective generation of psychotherapists. Check them out at www.bencaldwelllabs.com

Dr. Ben Caldwell returns to the show to pick a bone with John about a statistic he quoted during our popular Sue Johnson interview. Ben discusses divorce and marriage and its current state in our society. We also touch on the ever emotional subject of Emotional Support Animals and how or if therapists should support their use.

Curt and Katie talk about the mistakes that therapists make in their business that can impact their clinical practice, their financial stability, and their reputation both with their colleagues and their clients.    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: The intersection between business and clinical practices The different mistakes that therapists make like not returning phone calls, being clumsy with intake call and intake process, failing to talk about fees before meeting in person, insurance bait and switch, scheduling snafus in shared offices, lack of control in your space, running late, poor referrals, not getting consent from both parents, clients missing payments and racking up debt How to improve business practices to improve clinical relationships Using therapy skills to improve “sales” Systems to help clients engage in treatment from the beginning The importance of establishing fees and contracts/consents prior to the first session Clear parameters can equal clinical safety Timeliness can equate to trust The handoff from intake or practice owner to the clinician who will work with the client Showing confidence in your own work and any referrals you make Making sure to talk through all of the consents and policies Communication practices with clients Taking notes, remembering what has happened in the session Client experience, customer care Re-engagement Deliberate Practice and Scott Miller’s Feedback Informed Treatment The importance of putting systems in place that support you and your clients   Our Generous Sponsor: Thanks again to our sponsor, Ben Caldwell Labs. If you’re a therapist, there’s a good chance you already know Ben. He has built his career fighting for you, and for me, and for all of us to be able to do well even in a challenging professional landscape. Check out BenCaldwellLabs.com for his books, California exam prep, continuing education, and more. Thinking of taking your practice online? Visit bencaldwelllabs.com/online to get 20% off their on-demand CE course, Basics of Telehealth.   Resources mentioned: We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. SimplePractice Scott Miller’s Feedback Informed Treatment Maureen Werrbach with The Group Practice Exchange Dr. Ben Caldwell with Ben Caldwell Labs Mixing Modern Therapist live networking events – email us for info: events@therapyreimagined.com The conversations happening in Our Facebook Group first.therapyreimaginedconference.com   Other Relevant Episodes: Making Bank as a Therapist Deliberate Practice 1: Finding Your Blind Spots Deliberate Practice 2: Be a Better Therapist   Our event this year: The Therapy Reimagined Conference in Los Angeles in October 2018!!   Our new consultation services: The Fifty-Minute Hour   Who we are: Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, 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. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. 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 Survival Guide 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/

Curt and Katie talk about reimagining therapy, starting a #therapymovement, and pulling together a community to put on a conference 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: Curt’s love of Legos and the ensuing overuse of this metaphor to describe using building blocks to be creative This conference we’re putting on and why we named it Therapy Reimagined The building blocks that are the foundation of therapy, but how we can use them creatively The individual differences that have been growing the diversity of the profession Sacrificial Helping Syndrome (Katie’s concept about how clinicians can sacrifice their own well-being for the work) How the system isn’t working – it relies on us burning out Why advocacy is important for our profession The irony and sadness about us going into the profession to be a different therapist and then becoming the burned-out therapist What it means when we burn out: lack of resources, mental health stigma, poorer outcomes Creating an action plan for how you will improve the profession Why strong business practices are important for all of us Having a big idea and carrying it through The importance of diversity and our commitment to have diverse faculty and diverse ideas at Therapy Reimagined 2018 How important it is to us to hear from you and develop this community around us for the #therapymovement How to join the community and the #therapymovement A secret message from Katie at the very end Resources mentioned: We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Katie’s article on Sacrificial Helping Syndrome Katie’s writing about avoiding Sacrificial Helping Syndrome Dr. Ben Caldwell with Ben Caldwell Labs Mixing Modern Therapist live networking events – email us for info: events@therapyreimagined.com The conversations happening in Our Facebook Group first.therapyreimaginedconference.com Other Relevant Episodes: Our Therapy Reimagined speakers on the podcast - The Fight to Save Psychotherapy - Benjamin E. Caldwell What Therapists Get Wrong - Paul Gilmartin Social Media and Video Marketing for Therapists - Ernesto Segismundo Jr. Make Your Paperwork Meaningful - Maelisa Hall Be the CEO of your SEO - Perry Rosenbloom Becoming a Group Practice Owner - Maureen Werrbach Building Hope for the Next Generation of Therapists - Robin Andersen Crafting Your Authentic Message - Mercedes Samudio   Our event this year: The Therapy Reimagined Conference in Los Angeles in October 2018!! Our new consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, 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. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. 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 Survival Guide 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/

Curt and Katie talk about people who yell “That’s Unethical” whenever they disagree with what someone else is doing. It could be ethics, but it might actually be legal, clinically relevance, values, morals, what “should” be done or what has always been done – and how to navigate messy decisions. 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: The tendency of people to yell "That's Unethical!" when they disagree with what you're doing (even if it doesn't relate to an ethic) The differences between laws, ethics, clinically relevance, personal morals and values, and “shoulds” or what we’ve always done #citethestatute Being thoughtful about how we make decisions as a therapist Emotional versus wise mind arguments The messiness of reality – things don’t always stack up related to laws, ethics, clinical relevance, etc. The need to discuss these things, so we can make change when needed How to sort through the muddiness of real world scenarios where laws, ethics, and clinical interventions don’t line up. The need to sort through in a case by case basis Developmental stages of navigating the complexity of these differentiations Your own values, limitations The importance of consultation Facebook group consultation – pros and cons Seeking consultation on ethical, legal, and clinical complexity   Resources mentioned: We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Dr. Ben Caldwell with Ben Caldwell Labs Other Relevant Episodes: Dual Relationships Dating as a Therapist Social Media and Video Marketing for Therapists Managing Your Online Reputation How Much is Too Much? (on limit setting, talking politics with clients, etc.) The Brand Called You What Clients Want (on the therapeutic relationship) Our Take on Texts   Our event this year: The Therapy Reimagined Conference in Los Angeles in October 2018!! Our new consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, 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. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. 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 Survival Guide 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/

WE HEARD YOU AND WE’RE MOVING TO ONE EPISODE A WEEK! ALSO… LISTEN TO THIS EPISODE NOW TO HEAR OUR SPECIAL COMMUNITY MEMBER CODE TO GET EXTENDED EARLY BIRD PRICING THROUGH FRIDAY 4/27/18 ON OUR LAW AND ETHICS WORKSHOP MAY 18TH, 2018!! 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: The definition of Personal Branding and what it means for therapists How to use your authentic voice How to identify how best to present yourself How you come across to others, especially to clients Answering the question, what do I offer? The danger of mimicking others Professional bios versus authentic connection Your professional persona Why it is important to really represent who you are as a therapist Ethical reasons to embrace your style (and communicate it well) How to take off the blank screen or blank slate, looking at the self-exploration that’s needed How our experiences and our values can impact treatment Relevant ethics codes related to choosing who you work with, embracing your skill set, and rejecting clients based on demographics What to put on your website How fear can get in the way of effectively reaching your clients How personal branding is the antidote to being “too niched.” Resources mentioned: We’ve pulled together any resources mentioned in this episode and put together some handy-dandy links. Dr. Ben Caldwell’s Book Saving Psychotherapy Other Episodes Mentioned: Bad Marketing Decisions What is a Modern Therapist Are You Sure You’re a Specialist? How Much is Too Much? Building the Psyko Therapist Brand The Fight to Save Psychotherapy Therapists in Therapy     Our events this year: The Brand Called “You”: Legal & Ethical Issues in Developing a Personal Brand The Therapy Reimagined Conference in Los Angeles in October 2018!!   Who we are: Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, 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. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. 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 Survival Guide 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/    

In this episode, Greg, Leon and Rahul discuss: "Swamp Thing Winter Special #1" (https://www.dccomics.com/comics/swamp-thing-2016/swamp-thing-winter-special-1) "Death Of Love #1" (https://imagecomics.com/comics/releases/death-of-love-1-of-5) "Cold War #1" (http://aftershockcomics.com/cold-war/) "Twisted Romance #1 and #2" (https://imagecomics.com/comics/releases/twisted-romance-1-of-4) "Bingo Love" (https://imagecomics.com/comics/releases/bingo-love-ogn) "Exit Stage Left: The Snagglepuss Chronicles #1 and #2" (https://www.dccomics.com/comics/exit-stage-left-the-snagglepuss-chronicles-2018/exit-stage-left-the-snagglepuss-chronicles-1) "VS #1" (https://imagecomics.com/comics/releases/vs-1) "Florence" (https://itunes.apple.com/us/app/florence/id1297430468?mt=8) There are also some brief spoiler free impressions of the latest Marvel Movie Black Panther to round things off! and a little bit of chatter about the latest Injustice 2 DLC! Send any questions or feedback to (mailto:acecomicals@gmail.com) acecomicals@gmail.com. And also please subscribe (http://www.acecomicals.com/subscribe) and leave us a review! Ace Comicals, over and out!#

Top 10 Dec 2017, Harley Quinn: Be Careful What You Wish For, Superwoman 18, New Super-Man 19, Suicide Squad 33, Old Man Hawkeye 1, Avengers 675, Phoenix Resurrection 3, X-Men Gold Annual, Spider-Man/Deadpool 26, Dejah Thoris 0, Battlestar Galactica vs. Battlestar Galactica, Star Wars: Forces of Destiny - Rey, Ninjak vs. Valiant Universe 1, Stabbity Bunny 1, Gao 1, Atlas and Axis 1, Archie 27, Marvel buys Conan, Marvel movie news, Teen Titans Go movie trailer, Crosswind TV show, Neil Gaiman American Gods, Krypton trailer, TMNT cartoon, Sanctuary by Tom King, Secret History of the DC Universe, Exiles 5th member revealed, Joyride, 7 to Eternity, Spider-Man 2099, Miniaturist, Final Girls, Artemis, Chair, Defenders, Punisher, Greatest Showman, Best Superhero Performance Debate   Comics details: Harley Quinn: Be Careful What You Wish For by Amanda Conner, Jimmy Palmiotti, Ben Caldwell, Chad Hardin, Otto Schmidt, Paul Mounts, Alex Sinclair New Super-Man 19 by Mariko Tamaki, Brent Peeples, Richard Friend, Hi-Fi Suicide Squad 33 by Si Spurrier, Fernando Pasarin, Oclair Albert, Blond Old Man Hawkeye 1 by Ethan Sacks, Marco Checchetto, Andres Mossa Avengers 675 by Al Ewing, Mark Waid, Jim Zub, Pepe Larraz, David Curiel X-Men Gold Annual 1 by Marc Guggenheim, Leah Williams, Alitha Martinez, Craig Yeung Spider-Man/Deadpool 26 by Robbie Thompson, Scott Hepburn, Ian Herring Dejah Thoris 0 by Amy Chu, Pasquale Qualano, Valentina Pinto Battlestar Galactica vs. Battlestar Galactica 1 by Peter David, Johnny Desjardins, Kim Mohan Star Wars: Forces of Destiny - Rey by Jody Houser, Arianna Florean, Adele Matera Ninjak vs. Valiant Universe 1 by Eliot Rahal, Joe Bennett, Ulises Arreola Stabbity Bunny 1 by Richard Rivera, Dwayne Biddix, Liezl Buenaventura Atlas and Axis 1 by Pau Archie 27 by Mark Waid, Audrey Mok, Kelly Fitzpatrick   Comics Countdown 10 January 2018: Mister Miracle 6 by Tom King, Mitch Gerads Eternal Empire 6 by Sarah Vaughn, Jonathan Luna Runaways 5 by Rainbow Rowell, Kris Anka, Matt Wilson Damned 7 by Cullen Bunn, Brian Hurtt Detective Comics 972 by James Tynion IV, Miguel Mendonca, Diana Egea, Jason Wright Royal City 9 by Jeff Lemire Flash 38 by Joshua Williamson, Scott Kolins, Hi-Fi Bloodshot Salvation 5 by Jeff Lemire, Mico Suayan, Diego Rodriguez Ms. Marvel 26 by G. Willow Wilson, Nico Leon, Ian Herring Spider-Man/Deadpool 26 by Robbie Thompson, Scott Hepburn, Ian Herring

Hey there fellow nerds, geeks, artist alley evangelists and supporters of independent creators! Thanks for tuning into the Hall H Show podcast! Co-hosts, Aaron Nabus and Alex Benedicto and frequent guest, Keithan Jones, owner of comic book publisher, KID Comics and creator of the comic book, The Power Knights, recently hit the road from San Diego to Los Angeles for a special podcast with a few black comic book creators, Jason Reeves, Ruben Warren and Hannibal Tabu to preview Keithan's inaugural one day event, Black Comix Day 2018, which will take place on Saturday, February 17 at the Malcolm X Library in San Diego, CA. This particular day was chosen specifically to coincide with the highly anticipated Marvel Studios movie, Black Panther – which will premiere on Friday, February 16, the day before Black Comix Day 2018. Special thanks to Ben Caldwell for letting us record this podcast at the historic KAOS Network in the Leimart Park area in Los Angeles. Enjoy...and please come to Black Comix Day 2018 and see for yourself why black comic creators are important! Representation matters and Black Heroes Matter! This episode was about as long as Star Wars, The Last Jedi, so we appreciate all of our guests for taking the time out of their busy schedules to spend a few hours with us. Did you know? Aside from iTunes, GooglePlay, Stitcher and Tune In, the #HallHshow is now on Spotify! So there is no excuse to not be a subscriber to our show! Peace...cheers...and #ArtistsAssemble! ---------  Event Info: BLACK COM!X DAY 2018 Date: Feb. 17th • Time: 11am-5pm • FREE #BLKCOMIXDAY2018