Welcome to Linda's Corner, a top rated, positive, encouraging, self-improvement podcast. In this episode, I'm delighted to welcome Catherine O'Brien. Catherine is a Licensed Marriage and Family Therapist, the author of “Happy with Baby: Essential Relationship advice when partners become parents,” founder of HappyBaby.com, the California state co-coordinator for Postpartum support International; and she helped establish “A Mother's Heart” in Sacramento, where mothers with perinatal and anxiety disorders can go to receive support, and she participates in the Sacramento Maternal Mental Health Collaborative. You can reach Catherine at her website happywithbaby.com and on social media @happywithbaby. Please share, subscribe, leave a rating and review, visit the Linda's Corner website at lindascornerpodcast.com and/or follow on youtube, facebook, instagram, and pinterest @lindascornerpodcast.
This week on the Mimosas with Moms Podcast, Abbey welcomes Bryana Kappadakunnel, Licensed Marriage and Family Therapist, Perinatal, Infant, and Early Childhood Mental Health Specialist, owner of Conscious Mommy! Bryana shares her journey into conscious parenting and how she helps other parents learn new ways to parent in order to transform their relationship with themselves and their children. Bryana talks about breaking cycles, boundaries, and discipline as well as how to lean into the discomfort of parenting. How can we be a more conscious parent? Let's talk about it, CHEERS! ——————————————— You can find Bryana Kappadakunnel, LMFT: www.instagram.com/consciousmommy Private FB group: www.facebook.com/groups/consciousmommy Workshops & Courses: learning.consciousmommy.com Conscious Parenting Coaching: www.consciousmommy.com Freebie: Stepping Stones for the Conscious Mommy here: www.consciousmommy.com/freebie ——————————————— Instagram @mimosaswithmoms FB /mimosaswithmoms Email firstname.lastname@example.org An ABC of Families by Abbey Williams - https://www.amazon.com/ABC-Families-Abbey-Williams/dp/0711256535 ———————————————— This episode is sponsored by: * MANSCAPED - the best in below-the-waist grooming and hygiene! Check out their newly launched The Lawn Mower 4.0 and other products at www.ManScaped.com/mimosaswithmoms and use code MIMOSASWITHMOMS for 20% off and free shipping!
Today's show gives us a unique perspective on pregnancy and the postpartum while managing a physical disability. Join us to hear our guest's inspiring story. Rachel Brousseau is a Licensed Marriage and Family Therapist, Registered Drama Therapist, Drama Therapy Board Certified Trainer, and Perinatal Mental Health Certified Therapist. She has a private practice in Burbank, CA, where she specializes in helping highly sensitive mothers throughout their motherhood journey. She is the co-founder of the Creative Center for Motherhood, supporting moms through the use of group creative expression. Rachel has presented for Maternal Mental Health NOW, the North American Drama Therapy Association, USC School of Social Work, Cal State LA, and Heartbeat. She is also a Parent and Me class facilitator and teaches at the Drama Therapy Institute of Los Angeles. Through her personal experience, Rachel is driven to help mothers feel connected so that they never have to feel alone. Show Highlights: Rachel's story of being diagnosed with a very rare autoimmune disease that affects her muscles at age five; as the progression happened, she had frequent falls and times when she couldn't walk or navigate stairs How Rachel still played sports and performed in theater with adaptations Why Rachel struggled as an adult to get insurance, being forced to get creative with the medical system to get the services she needed How Rachel learned to advocate for herself and can now support and advocate for her clients How heavy steroids as a child led to eye problems like cataracts, glaucoma, and retinal detachment Why Rachel rejected the idea of parenthood because she overheard a doctor tell her parents that she would never have children How Rachel reconsidered pregnancy after her marriage, even though there was no research to go on for mothers with her condition When she became pregnant, things went well until her third trimester, when she began falling frequently After giving birth, she began having scary thoughts about falling and dropping the baby and her baby getting sick or inheriting her illness How she began attending a Mommy & Me yoga class about 2-3 months postpartum; there were a lot of stairs at the studio, and Rachel was told to “get in shape” when she inquired about an elevator How a similar experience at a second yoga studio left her feeling shut out, unwanted, and like she “couldn't do motherhood well” How art therapy finally left her feeling acknowledged and made all the difference How Rachel handled going back to work with certain accommodations Why Rachel started researching perinatal mood and anxiety disorders, making sense of it all, and determining to help other moms Why Rachel stuck with strict criteria for her private practice office space to accommodate herself and her clients Rachel's checklist to consider for disability and accessibility How support and telehealth help during the postpartum period Rachel's advice for those with disabilities in dealing with “able-ist” attitudes, microaggressions, astonishment, and assumptions Why therapists and providers should take a support role and not an expert stance Resources: Connect with Rachel on her Website and Facebook.
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.
Christine Quynh Anh Nguyen is a COAMFTE certified Associate Marriage and Family Therapist currently working in Los Angeles. Prior to her current position at Pacific Marriage and Family Therapy Network, Christine has worked with diverse populations in research, community health, and nonprofit settings all across Southern California. She has lived and clinical experience with trauma, intergenerational and multigenerational families, race/identity, anxiety, insomnia, and LGBTQ+ issues. Christine has served as a bilingual mental health educator, in-home crisis counselor, community outreach coordinator, and research assistant for the Vietnamese community. Open Path Psychotherapy Collective Rise Above the Disorder 211LA Christine Nguyen - Pacific MFT Network Christine Nguyen - Psychology Today ------ Instagram Facebook
Find out what happens when we mix Executive Presence with Relational Mindfulness! Our guest: Shari Foos Shari Foos is a Marriage and Family Therapist, adjunct professor, writer and improvisational artist. After twenty years of private practice, she wanted to address the growing isolation and need for real connection in an increasingly technological world. While one-on-one therapy and counseling offer profound help, only groups can provide the sense of empowerment and belonging within a family or community. So in 2013, she founded The Narrative Method, a 501C3 with the mission to create group programs in which participants could see themselves in each other's stories, increasing empathy and mutual understanding. The effectiveness of hundreds of transformative workshops with at-risk populations including veterans, youth and disenfranchised women, was proven in a study by California State Northridge. Connect with Shari: https://www.thenarrativemethod.org/what-is-tnm --- Send in a voice message: https://anchor.fm/executivepresence/message
It's the beginning of the year and as you are considering what goals to set or reset, the Mattsons thought it would be the perfect time to discuss the skill of TIME BUDGETING. In Part 2 of this conversation, Jeff and Terra explore the impact of one's Core Value Index on the way they view and steward time. If you are not familiar with the Core Values Index, the Mattsons use this time tested assessment in their twenty years of practice, helping parents, couples families and organizational teams grow in their understanding of self and others. The CVI is over 97% reliable and helps us understand what motivates and brings anxiety. Listen in as Jeff and Terra make some key connections between how we best manage our time as a Merchants, Builders, Innovators or Bankers and how one might lead or parent others who are different from them when it comes to their CVI. Jeff Mattson (MA ORGL) and Terra Mattson (MA LPC, LMFT) are the married co-founders of Living Wholehearted LLC and the Courageous Girls movement and the weekly hosts of the Living Wholehearted Podcasts. Jeff is an Organizational Leadership Coach and Terra is a Licensed Marriage and Family Therapist who is now solely working with executives. With a team of 11, Living Wholehearted helps leaders in a variety of settings, from corporate offices to leadership retreats and individual counseling. Jeff and Terra have each invested more than two decades in leadership coaching and trauma-informed therapy – and have helped national organizations and churches navigate difficult leadership crises. Their professional experience and research have formed their unique perspective on the relationship between leadership, integrity and trauma. They are parents to two teen daughters, speakers, authors, executive coaches, and business owners who get what it's like to juggle many aspects of one's lives. With the help of Terra's book, Courageous: Being Daughters Rooted in Grace, and their co-authored book, Shrinking the Integrity Gap: Between What Leaders Preach and Live (October 2020, David C Cook), the Living Wholehearted Podcast is reaching a growing number of leaders in the home, at work, and in the community. The Mattsons are also spokespeople for Christian Parenting, which reaches 1 million parents and produces the Dear Mattsons youtube series. One of the Mattsons primary goals is to share Biblical, clinical and relational wisdom to help leaders live and lead with integrity, addressing the real struggles that keep people up at night. Jeff and Terra believe that when a leader shrinks the integrity gap between what they preach and how they actually live, everyone in their wake benefits. And when they don't, everyone in their wake pays. It's just a matter of time.
How to Understand and Treat Psychosis: An interview with Maggie Mullen, LCSW Curt and Katie interview Maggie Mullen, LCSW, a national trainer on culturally responsive, evidence-based care for psychotic spectrum disorders. We talk with Maggie about her anti-racist and disability justice framework of psychosis, understanding psychosis on a spectrum, what to do when psychosis enters the treatment picture, assessment of psychosis, and treatment using Dialectical Behavior Therapy (DBT). We also talk about how society defines “normal” and pathology, exploring cultural differences in these definitions. Interview with Maggie Mullen, LCSW Maggie Mullen, LCSW (they/them) is a clinical social worker, national trainer, community activist, and author of The Dialectical Behavior Therapy Skills Workbook for Psychosis. Maggie specializes in culturally responsive, evidence-based care for psychotic spectrum disorders, trauma and PTSD, the LBGTQ+ community, and formerly incarcerated people. As a training director at Kaiser Permanente, they take great pride in mentoring, training, and supervising the next generation of social workers. You can find them online at www.maggiemullen.com In this podcast episode we talk about looking at psychosis differently We started the conversation on psychosis when we were looking at conspiracy theories. We know that folks who believe in conspiracy theories and those who have a diagnosis of psychosis are different, but knew that we needed a deeper dive into how to understand and treat psychosis. We dig deeply into this conversation in this week's podcast episode: Maggie Mullen's anti-racist and disability justice framework of psychosis “People with psychosis [are] being overly institutionalized… over medicated or highly focused on medication as the sole treatment. And particularly for our… black, indigenous, and folks of color experiencing psychosis, and people who are being shot and killed by police… when they're out responding to their symptoms in a public way, or being incarcerated and not receiving treatment.” Maggie came from a community organizing background Inequity and lack of resources for people who experience chronic psychosis The focus on medication rather than other forms of treatment for psychosis BIPOC individuals being shot by police when psychosis shows up in a public space “Psychotic spectrum” versus the segregation of psychosis as “other” “We are often the least prepared to deal with our most acute clients” The continued segregation of psychotic disorders Cultural considerations when determining what is psychosis or other types of experiences The lack of inclusion of psychosis in the research Psychosis is not “other” but is actually a spectrum of behaviors and are very common The symptoms of psychosis are not constant, they fluctuate for every individual The importance of following the model and voices of the disability justice movement Including education on the treatment for psychosis, rather than allowing therapists to opt out Folks with psychosis are often not included in the research, which needs to change What to do when psychosis comes into the treatment picture for our clients “The reality is there are wonderful outcomes, I think, for people with psychosis, when we look at it from a different perspective. Which is to say – what if some of the work might be on changing your symptoms themselves? But what if part of the work is actually on accepting your experiences so that you can just experience less stress with them?” We need more training on psychosis to feel confident Normalizing the experience of psychosis Helping to make peace with psychotic symptoms (i.e., making friends with the voices) to decrease distress Looking at treatments beyond medication How to identify psychosis and assess for impact and impairment The myth that all elements of psychosis are distressing and bad Why Maggie Mullen is using Dialectical Behavior Therapy (DBT) to treat psychosis “People with psychosis deal with emotion dysregulation, actually more so than the average person…that's where we know DBT is really effective” We frequently underestimate the ability to help folks with psychosis Using DBT skills for emotion regulation concerns that frequently come up in psychosis Psychosis and PTSD oftentimes occur together and aren't always diagnosed Trauma can influence the onset of psychosis AND psychosis can be traumatic Maggie's pilot program with DBT for psychosis The concrete and straight forward nature of DBT skills make them very accessible Understanding psychosis differently, including the cultural differences of what is “normal” How to identify what is “real” and what is psychosis How do you define what is normal for someone? What do we decide what we pathologize? Breaking up the binary of normal or not normal – reframing as “experience” The importance of understanding what is negatively impacting the client and how to keep clients safe Take the lead of your client and trust that they know themselves best The tension between taking the lead of the client and mandates and requirements as a therapist The Dialectical Behavior Therapy Skills Workbook for Psychosis by Maggie Mullen, LCSW Maggie wrote a book to democratize DBT skills Using DBT, but making the skills more concrete and accessible Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Buying Time LLC Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They've got you covered. Don't know where to start? Check out the systems inventory checklist which helps business owners figure out what they don't want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/ Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/ Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Maggie's website Maggie on Instagram The DBT Skills Workbook for Psychosis by Maggie Mullen, LCSW Relevant Episodes of MTSG Podcast: Conspiracy Theories in Your Office Fixing Mental Healthcare in America: Serious Mental Illness and Homeless Fixing Mental Healthcare in America: Psychiatric Crises in the Emergency Room Fixing Mental Healthcare in America: Peer Support Specialists Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: www.mtsgpodcast.com www.therapyreimagined.com https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated): Curt Widhalm 00:00 This episode of the Modern Therapist's Survival Guide is sponsored by Buying Time Katie Vernoy 00:04 Buying Time has a full team of virtual assistants with a wide variety of skill sets to support your business. From basic admin support customer service and email management to marketing and bookkeeping, they've got you covered. Don't know where to start, check out the system's inventory checklist, which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at buying time. llc.com forward slash systems stash checklist. Curt Widhalm 00:31 Listen at the end of the episode for more information. Announcer 00:34 You're listening to the modern therapist survival guide where therapists live, breed and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 00:49 Welcome back modern therapist. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all sorts of stuff and just my continued ability or inability to introduce episodes well here but Katie Vernoy 01:06 yes, yes. Curt Widhalm 01:07 Recently, we had an episode on conspiracy theories. We very, very briefly talked about the difference between people who are following conspiracy theories and psychosis. We did an almost barely adequate job of talking about it and decided that we needed to follow up with somebody could who could help us talk about psychosis a little bit more deeply. And so we have a guest today, Maggie Mullen LCSW w. And they are a fantastic resource when it comes to working with psychosis and very glad to have them with us here today. So thank you very much, Maggie, for joining us. Maggie Mullen 01:49 Thanks so much for having me, Curt. And Katie. Katie Vernoy 01:51 So glad to have you here. Like I told you before we got started, we needed somebody to talk about psychosis saw that you had sent in a little pitch to us. And we're like, oh my gosh, this is perfect. We're so excited. And I can't wait to kind of get to meet you here on the podcast. But let's, let's have everyone meet you and say what we always say to all our guests, who are you? And what are you putting out to the world. Maggie Mullen 02:12 As Curt mentioned, Maggie Mullen, LCSW I use they them pronouns. And I am an author and trainer. And what I am working right now to put out into the world is an anti racist and disability justice approach to working with people experiencing psychosis that really focuses on centering their experiences and needs. And one of the ways that I'm really going about that right now is by offering DBT informed treatment to people who are struggling with psychotic spectrum disorders like schizophrenia, schizoaffective, disorder, bipolar disorder, etc. Curt Widhalm 02:43 You get into this work, that a lot of therapists have their own stories that just what's your story as far as getting into working with psychosis, and really having this level of passion for it? Maggie Mullen 02:59 So I come from a community organizing background, right, a lot of the work that I was doing before grad school was really centered around how do we bring communities together to fight for change. And I chose a path of social work, because I really wanted to have the opportunity to do both that macro kind of bigger level practice, but also help individuals because I was somebody who was able to connect with people pretty well and really enjoyed that part of the work. And as I was in grad school, learning more about mental health and kind of being in that part of the field, the thing I kept seeing over and over again, was the inequity and really lack of resources for people who are experiencing psychosis in a chronic way. And the way that, you know, that kind of shows up and at least at US, US society is, you know, seen people with psychosis being overly institutionalized, you know, really over medicated or highly focused on medication as the sole treatment. And particularly for our, you know, black indigenous and folks of color experiencing psychosis, and people who are being shot and killed by police, right when they're out of responding to their symptoms in a public way, or being incarcerated and not receiving treatment. And for me, that just felt like a call to action to say, I want to get involved in this area that really needs to be expanded. And I think one additional piece is if you look at almost any piece of literature in our field, right? So if you're like nerd like me, you want to go and do research about something. If you look into almost any psychotherapy treatment, you'll see that there's a rule out for participants who experienced psychosis. And that's really widespread across almost all therapies. And I find this odd because the same type of like what we used to call delusional beliefs we now call distressing beliefs or distorted beliefs, those same types of things happen in other diagnoses, right? We see this in eating disorders, right? People who have such distorted beliefs about their bodies to the point that they're willing to, you know, encounter significant health issues in order to engage in certain behaviors, right or even with depression, right, where we have distorted beliefs about your self worth to the point that you're willing to hurt yourself. but we don't exclude people so aggressively from treatment as we do with psychosis. And for me, that's really kind of a question that I kept coming on grad school, like, why this group? Why are we segregating them in this kind of way that's leading to, you know, high rates of suicide, high rates of incarceration, all those things that I mentioned before, that are just poor quality of life issues for these folks. Curt Widhalm 05:20 So to ask maybe an obvious question here. Why, why what have you found out and asking this big question, what is our system have against psychosis? Is it fear from treatment professionals in the past? I'm sure that you've come up with some at least explanatory answers here. Maggie Mullen 05:41 Yeah, there's not one right answer, I think is part of this, right. Like, if we went back really far in history, one of the things that we would see is that across cultures, right, there are really different approaches to psychosis, right? We see in a lot of indigenous cultures, the idea that people with psychosis are actually, you know, accessing other states of reality, and that scene is a strength, right? And something that's really valued, right, like people who are medicine are healers. And we don't see that particularly in white society in the US, right, where we're really have kind of more colon colonized mindset. But I think a lot of this comes from fear, right? Just the idea that I don't understand maybe what's happening to this person, they're behaving in a way that's, you know, erratic in my eyes, when it can't really get into their, you know, headspace and understand what they're experiencing. And I think that's part of how our field is responded, because if we look back at Dr. Aaron Beck, right, the creator of CBT, who just passed recently, he was doing trials of CBT, with people with psychosis back in 1950s. And for some reason, and I don't know all the reasons why his research kind of stopped around that point, right, kind of hit a dead end. And then we just kind of started offering these things to people with more like depression, anxiety, etc. I think part of this is just again, that fear that you mentioned, Curt, more than anything, unfortunately, Katie Vernoy 05:45 when we look at this, there are folks who try to exclude psychosis from their practices, especially private practices. But we can't always exclude it. Right? Like there are times when it comes into our office, we've an established relationship with the client, and we can't always exclude and I'm not saying that we should always exclude it. I think that's part of the problem. But when we don't when we actually start working with psychosis, because it is so... I don't even know what the right word is...kind of fringe, maybe to our profession. I mean, I even think about I know you do DBT for psychosis, I've talked with DBT centers that say if they have psychosis, they shouldn't be doing DBT. I mean, like, there's, there seems like there's not really guidance, when whether you invite or exclude psychosis, when it shows up in your office, it seems like there's there's an opportunity for us to really do it wrong. And so I mean, typically, we asked what a therapist get wrong. So I guess I'm asking that question. But I, I'm trying to sort out kind of even how to get to the correct question, because it seems like part of what we get wrong as we exclude these folks from our practice. But if they show up, I imagine there's stuff that we're really getting wrong in the room and in the treatment planning. Maggie Mullen 08:18 Yeah, I think part of this is that combination of we need clinicians to have more training across the board and treating psychosis. And again, I think with these newer wave therapies, like CBT, for psychosis, act for psychosis, more DBT skills kind of approach that are really emerging as very strong in the literature and really effective for people. And that are offered, but just not I think, in a very widespread way, again, at least in the US. And so I think part of it is we need clinicians with more training, so they feel more competent. And I think part of where we get things wrong, is that we think of psychosis as like these people over there, right? We kind of again, like you said, kind of put them in like a box segregated in some way. And the way that we really approach psychosis now in a kind of more modern or progressive sense, is that there's really a spectrum of psychosis. Right. On one end of the spectrum, we see people with less distressing less bothersome experiences of psychosis. And that for like, for me, for example, that looks like I'm on call for my work every once in a while, and I My phone has to be on 24/7 because I might be calling the emergency room to do an evaluation. And what will happen to me occasionally is I will think I hear my phone rang, and I will look down and I'll see no miss call, right? And I'll like say to my partner like hey, did you see Did you hear my phone ring? And they're like, No, that's an experience of an auditory hallucination, right. I've just had experience of psychosis. And on the other side of the spectrum, we have more of these distressing chronic life impairing experiences like psychosis that are more common for people who get diagnosed with schizoaffective sorta are psychotic spectrum disorder of some kind. And people who experienced those diagnoses fluctuate on the scale in the same way, right? That they are doing better at certain points, or their symptoms are not as distressing, etc. And part of the reason we frame it in this way now is to normalize the experience of psychosis that at some point, almost all of us will have some experience of psychosis. And I think when we look at it from that perspective, it feels less scary to approach psychosis. And I think also it can instill some hope that I think a lot of therapists don't have when they work with psychosis, right? We feel like, it feels hopeless, nothing's going to change, things are not going to get better. But we get training, I think and experience in that way. And the reality is there are wonderful outcomes, I think, for people with psychosis, when we look at it from a different perspective, which is to say, what if some of the work might be on changing your symptoms themselves? But what if part of the work is actually on acccepting your experiences so that you can just experience less stress with them? Right, so how do I make friends with my voices? So they don't bother me in the same way? Or how do I have to, like, do education with somebody's loved ones and families or societies to accommodate the fact that this person may need to, you know, do certain things to manage their psychotic symptoms, right. And that's just a normal part of their experience, rather than a pathologized experience. So I think these are ways as therapists that we have been getting things wrong historically. But we also know that there's plenty of ways that we can shift that with training with education, to make ourselves feel more confident doing this work Curt Widhalm 11:37 The longer that we do this podcast more than I recognize that maybe my graduate training was not the greatest. And I'm trying to recall back to the way that we were educated on it. And it just seems to have been like one class in like the the psychopathology class that was just kind of, here's defining what it is. And if you ever end up working on it, then you'll get trained at your site. And it really kind of allowed for opting out of even having to learn about it. And my experience across time has been that it still shows up in my office that clients still present with this kind of stuff. Where do you see, you know, if my experience is really bad, where do you see graduate education needing to go as far as removing some of this fear or other ring of psychotic spectrum as a thing that needs to be feared? Maggie Mullen 12:43 I think it starts with following the model and the experiences of the Disability Justice Movement, right, I think the thing that we can do first and foremost, is bring in the voices of people who experience psychosis themselves, right, have this lived experience, into our education or classroom settings. Because it's one way that we, I think, with any kind of stigma, right, that's out there is that through more dialogue and experience with people who are living with this, you know, whether we call it condition or experience or whatever, the more comfortable we get with it, the more normal it becomes to us. And so I think it's starting there and in the education and kind of classroom settings to reduce that kind of othering. And then, in addition to that piece, I think, again, it's the part of actively including, and teaching the treatments for folks with psychosis, and not acting like we can opt out of it. I think one thing I find, with therapists, not across the board, but oftentimes, is that we are often the least prepared to deal with our most acute clients, right? So we are often trained really well to work with people with, you know, garden variety, depression and anxiety adjustment issues, etc. The word Well, exactly right. And we don't get a lot of trained, I think that is very quality for people who are chronically struggling and dealing with things that are acute and very difficult for them very distressing. And I think that's part of where our education and our schools needs to change is to shift away from, you know, exclusive treatment of worried well, and really integrate the bigger spectrum of mental health and well being overall, Curt Widhalm 14:20 to maybe even further add to this is not necessarily treating psychosis as something that just needs to be medicated away, which has been historically just kind of where well, you ship them to a psychiatrist, and that'll take care of the voices. Maggie Mullen 14:38 Absolutely. Yeah, I hear that even for my colleagues, right, who work in my clinic have the idea that like psychosis is actually easy to work with because it's on the psychiatrist right to do that work. It's not really on us. We're just chasing them around getting them on medication. But as you've probably experienced in doing any of this work yourselves, many people with psychosis struggle with medications as an intervention, right? That can be life changing. For a lot of people, and for other folks, the side effects that come with them, you know, are so impairing that they're like, I don't want to do this right or, or I'm scared to do this or whatever it is because they can really change your life, your health outcomes, and even just the longevity of your life. So when we rely exclusively on that stuff, it really denies people the ability to build a life worth living, but isn't just, you know, kind of circled around medications as the only treatment Katie Vernoy 15:26 Well, even in and how you're talking about psychosis, it just really puts a different flavor of it for me with this whole idea of a spectrum of psychosis. And to me, I mean, if we're really looking at auditory hallucinations, like hearing the phone ring, but it hasn't really wrong, or, or even, you know, kind of some of these really distorted thoughts that come up and these delusional beliefs that we have about ourselves that happen in, you know, even kind of garden variety, depression and anxiety, it seems like assessing psychosis would actually be much more complicated. If we're really looking at the full spectrum of the experience. What is your advice as far as identifying, you know, kind of what, what requires or what would be helped by this knowledge around psychosis? Maggie Mullen 16:16 Can you answer a different way, Katie? Katie Vernoy 16:19 Yeah, I guess I'm just asking, basically, how do you assess psychosis when it's not kind of this florid psychosis? How do you how do you actually assess psychosis with this idea of a spectrum of psychosis and psychotic experience? Maggie Mullen 16:38 I think it's really dependent on the level of distress and impairment and causes in somebody's life. Right? Like with all things, when I think about if you're doing really good assessment for any mental health issue, and psychosis is no exception. It's like, how is this interfering with your goals? And the things you want to be doing with your values, your ability to do what you love? How is this in terms of the emotional side of it, right? Like, how much distress how much upset is this causing you, etc. And getting a really clear picture from clients around those pieces, I think can tell us whether we what level of intervention we need to kind of do. Because again, I think one thing that providers often do is we also kind of do the other extreme, which is to assume that if you have any experience of psychosis, it is distressing, and it's bad, right? Like we need to get rid of it. And I think a lot of people who have lived experience of psychosis will tell you, I actually find that there's some very comforting parts of my psychosis, right? Like, maybe I hear the voice of my mom talking to me who passed away or some other loved one, right, or, you know, something that can feel like it's just reassuring to them. And so when we need to when we're doing these assessments, we want to also be integrated in what's the problem and what's actually quite adaptive and works for your life instead, Curt Widhalm 17:51 So why DBT for psychosis Maggie Mullen 17:54 So in thinking back to the part about like, where researchers and mental health people got it wrong. So for a long time, providers assumed that people with psychosis didn't experience emotions in the same way as people who were maybe more neurotypical because they weren't expressing their emotions through their effect or their body language, right. And a lot of that has to do with negative symptoms, which are part of that spectrum of psychosis. And what we now know is that people with psychosis deal with emotion dysregulation, actually more so than the average person, right? So they're dealing with overwhelming emotions, that are sometimes triggered by their symptoms, right. So if you have a critical voice telling you, you're a bad person, that's going to cause emotion dysregulation, we're going to get emotional, sure, and kind of the cycle that can happen where then you might experience more psychosis, right? More symptoms, because of an increase in emotions, so kind of becomes a cycle. And what we know to be true is that people then cope with that emotion dysregulation the same way that somebody with, you know, BPD, who's in treatment for DBT, like do which is self harming suicide attempts, substance use, etc. And so that's where we know DBT is really effective, right, based on both the literature, the research, but people's lived experience around it. And so the idea with how we use DBT skills, and I say DBT skills, because we're taking an informed treatment approach, we're not necessarily doing a full DBT treatment program, although that is appropriate for some people with psychosis. We're thinking, let's break that cycle of again, emotions and symptoms kind of escalating each other by using something like distress tolerance skill, or an emotion regulation skill or mindfulness to help break things up and help reduce your distress. Katie Vernoy 19:44 It seems to be completely logical that that would be the case like and my experience of working with some clients that had different different diagnoses on the spectrum of psychosis, and I also in my experience, if in any way was was aware of oftentimes trauma histories as well as is that? Is that relevant to this conversation? Maggie Mullen 20:09 Absolutely. Yeah. Thanks for bringing it up. So one thing that I think is, or I don't think I know is very common amongst people with psychotic spectrum disorders is PTSD. So not just experiences of trauma, but experiences of trauma that are continuing to impact our life in a really significant way. And right now, we think about a third of people with schizophrenia have PTSD, which is a very high number. We actually think it's probably higher, though, because clinicians tend to not assess for PTSD very commonly. And clients don't tend to also report those symptoms very actively when they're not asked. So when we think about, again, what clinicians might be missing, it's important that we assess for that and, and part of how we think about trauma with psychosis is that it's really common for people with a psychotic spectrum disorder to have, you know, childhood trauma, so some kind of trauma from growing up. That might be one of the contributing stress factors in the development of psychosis over time. And we also know the experiences associated with experiencing psychosis are traumatic, right. So for example, we talked about the idea of like being incarcerated or being taken by the police in handcuffs to go to the hospital, right, that's a traumatizing experience for a lot of people, particularly for people of color. We also have, you know, being mistreated in hospitals kind of being warehoused there for long periods of time. And then certainly just the experience of psychosis itself, right, when you're just oriented and you're, you know, kind of separated from reality that can be really scary for people, right, we might do things that are out of character for ourselves. So trauma is a common experience, I think, for people with psychosis. And secondarily, there's really great treatment for people experiencing PTSD who also have a psychotic spectrum disorder. But it's really uncommon for providers to offer it because of fear, I think, again, to what we were talking about earlier. And we know, I think more so part of what we see the literature and research changing is that we are including more people with psychosis and studies now than we used to before. So for example, we see a lot of the new prolonged exposure, which is, you know, one of the gold standards for treatment of PTSD, that if somebody has relatively well controlled psychosis, so they might experience some active psychosis, but it may just not cause strong levels of distress. They're a great candidate for PTSD treatment. And same thing for cognitive processing therapy or CPT as well. Curt Widhalm 22:31 Over the couple 100 episodes or so that we've done, we've had plenty of guests who come in and speak very well about their their target populations. But I don't think that we've had people like you who've actually piloted programs that back up that this is just beyond kind of the here's something that I've experienced a lot in my office and done well with, can you talk about what you saw as an opportunity with the program that you piloted? Maggie Mullen 23:00 Sure, so I was trained as a DBT clinician, that's like my bread and butter as a therapist and working in a fully intensively trained DBT program. And I like live and breathe DBT, like, I am one of those DBT nerds that you hear about in grad school. And I think I felt like I was working, you know, as a DBT therapist, but also working a lot with people with psychosis in a in a kind of a treatment program. And there was this weird separation where we saw like, these two worlds being again, just very disparate, and not a lot offered between them necessarily, even though again, for people with borderline personality disorder who are really well treated by DBT. A lot of them actually experienced psychosis as part of their symptoms. And so what I did, essentially, with the encouragement of my colleagues was to say, why don't we just try to offer some of these skills to our clients and see how they do with them, see if they're practical enough, if they're concrete enough, which is, you know, important for people who might be experiencing chronic psychosis to be able to use them. And I really did this in conjunction with cognitive behavioral therapy for psychosis, right. CBT for psychosis has a really strong evidence base. And so I felt like, let's address this cognitive piece that CBT is really good at, but also integrated behavioral piece of DBT. And our clients loved it. Like it was actually kind of overwhelming the response that we received, as well as the outcome studies that we were doing around clients talking about how they were using those skills, and what that what that was shifting in their life, essentially, to feel like, not only do I know how to shift my thinking, but I can do something differently about it. And the thing about DBT skills that maybe no one will tell you is they're very straightforward, right? There are a lot of things people are already doing. Right? So self soothing, right? Many of us self soothe in many different ways, right? we distract ourselves, right? We use all of these skills, I think in many adaptive ways. And part of the work I think of integrating DBT skills is saying, Okay, do that intentionally now, right like don't just Do it as a background thing, but like think about what do I actually need right now that I'm feeling distressed? Because of the voices I'm hearing? You know, do we need to practice? You know, tip, right, which is a common skill in DBT when somebody is really distressed? Or do we want to practice opposite action here, because you're feeling some unjustified emotions, for example, and really just getting people to practice those in a more active way. Katie Vernoy 25:20 I guess I keep going back to this notion that psychosis is not something that is separate, although I think there are programs where folks end up that are separate, like a day treatment program, those types of things, but oftentimes, even in those programs, it's folks that have had pretty intense emotions, intense suicidality, you know, there's, there's a reason that they're there, it's doesn't always mean that every single person in these day treatment programs have psychosis. But regardless, I think that the, the thing that I keep coming back to is this idea around looking at psychosis differently. And when we do that, it opens up all these other treatment options, because we look at as folks who have this element, and not "them", when you were talking about the way that other cultures look at psychosis, and the ways that folks who are having some of these experiences are, are seen as whether it's a medicine person, or someone that has insight in a different way. Or there's, there's different things where, you know, people are in touch with different parts of reality. I think about religion in the United States, and the similarities with that, and how people will hear God, they'll they'll, you know, they'll see signs, there's, there's a lot of things where there are pieces of things that are kind of acceptable, and culturally appropriate. And there are things that are seen as other and I'm just curious, because you talk about kind of your your background and the way that you're perceiving psychosis, and it seems like it would be very hard. And maybe this is what I was trying to get to earlier with the assessment question, but it seems like it's very hard to identify, in some cases, what is real? And what is psychosis? And so the question I have is, again, kind of like, how do we sort through that? How do we sort through? Is this a cultural experience? I mean, I think earlier, you said it was more around, you know, kind of distress. But sometimes having these things that are culturally appropriate are very distressing, you know, you get messages from God, or you get messages from other sources that are very distressing to you. And so how to how do you grapple with that when you're really trying to honor the experience of the person and sorting through whether it's psychosis or whether it's something else? Maggie Mullen 27:48 I think one of the questions that you're kind of getting at is the question of like, how do you define what's normal for somebody? Katie Vernoy 27:55 Yes. Maggie Mullen 27:56 Yeah. And I, this is a question. I think that is when we like really backtrack as mental health professionals to the idea of like, what do we pathologize? And what do we consider normal? It's really hard to do our jobs to some extent, because the DSM is, right, kind of almost based on the idea that there are certain things that are not normal. But Katie Vernoy 28:17 yeah, Maggie Mullen 28:17 normal is really relative, right, based on culture based on history based on so many different parts of our experience. So it's, it's a little bit hard to answer that question, because it's a real philosophical one, in a way. Katie Vernoy 28:28 Yeah. Maggie Mullen 28:28 I think that is what informs our approaches, different providers is like, where do we come from? And our background of how we approach this type of stuff, again, of the idea of like, is there anything that's normal. And so I think when I see like this disability justice pushing around this piece, that's the part that really aims to sort of break up that binary of normal or not normal and say, like, this is all just experience. And again, the part that becomes how we assess things as clinicians is when somebody tells us this is a problem for me, or this isn't normal for me, right? Or this is scaring me, for example. And that's when we treat things with that kind of lens. It's complex. I think, in many ways, though, because for example, if I have somebody who is experiencing mania, they're not going to tell me something as a problem, oftentimes, right, you know, kind of, again, is a kind of generalization. When people experience mania, oftentimes, they feel amazing, right? They feel very on top of the world, not all the time, but for many folks. And they don't want an intervention at that point. And the thing that I'm always weighing right is the idea of, can you be safe at this point, right? Like art, what kinds of risks are you taking, for example? And what are ways that like, I need to intervene to help you just live your best life but take more of a harm reduction approach here, right like to keep you on track so that you're doing okay, the least amount of harm happens. But it's I think it's very tricky because so much of this stuff is relative and I honestly don't know if I have a great answer to Your question because of how murky things get around this piece. And so I think maybe my best advice around it is to say, take the lead of your client and know that they know themselves best and will inform you if something's an issue. Katie Vernoy 30:12 Yeah, yeah, I think the the thought process that I've heard a number of different times and in my travels and learning about psychosis, is being able to inhabit the world where your client is, and then kind of slowly assess what is real and not real with the client from the clients perspective. And, and to me, I feel like that can be very, very challenging, because I think there's so much bias that comes into how we perceive the world that it's can be hard to truly take the lead of the client, do you have advice on how to how to do that when when it's not like, Oh, you have a different opinion for me, but it's like, Oh, your, your reality is different than mine. Maggie Mullen 30:54 It's tough. It's really, it can be very challenging, because again, we have two different systems of training, right. So like, I have my beliefs around strengths based approach, following the lead of the client, like they are the expert on their own life that we get. And then there are things like being a mandated reporter, right, and like, needing to assess for risk and safety and things that my agency requires. And those are often at odds with each other, I think with a psychosis with the idea that I approach that really, by trying to be as transparent as possible with my clients coming into treatment around what their experience might be like, and maybe the way that I'm documenting things in my notes, right, and like trying to more educate them and say, Okay, so your doctor is going to talk about your delusions, your ideas of reference, etc. Here's what that means. Now, what's the language that you and I are going to use to describe that type of stuff that is affirming to you, and that is recognizing your experience as unique? And I try to take a bit of that perspective around all of this, because I think we can't necessarily fight the existing system. We have without I think, like working around it in that kind of way. So I don't know if that answers your question. Exactly, Katie, Katie Vernoy 32:07 Yeah, no, that totally answers my question. Thank you. Curt Widhalm 32:09 And I think your last couple of answers have really demonstrated why the DBT approach to psychosis fits so naturally, yeah. And I think is where your book probably just came very naturally in this whole process. Maggie Mullen 32:27 It did it well. And I'll tell you, I didn't start out to write a book. Because I don't know, I didn't ever think of myself as somebody who's a writer, or even frankly, like training. But I got recruited to write a book because I was doing something it was a bit more innovative in this approach to working with psychosis. And the funny part is, one of the things that came up really frequently, just as kind of an aside is getting messages about people with psychosis don't read, right? There isn't a market for this. And it first of all, that's, that's very discriminatory. Yeah, for lack of a better term wrong. It's awful. And I think part of the reason people assume that A is because of stigma, and you know, wrong beliefs about people with psychosis, but also because there are literally aren't any other books written for people that are self help books for somebody with psychosis. And, you know, we have a wonderful books on the market for loved ones, or families or mental health providers working with psychosis, but almost nothing that is geared for the experience of somebody with a psychotic spectrum disorder to say, you take control of your own experience, right, you get to be educated and learn and be offered skills. And I think in particular, with psychosis, the other thing that we know is that most people with psychosis don't get mental health treatment, right, they don't either have access to it, they don't want it or they don't have providers who are, you know, competent in providing, as we talked about before. And so this book, obviously, is not a substitute for therapy. But it's a way to really, I think, democratize these skills to say, I want to get these out to you in a form of offering that's less than $20. And so I always encourage people to seek treatment as part of that book. But this is just one way to kind of get that message out there. So that's part of kind of the journey that led me to writing the book is just wanting to make sure people had access to these skills one way or the other, essentially, Katie Vernoy 34:16 are there differences and how DBT skills are used when you are learned when you have psychosis as part of the the makeup. Maggie Mullen 34:25 So the actual skills themselves are really identical to Marsha Linehan's work, right. And I really respect her work. And for me, I did not want to stray away from what the model is because the model is really effective. We're seeing more research now around full DBT treatment programs serving people with psychosis, but that's still kind of emerging literature. And Marsha Linehan, and her book actually even talks a bit about that. But to go back to your question, I think, part of what we do need to do when we're kind of, you know, adapting or kind of shifting. The way we teach DBT skills for these clients is to do a few things. One is to make them really concrete. so that there's just really straightforward information, there's not a lot of psychological jargon, right? Things that are just very straightforward. We also want to make sure that whatever we're offering is accessible. Because, you know, as we talked about a little bit before, you know, rates have been on, you know, for example, like SSI, so like being on a fixed income are really high amongst people with psychosis. So people don't have a lot of money. A lot of folks are marginally housed don't have stable housing or food access. And so we want to make things that are really accessible, right? You know, there's a DBT skill about going on a brief vacation, for example, we have to talk about, what does that actually practically look like in the life of somebody who has who's getting 700 ollars? a month, right? Like, what does that look like? So we want to adapt the examples to actually be a reflection of their personal experience as part of that as well. But otherwise, I think the skills really kind of match on well to the experience of psychosis. Curt Widhalm 35:53 We've mentioned your book a couple of times, I think it's fair for us to actually name it. So dialectical behavior therapy skills, workbook for psychosis. We'll put a link to that in our show notes. But where else can people find out about you and the work that you're doing? Maggie Mullen 36:12 So first is my website, which is Maggie mullen.com. I'm on Instagram. I'm working on building that following. It's Maggie Mullen, LCSW W there. And those are the main pieces you can contact me and reach me my direct contact information is there. I really am trying right now to put the work out again of this more progressive approach to treating psychosis into the world and doing a lot of consulting and training with agencies. So that's definitely something that I'm always excited about doing with new folks. Curt Widhalm 36:40 And we will include links to Maggie's websites and Instagram handle over in our show notes. You can find those at MTS g podcast.com. And you can follow our social media come and let us know about your experiences and getting trained or poorly trained in working with psychosis. Come in and be a part of our Facebook community, the modern therapist group, and until next time, I'm Curt Widhalm with Katie Vernoy And Maggie Mullen. Katie Vernoy 37:10 Thanks again to our sponsor, Buying Time Curt Widhalm 37:12 Buying Time's VAs support businesses by managing email communications, CRM or automation systems, website admin and hosting email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly with a full team of VAs gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Katie Vernoy 37:41 book a consultation to see where and how you can get started getting the support you need. That's buyingtimellc.com/book-consultation once again, buying time llc.com forward slash book dash consultation. Announcer 37:57 Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. 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In this session, Certified Life Coach and Trauma-Informed Wellness Practitioner Reita Johnston sat down with Samira Blair (she/her), a Licensed Marriage & Family Therapist. She's been practicing for 10+ years serving individuals, couples, and families in Missouri, Georgia, and Florida. She specializes in perinatal mental health and is the owner of Strength & Serenity Counseling, LLC. Simara is a wife of 10 years, a mom to a 2 & 4-year-old, and a lover of essential oils, sage, old-school soul, and DIY's. I hope that you enjoy this conversation with Samara as much as I did, and I hope that you get to pick up some of the nuggets of wisdom she shares on burnout, relationships, and taking care of our whole selves. Connect with Simara: www.strengthserenitycounselingservices.com IG: @simarablair Connect with Reita: The hashtag for the podcast is #HATTpodcast Instagram: @reita.johnston Facebook: @reita.johnston Email: email@example.com Join me on Patreon for exclusive behind the scenes access, VIP coaching opportunities, and discounts at: www.patreon.com/reitajohnston Leave a question or comment for the show! Visit https://anchor.fm/reitajohnston/message Thank you for listening! If you enjoyed what you heard, subscribe to the show and share your love with a 5-Star review.
It's the beginning of the year and as you are considering what goals to set or reset, the Mattsons thought it would be the perfect time to discuss the skill of TIME BUDGETING. Like budgeting money, time is a resource we often believe we have little or none to give away. Leaders are at the top of the list, running ragged and sacrificing what they say they love the most at the end of each day. So in this episode, Jeff and Terra talk about the art of stewarding our calendars, giving practical tips to shrink the integrity gap when it comes to budgeting time. From day-to-day disciplines to planning out annual Big Rocks, the Mattsons believe that every wholehearted leader understands the value and stewardship of time. Jeff Mattson (MA ORGL) and Terra Mattson (MA LPC, LMFT) are the married co-founders of Living Wholehearted LLC and the Courageous Girls movement and the weekly hosts of the Living Wholehearted Podcasts. Jeff is an Organizational Leadership Coach and Terra is a Licensed Marriage and Family Therapist who is now solely working with executives. With a team of 11, Living Wholehearted helps leaders in a variety of settings, from corporate offices to leadership retreats and individual counseling. Jeff and Terra have each invested more than two decades in leadership coaching and trauma-informed therapy – and have helped national organizations and churches navigate difficult leadership crises. Their professional experience and research have formed their unique perspective on the relationship between leadership, integrity and trauma. They are parents to two teen daughters, speakers, authors, executive coaches, and business owners who get what it's like to juggle many aspects of one's lives. With the help of Terra's book, Courageous: Being Daughters Rooted in Grace, and their co-authored book, Shrinking the Integrity Gap: Between What Leaders Preach and Live (October 2020, David C Cook), the Living Wholehearted Podcast is reaching a growing number of leaders in the home, at work, and in the community. The Mattsons are also spokespeople for Christian Parenting, which reaches 1 million parents and produces the Dear Mattsons youtube series. One of the Mattsons primary goals is to share Biblical, clinical and relational wisdom to help leaders live and lead with integrity, addressing the real struggles that keep people up at night. Jeff and Terra believe that when a leader shrinks the integrity gap between what they preach and how they actually live, everyone in their wake benefits. And when they don't, everyone in their wake pays. It's just a matter of time.
Which Theoretical Orientation Should You Choose? Curt and Katie chat about how therapists typically select their clinical theoretical orientation for treatment. We look at the different elements of theoretical orientation (including case conceptualization, treatment interventions, and common factors), what impacts our choices, the importance of having a variety of clinical models to draw from, the types of practices that focus on only one clinical theory, and suggestions about how to approach choosing your theories for treatment, including some helpful assessments. In this podcast episode we talk about how therapists pick their theoretical orientation We received a couple of requests to talk about clinical theoretical orientation and how Curt and Katie chose their own. We tackle this question in depth: Choosing a clinical theoretical orientation The problem with the term “eclectic” when describing a clinical orientation How Curt and Katie each define their clinical orientations “Multi-modal” therapy The different elements of clinical orientations Case conceptualization Treatment interventions Common Factors and what actually makes therapy work What impacts which theoretical orientation we choose as therapists Clinical supervision Training Personal values and alignment with a theoretical orientation Common sense (what makes sense to you logically) Choosing interventions that you like The importance of having a variety of clinical theories that you can draw from “You need to know the theories well enough to know when not to use them” – Curt Widhalm Comprehensive understanding is required to be able to apply and know when not to apply a clinical orientation Avoid fitting a client's presentation into your one clinical orientation Deliberate, intentional use of different orientations Why some therapy practices operate with a single clinical model Comprehensive Dialectical Behavioral Therapy (DBT) therapists run their practices and their lives with DBT principals Going deeply into a very specific theory (like DBT, EMDR, EFT, etc.) while you learn it Researchers are more likely to be singularly focused on one theory Suggestions on How to Approach Choosing Your Clinical Theoretical Orientation “Theoretical orientation actually can be very fluid over time” – Katie Vernoy Obtain a comprehensive understanding of the theoretical orientation Understand the theory behind the interventions Recognizing when to use a very specific theory or when you can be more “eclectic” in your approach Deciding how fluid you'd like to be with your theoretical orientation Find what gels with you and do more of that The ability to pretty dramatically shift your theoretical orientation later in your career Instruments for Choosing a Theoretical Orientation Theoretical Orientation Scale (Smith, 2010) Counselor Theoretical Position Scale Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Buying Time LLC Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They've got you covered. Don't know where to start? Check out the systems inventory checklist which helps business owners figure out what they don't want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/ Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/ Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Institute for Creative Mindfulness Very Bad Therapy Podcast Petko, Kendrick and Young (2016): Selecting a Theory of Counseling: What influences a counseling student to choose? What is the Best Type of Therapy Elimination Game The Practice of Multimodal Therapy by Arnold A. Lazarus Poznanski and McClennan (2007): Measuring Counsellor Theoretical Orientation Relevant Episodes of MTSG Podcast: Unlearning Very Bad Therapy Interview with Dr. Diane Gehart: An Incomplete List of Everything Wrong with Therapist Education Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: www.mtsgpodcast.com www.therapyreimagined.com https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated): Curt Widhalm 00:00 This episode of the modern therapist Survival Guide is sponsored by Buying Time. Katie Vernoy 00:04 Buying Time is a full team of virtual assistants with a wide variety of skill sets to support your business. From basic admin support customer service and email management to marketing and bookkeeping, they've got you covered. Don't know where to start, check out the system's inventory checklist, which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at buyingtimellc.com/systems-checklist. Curt Widhalm 00:31 Listen at the end of the episode for more information. Announcer 00:35 You're listening to the modern therapist survival guide where therapists live, breed and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 00:51 Welcome back modern therapists. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about how we are as therapists. And we have received a couple of requests for in episodes about how people select their theoretical orientations. And I think that this is a great opportunity for us to maybe gear an episode a little bit more towards early career therapists, some of the students who listened to our show, but also for those of you who are maybe a little bit later in your practice to consider how you came up with your theoretical orientation or orientations. And we're gonna dive into a little bit of our stories about this, but also what some of the research ends up saying about how a lot of therapists end up practicing in the way that they do. So, Katie, from the top of the show, what are your orientations? And how did you get to where you are? Katie Vernoy 01:54 I think the the word that probably best describes my orientation is one that I was told not to use because it was bad, which was eclectic, Curt Widhalm 02:06 eclectic Katie Vernoy 02:07 ecelctic! Curt Widhalm 02:08 lazy eclectics. Katie Vernoy 02:11 And I think it's, it's not exactly true. But I really feel like I draw from a lot of orientations. A lot of models, maybe it's better than orientations, where there are a lot of really cool interventions that I like from CBT DBT narrative, even psychodynamic or Gestalt, or different things like that. There's a lot of really cool interventions that I've been able to kind of pick up in my my toolbox or tool tool belt over the years. And so to me, when we talk about orientation, and maybe this is a question to ask, I would say, I'm probably mostly existential, and certainly relational. And, and that's kind of where I sit. I think with orientation, though, there's how you conceptualize a case, how you treat a client's you know, so, orientation feels like a very broad thing, where case conceptualization seems more like okay, that's my that's how I'm orienting myself to a case specific interventions, I think tie to theoretical orientations. But I once had a supervisor say, pretty much all theories are the same. They just use different words, people want to make money. And orientations are different, but I feel like you can you can mix and match pretty well. Curt Widhalm 03:33 And on that point, you're talking about Bruce Wampold's common factors that soar looking at therapeutic treatment where theoretical orientation affects treatment about 1%. Maybe some of the emphasis of where some of these questions are coming from is our therapists, education, emphasis on every class being about orientation, really not looking at the other 99% of what actually makes therapy work? Yes. Now, like you, maybe Unlike you, I look at myself not as a dirty eclectic therapist, but as a very intentional, multimodal therapist. Katie Vernoy 04:19 Oh, my goodness, words, words. Curt Widhalm 04:24 So, like you, I also end up using a lot of CBT. In my practice, I'm also drawn to existentialism, and very much utilize a lot of EMDR work which, for the EMDR people that I trained with over at the Institute of creative mindfulness, we really look at EMDR as being the greatest hits of a lot of other therapeutic styles that got it just naturally pulls from a number of different areas. But when we first got these cases, My first reaction was kind of, I wonder how much of how we practice is based in who our supervisors were and how they practiced at, you know, kind of a developmental stage of where we were at in becoming therapists. And if that's just stuff that because we were forced to practice in a way for a while, if that's why we continue to practice that once we're out on our own, and I'm wondering how much of that rings true for your story here. Katie Vernoy 05:34 It certainly rings true for me, I think about some of the newer clinicians and certainly talking to like Carrie Wiita and Ben Fineman over it. Very bad therapy, it seems like they're more thoughtful than we are, or than I was anyway, when I was coming up. But I found myself trying to soak everything in and I had a psychodynamic supervisor and a CBT supervisor when I first started, and then I went into community mental health, it's very behavioral and, and CBT oriented, with some, you know, trauma informed, you know, different things that kind of layered in there. But I did find that the supervisor made a big difference if they had a strong orientation, because I that's how they framed everything. And that's why I think I, when I say the case, conceptualizations are oftentimes more along the lines of like psychodynamic or CBT. I think it's because that was how I was trained. The other piece that I was really lucky is that I also had a group supervision with several folks who are narrative, and they would talk about their cases from a narrative perspective, and would provide feedback on some of the cases that I was working on from a narrative perspective. And so I feel like there's some narrative that came in early enough that that was something that also I added to the pool. But it wasn't something I learned in school, I think it was newer, you know, I was getting ready to get licensed at that time. So to me, I feel like the people around us, primarily the supervisor, but also potentially even, you know, our colleagues in our group supervision can really impact how we see cases how we've, you know, kind of the types of interventions we try, and therefore our orientation. Curt Widhalm 07:22 I don't know that I can tell you my supervisors orientation from my trainee years, maybe that speaks to the quality of supervision that was being given at the time, potentially, but I, I largely agree with you in the what did end up shaping up out at the time was the other people who were part of my supervision groups and kind of being pushed into recognizing that we were naturally drawn to some techniques, whether we knew it or not. Looking at a 2016 article from the universal Journal of Psychology, this is by Pepco, Kendrick and Jung, and aptly titled selecting a theory of counseling, what influences it counseling students to choose? Katie Vernoy 08:13 Very good, very appropriate, Good, find, Curt! Curt Widhalm 08:16 Good find Curt. They came up with three categories that probably worth exploring here a little bit for ourselves, the first topic on here does not necessarily fall into that I practice this way because my supervisor practices this way. And in fact, none of these three do. The first one is the counseling theory is similar to my personal value system. And Katie Vernoy 08:43 that's where I remember because we did that orientation game. What was that called? With Carrie and Ben and Ben? Curt Widhalm 08:51 Oh, the elimination game? Katie Vernoy 08:53 Yeah, yeah. And I just I hear Ben talking about how amazing narrative is. And it seemed like it was so aligned with his values and stuff like that. I was like, I don't know that I was that thoughtful when I was in that stage of my my development. Curt Widhalm 09:09 It's something where I really expect our audience to resonate with this one, just because we do talk about value systems as such an important factor of the work that we do, and that obviously should be reflected in the work that you do with your clients and make sense as far as how that would carry over as, as an extension of yourself and your personality to make the therapeutic alliance work. I think it's better done when it's intentional, maybe not in the way that you're describing of like looking for justification five years after a journal article is published to be like, Yeah, that's what I did. But to really be able to clarify, it's like you're giving credit to Ben for doing it. As far as saying, These are my values, this is a theory that ends up reflecting what those are. And I think that there are going to be certain theories that end up lending themselves to that more easily than others. Things like narrative therapy, where it really does have more of a social justice aspects to it. Yeah, as compared to something like behaviorism, which is going to be very much about pushing people to certain measurable outcomes, unless that's who you are as a person and why you don't get invited to dinner parties? Katie Vernoy 10:38 Well, I think that there are things that I was trained as a therapist 20 years ago. And I think that there are, there are limitations on some of the research that was available 20 years ago, and so even if I were to come up now, I don't know that I would spend a lot of time on CBT, just based on, you know, kind of the limited transfer across different cultures and that kind of stuff, I think that there are great interventions, and I've kind of learned over the years, especially in working in a lot of different multicultural and cross cultural environments, how to make those adjustments and kind of what to hold to and what not to, but I think that there are, are definitely different pieces of information around orientation and kind of our personal value systems that I think, is a constant or a continual assessment. I don't know that, you know, I don't know that there's, you know, it kind of goes to that, like, what's what's been indoctrinated and what needs to be unlearned, and kind of the whole decolonizing therapy, but I think that there's, there's definitely things that feel inherently true to me, because of when I learned about them and and how they were just kind of organically fold it in. And I would have liked to have that assessment that personal values assessment around which theory fits best for me early enough on so I'm glad we're talking about it, hopefully, the students are going to do those assessments for themselves. But, um, but I don't know that I even thought to do it, because it was, you know, everything was kind of a truism. Like, this is what psychology is, you know, back in the olden days, when I was trained. Curt Widhalm 12:20 And you what you're leading into, is this second on this list, which is people to series, because it's what makes sense logically, yeah, it's, oh, I can see how a leads to B leads to C. And this might lead to some more of those directive type therapies and CBT being an example of this, where but I think in, it's not just let me get to CBT. It's also being able to look at anything from a comprehensive way. And as much as I know, students, and really anybody else hates doing case conceptualizations it's an important factor to be able to see this is how people fit logically into this set of patterns as described by this theory. Historically, I have seen some pushback from educators and supervisors as far as this approach when it comes to trying to make clients fit into a theory, rather than hearing the client stories. And this is where I think most educators, most researchers when it comes to this, and we'll put some citations in the show notes. But people like Lazarus, Norcross and golden freed, all talk about the importance of learning a variety of theories. So that way you can shift to when clients don't fit a particular one that you're still able to practice in a way that makes sense for them. So having some theories that do make sense to you make sense. But don't, don't fall just into the logic trap of everything needs to follow into this set of patterns. Katie Vernoy 14:05 Completely agree. And I want to just acknowledge that what makes sense to you may be what you were trained, which I think ties back into, it makes sense to me because that's what my supervisor taught me. And that's how the, the practice of doing therapy, this is what it is, and this is what makes sense to me. The follow on to that is the importance of either having a supervisor that has this kind of palette of different orientations and teaches to all of them and and has that as part of your supervision or having a number of different supervisors across your internship or trainee years or your associate years so that you can get your own perspective on something versus this is how it logically fits into the model I was trained by my one supervisor. Curt Widhalm 15:02 And this is getting a comprehensive understanding, not just not just like, oh, we covered this in class last week, and I should try this out on clients. And here's parts of it that work. And because it worked, it made sense to me. But it does take a ability to get in to the depths. And I've always kind of naturally described this as you need to know the theories well enough to know when not to use them. And knowing that you should be able to shift to something else is the level of depth that you need to know. And rather than just forcing clients to do something, because the theory says that it should work means that you're maybe not quite there yet. And that's where having a more comprehensive understanding of switching between theories, or utilizing aspects of different theories, together with intention definitely helps out. Katie Vernoy 16:04 Oh, for sure, I think to me, I see folks that are very immersed in a single theory, or a single orientation. And I think there are reasons to do that. I don't want to say anything negative about folks who do that. But to me, that wouldn't fit for me, because I would have to refer clients out who I could serve with a different theory. But specifically, I'm talking, the most frequent one that I see are, are people who are like doing comprehensive DBT. And that's their whole practice. And then there's also folks that end up doing a lot of EMDR, I feel like that's become less because there's so many people that have been trained in EMDR at this point or anything. But the DBT thing, it requires a lot to set up, you have to have a consultation team. You know, if you're doing comprehensive stuff, you have to have a group with CO leaders, there's a specific way you run your individual session. And it works really well for the folks that works for. And I think that the comprehensive DBT therapists who only do DBT would argue they know who it's not for, and they refer them out. For me, I don't think I'd be comfortable with that. But I think the level of knowledge to determine that, I think is is higher than I think some folks who initially come into a single theory, and maybe this is where the question came from is I need to have my orientation. And it's like, should I become an EMDR? therapist, or a DBT? therapist, or a CBT? therapist or a blank right? kind of therapist? And I think very few people end up with just one orientation, I believe. I think when someone's learning an orientation, you know, and I've seen this with like EFT folks, they go really deep into it. It's like they have, you know, at least a portion of their practices only EFT. I think that there is there is a and I'm talking about Emotionally Focused Therapy, not Emotional Freedom Techniques. Right? I understand there's two FTEs. But But I think that there's a necessity when you're digging deep into a very specific theory maybe to focus in on it. But I really like this idea of having that palette of orientations and intervention so that you can shift when it makes it makes sense. But what would you say for folks who are single theory that there is a different developmental stage? Or do you feel like it's folks that have a different style? Like, where does that fit? Do you think? Curt Widhalm 18:41 You know, it's interesting that you talk about the DBT therapists, and when I talk with other therapists and in the community, and some of you are listeners of the show it sometimes I get accused of being a DBT therapist, I know I heard that recently. And I liked DBT, I've done some workshops towards, you know, learning DBT a lot of it, a lot of it makes sense. I'm not trained in DBT. But just the way that I understand where these comments are coming from is for a lot of DBT therapists, it's also ways that you run your life, and it's ways that fall into that first category of almost being value based. And with the bonus of things making sense. And also with the the third category here that we'll be leading into in just a moment, but it's a very comprehensive structured package that also immerses the clinician in needing to be in that lifestyle, too. I don't see this with other theories quite to the same extent. You know, I think they you bring up EMDR I think that there's a very big mindfulness component of it that the good EMDR clinicians that I know tends to exhibit as far as their practice. I don't necessarily see it when it comes to some of the more directive therapies that I don't see solution oriented therapists being like, standing in front of the the milk cartons in the grocery store being like, this one is an eight out of 10 solution, but this one over here is a nine out of 10 solution. Maybe they do, maybe it's just internal, I don't know. And, but the people that I really do see, stuck very much into single theories really aren't practitioners, it's researchers. And it's people whose research is based on needing to stay within a particular theory. And, you know, while I do have respect for the CBT therapists out there, it's those people who are like, well, everything's CBT, you know, that's just, you know, CBT with this or equine therapy is just CBT with more horsepower, or, but our third category is that people choose theories because they like techniques, or they like interventions that come from that theory. And it may not be the most comprehensive way of choosing a theory, it might be something that you find that a particular set of interventions works for certain situations. It's from just that description of it go further than that, like yes, yes, you know, you can't be in the middle of psychodynamic and being like, you know, what, we need some intermittent reinforcement right here. But it can be a place that starts you into getting more of that comprehensive look at a theory if what you find is that a certain technique ends up working, learn more about the theory. So that way, you can understand how it fits comprehensively in the explanation for why a client's pattern of behaviors or outlook on the world may be influenced or susceptible to being changed by that kind of an intervention. Katie Vernoy 22:13 As you were talking, the thing that came to mind, for me, was the validity of this kind of construct. So I'm getting really far afield. So we'll see if this bears fruit. But there are some theoretical orientations that feel very rich, they feel like they have a lot to them, that you can really dig your teeth into them. They're a way of conceptualizing a case with potential suggested interventions or ways of being with the client in the room. And there are others that feel a little bit more stilted or really based on someone trying to put stuff together. So they can prove a point with their research or a slight change to something that's already present and all of that. So I guess I'm kind of pushing back on, needing to have a really in depth understanding of all of the orientations. And I know, you didn't say that, but like, there's some of this where I think about how I actually work. And I, it's almost kind of a post hoc description, saying that I'm existential, or I use narrative, or I've got psychodynamic or or CBT, or DBT, or whatever. Like, to me, it's something where and this is potentially more of a later career situation. And I'm sure you experienced this too. I have absorbed so much knowledge from so many different continuing education, things, different clinical consoles, and conversations. That to me, and this kind of talks about, I think what Diane was putting forward is that there's so many orientations at this point that it's gotten ridiculous. And so she's simplifying it doing something and we'll, we'll put Dr. Gehart's episode in our show notes, the link to it, but, but to me, I feel like there's so much I've absorbed so much that is similar. It's so much that goes together. And maybe this is about making sense and having techniques. And so it's not the strongest way to do it. But I don't know that I'm ever consciously thinking, Well, I'm going to approach this client with CBT to start and then we'll see if it goes into something else. Like I feel like I'm meeting the client. I'm hearing what they have to say I'm conceptualizing it probably from two or three or four different theories because they kind of all melded into one. And then I'm doing interventions based on my conceptualization, but it doesn't necessarily tie and maybe this just is lazy. eclectics eclecticism but it doesn't necessarily apply. Like I'm going to start with this orientation and move to this one then move to this one and that feels to in a box for me and how I actually practice. Curt Widhalm 24:52 I think that with practice, it ends up becoming where, when you're versed in a couple of different theories, you see that certain things are going to be better approached in certain ways. If a client's coming to me, the intake phone call is to deal with trauma, I'm immediately going to go to my trauma modalities. First, as far as how I'm listening for the story developing, somebody is coming to me for something like obsessive compulsive disorder, I'm pretty much going to be going to what's an exposure and Response Prevention Plan. Part of these are where research shows some of the effectiveness part of this is really being able to look at how things make sense. And honestly, for me, part of it is how am I going to be most effective at utilizing something that I can be decently good at some theories that research shows, you know, 95% of people who get CBT by this are fixed by this. But if it doesn't fit with how and how I think about the approach, it's something where I may only be 75%, effective using CBT, with something where I might be 93% effective with something else. Yeah. And so part of that also does look at the influence of who I am. And one of the people that really led the way, as far as this kind of thing is one of those people who had a theory, and that was Milton Erickson, who was largely just kind of seen as it was his relationship with his clients. And yeah, he did a lot of strategic therapy work, but it ended up being him pulling from stuff that worked in the moment because that's what worked for him and the relationship that he had with his clients. So I Katie Vernoy 26:49 guess the point that I wanted to make with that a new just kind of set it in a different way. But I want to make sure we're on the same page is it can be very fluid, it doesn't need to be I start with a conceptualization that is tied to one theory. And I make a treatment plan that's tied to that theory. And then if it needs to shift, I shift to a different theory. It's really to me it feels way more fluid than that. And like I said, I'm existentialist I'm, I'm a Yalom existentialist where it's really just about the relationship and being a real person in the room. So it gives me a lot of freedom to conceptualize things differently. But I think it's hard to describe it to someone that's just starting out when they're like, Okay, what do I do in therapy, and it's like, we'll be in the room, see what's happening with the client, and provide them what they need. I mean, like, that's kind of how I that's, that's my orientation. Curt Widhalm 27:45 So I do want to point out that there are a handful of different instruments that are out there that you can look at, take it with a grain of salt. You might talk about the ways that you might view the importance of aspects that might steer you in the direction of looking at theories that might more naturally come to you. A couple that we've come across in preparation for this episode. One is the theoretical orientation scale, developed by Smith in 2010. It's 76 questions that you fill out Likert scale types, you score it, it points you to sub scales that might fall across a couple of different theories that you might want to look at. Another one is a 40 item scale called the counselor theoretical position scale. This was developed by Posnanski. And McClellan, either of these might be things where if you're looking for a questionnaire that is based on where you're kind of already existing, as a person might steer you into some directions to more easily find, I might want to research this more, you get into practicing that way, you might find that it continues to gel with you, you might find that parts of it gel with you. But if you're looking for a little bit more of a direction, if you're not quite familiar with a number of different theories, yet, these might be some starting places for you to look at as well. Katie Vernoy 29:15 And I think the takeaway that I want folks to have or a takeaway that I want them to have is that theoretical orientation actually can be very fluid over over time, you can start with, I really want to dig into narrative and you do narrative therapy with a lot of your clients. you conceptualize it that way. Maybe you have a few other things that you're doing in the background and not just adhering to one theory. But over time, there may be something else that comes down the pike. You do a training on Emotionally Focused Therapy EFT I have a lot of people that they later in their career, start sending EFT and they're like I'm completely changing how I'm working. This is an awesome way to work with couples or even individually EFT or you Find DVT later and you start digging into that, and you really understand the conceptualization, those things. I think people get really freaked out. And part of it is, I think, the interview questions. I've even designed them, like, what is your theoretical orientation? Like, I think people get freaked out that they have to choose an orientation, and that sets them up for the rest of their career. And I don't think that's true. I think that they there there is certainly foundational work that may stick with you forever. And so you don't want to be mindless about what you choose to focus your attention on at the beginning of your career. But I think it is something where it does shift, you're going to be impacted by research that hasn't even been done or theories that haven't even been concocted yet. And so I think find things that gel with you I'll use your word there and and dig into them, but but don't fear that you're going to be locked into a particular orientation for the rest of your career you You most likely won't be, Curt Widhalm 30:54 we'd love to hear how you came up with your theories or further questions that you might have the best place that you can do that is over in our Facebook group, the modern therapist group. You can follow us on our social media and we'll include links to those as well as the articles and measurements and citations in our show notes. You can find those at MTS g podcast.com. And until next time, I'm Curt Widhalm with Katie Vernoy Katie Vernoy 31:22 Thanks again to our sponsor Buying Time Curt Widhalm 31:25 Buying Time's VAs support businesses by managing email communications, CRM or automation systems, website admin and hosting email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. The full team of VAs gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Katie Vernoy 31:54 book a consultation to see where and how you can get started getting the support you need. That's buyingtimellc.com/book-consultation once again, buyingtimellc.com /book-consultation. Announcer 32:09 Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
HAPPY NEW YEAR 2022! NEW YEAR, NEW YOU, NEW HABITS ON How to Build Healthy Relationships and Meaningful Connections. We begin this New Year 2022 with a New Season Series on BEChange Podcast. In this new episode, I welcome a special guest, Shari Foos, a licensed Marriage and Family Therapist and the founder of The Narrative Method. Shari holds a Master of Arts in Clinical Psychology from Antioch University in Los Angeles and a Master of Science in Narrative Medicine from Columbia University. I invited Shari to help us understand how to build healthy relationships and meaningful connections. BEChange Podcast is a podcast where we feature changemakers who are working to make the world a better place for all of us. Check out the episode wherever you listen to podcasts!⠀To learn more about Shari Foos's work, check out her website: www.thenarrativemethod.org. To learn more about my work, go to: www.secondenimenya.com Subscribe to this podcast and share your feedback on social media, follow me on Instagram: @authorseconde HAPPY NEW YEAR 2022 from my family to yours! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/seconde-nimenya/support
The January 2022 Surprise of Good Faith Estimates Requirements Curt and Katie chat about the No Surprises Act, specifically how to navigate the requirement for clinicians to provide Good Faith Estimates to clients. We talk about the impact of Good Faith Estimates on the intake process, potential complications when providing these estimates to your patients, and suggestions for how to simplify and systemize this requirement. In this episode of the Modern Therapist's Survival Guide we talk about the No Surprises Act and the Good Faith Estimate Requirement When we heard about the planned implementation of these new requirements, we decided to dive into the legislation and articles from professional associations to understand what we actually need to do starting January 1, 2022. What is the No Surprises Act and the Good Faith Estimate (GFE) Requirement? “Some folks don't have a clear sense when they come into therapy, how long they're going to be there for.” – Katie Vernoy The goal of the No Surprises legislation is to avoid surprising patients with large medical bills There are benefits and challenges with the requirement to provide good faith estimates to our clients The Good Faith Estimate requirement is to provide the estimated cost of services (fee times number of sessions) at the beginning of treatment (if asked) and at least annually, if needed How will the Good Faith Estimate Requirement impact the Intake Process for Therapy? “These are not contracts; this is not guaranteeing the therapy is going to end after that many sessions.” – Curt Widhalm We are required to determine whether someone is hoping to get insurance reimbursement We must communicate the ability to obtain a written good faith estimate from providers We are required to estimate the number of sessions and total cost of treatment We talk about when you may need to provide a new good faith estimate (and explain changes) We provided a suggestion to start with a GFE for the intake session and then provide a second GFE after that initial session Potential Complications Curt and Katie see for Therapists Providing Good Faith Estimates The requirement for diagnosis very early in treatment The requirement for a diagnosis written on paper – both for folks who don't know or have not asked before, as well as for folks who do not want a written diagnosis Concerns related to putting forward the total cost of therapy for the year The elements of bureaucracy that could negatively impact the therapeutic relationship The No Surprises Act legislation isn't finalized and may have additional components or changes Our Suggestions to Systematize the Good Faith Estimate (GFE) Requirement for Therapists “There are certain aspects of this that I think - while onerous as far as communication with our clients - have the potential to make us actually talk with our clients about their treatment more frequently.” – Curt Widhalm Consider coordinating the timeline for updating GFEs, treatment plans, frequency of sessions, progress in treatment, and a reassessment of the sliding scale Think through how you talk about diagnosis and treatment planning ahead of time The idea to create some sort of mechanism for folks to either decline a GFE or to request an oral versus paper GFE Use recommended language to create your notice for your office as well as on your website Create your own template to simplify the process, including a boiler plate GFE for your intake Create a template for GFEs for on-going treatment Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Simplified SEO Consulting Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. These days, word of mouth referrals just isn't enough to fill your caseload. Instead, most people go to Google when they're looking for a therapist and when they start searching, you want to make sure they find you! That's where Simplified SEO Consulting comes in. Founded and run by a private practice owner, they understand the needs of a private practice. They can help you learn to optimize your own website OR can do the optimizing for you. Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code "MODERNTHERAPIST" Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! APA Article: New Billing Disclosure Requirements Take Effect in 2022 Suggested Notification Language for Good Faith Estimates Template for a Good Faith Estimate Good Faith Estimate Legislation Language from the No Surprises Act Federal Register: Requirements Related to Surprise Billing; Part II CMS.gov: Requirements Related to Surprise Billing; Part II, Interim Final Rule with comment period Relevant Episodes of MTSG Podcast: Should Private Practice Therapists Take Insurance? Make your Paperwork Meaningful Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: www.mtsgpodcast.com www.therapyreimagined.com https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated): Curt Widhalm 00:00 This episode is brought to you by simplified SEO consulting. Katie Vernoy 00:03 Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. Curt Widhalm 00:21 Stay tuned at the end of the episode for a special discount. Announcer 00:26 You're listening to the modern therapist Survival Guide, where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 00:41 Welcome back modern therapists. This is the modern therapist Survival guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about things that affect therapists, our practices, the ways that we practice the ways that we interact with clients and stay I'm going to start by talking about back when I was in high school, I had to take chemistry class, and studying the periodic table. Katie Vernoy 01:08 Where are you going with this? Curt Widhalm 01:10 My favorite element at the time was tungsten because will W on its butt over time, my new favorite element is the element of surprise. Katie Vernoy 01:26 Surprise! Curt Widhalm 01:27 I think actually, a lot of providers are surprised at the no surprises Act, which we're actually talking about today, going into effect January 1 of 2022. And many people have been over the last couple of weeks, speculating on what this means for their practices, what actions that they need to take. And it's seeming to get to be a little bit of a game of telephone out there in therapy land when seeing everybody talk on Facebook groups and this kind of stuff. So Katie, and I have done an adequate job of diving into this. And how to Katie Vernoy 02:10 Adequate is the right word, I think. Curt Widhalm 02:13 So we wanted to be able to talk about the big scary aspects of this, the not so scary aspects of this, and the parts of this that are TBD, because it's not even fully out there yet. And much like the Spanish Inquisition, nobody knows when it's coming. So. So we are going to include some helpful things in our show notes, you can find those over at MCSG podcast comm. I'm sure we'll be doing a follow up episode to this a little bit later, we will also include a whole bunch of very boring and dense government regulations in those show notes as well. So that way, you know that we at least can link to other things in our show notes. Katie Vernoy 03:09 We've already started off great, very adequate Curt, very adequate. Curt Widhalm 03:13 Yes. So probably the best resource out there, at least as far as condensing down a bunch of Katie Vernoy 03:22 At the type of recording. Curt Widhalm 03:24 Yes there is an article from the American Psychological Association originally created December 10 2021, that outlines what this means for psychologists. But if you are a healthcare provider of any other status, and you are operating within your license or your credential, this article pretty much applies to you too. So we're going to go through this, we're going to add little bits here in there and also make some suggestions that aren't included in this article. And continue to listen to the show and join our Facebook group for further updates on any of the stuff that we're talking about here today as we find important stuff to share. So now, actually, to the content of the show, if you haven't left yet, but the no surprises Act was part of a broad package that was signed into law during the Trump administration. This was a bipartisan bill. And this was really to be a very consumer friendly bill that prevents patients from getting surprise billing. Now, if anybody's ever been in kind of an emergency situation before, what you'll know is that you don't get a whole lot of time to be in the hospital and ask every single provider Hey, are you in my insurance network? Is this going to be covered that it's kind of just who you And not every person who's working on you is necessarily in network, not necessarily an employee of the hospital. And so what ends up happening is that all of your your treatment stuff gets submitted to insurance companies. And then, like Spanish Inquisition, surprise, there's bills that show up in the manual. And this is generally not seen as very consumer friendly, because people don't know what's coming. Yes. Having been on the receiving ends of those kinds of treatments myself in the past. Now, I kind of like where this bill is going, being a healthcare provider, in my own little practice, not liking where this is going. Because there is a lot of regulations that are being added into this that while intended very well, for kind of emergency situations are fields a little bit different. Katie Vernoy 06:03 Yes. And I think that for private pay providers, there can be times when folks are surprised, not by Oh, the anesthesiologist wasn't in your network. And this extra special treatment that happened because of you were under sedation, cost $27,000. But it is something where some folks don't have a clear sense when they come into therapy, how long they're going to be there for. I think, as a profession, I think we're very good at making sure someone understands the fee before they come into the first session. They know what they're going to be charged when they sit down with us. I think the part that feels both, I guess positive, but also onerous is having to say like, Hey, this is how long your treatment is going to be. This is what it's going to cost and, and giving so much information. I mean, it's it's a lot of information that you're having to provide very early in treatment to a client. And they basically will hold you to it, and then they're given information that they can hold you to it if if it does shift, too, dramatically. So I see that I see the point. But I also see that it's going to be a lot of work. Especially I think just to set it up, I think that there's a way to systematize it. And we can talk about that when we have our kind of discussion around suggestions later. But to begin, it's going to take some work. Curt Widhalm 07:32 And so the main crux of what you're talking about here is providing clients with a good faith estimate. Yes. Before we get into what the good faith estimate is, let's talk a little bit about the intake phone call with clients. Because I think certain aspects of this, many providers are doing in one way or another where in many jurisdictions were required to discuss our fees with clients before they come into our first session. Yes, it's, you know, no surprises. It's not that they're showing up in our office, it and then all of a sudden being like, wait, what that we yeah, do provide that, usually verbally in an intake phone call, what that good faith estimate now adds to our work is in that intake phone call, we need to start having language around, are you planning to submit a claim to your insurance company for the services that you're going to receive for me, those of you who are in network with insurance companies, that's all to be determined in the future. As far as how that works with insurance companies, we're really talking to those cash paying clients, those out of network therapists, those who provide super bills, if you have a hybrid practice, half, listen to this, turn off the insurance side of your brain. But in that initial phone call, you need to ask clients, are you planning to submit this for a claim? Now, the way that most of us are already doing this is around this language Trooper bills? Hey, do you want a super bill for our services? Katie Vernoy 09:11 And I also do "Do you want me to do courtesy billing" and actually take the reins on, you know, kind of getting insurance information and that kind of stuff? So I think those of us who are that have a sizable portion of our practices that are private pay, navigate this, but there are some clients that come in never discuss insurance. And I think that the the shift that I'm going to make us I'm going to ask that directly versus kind of allowing it to organically happen in conversation because if somebody comes says, What's your fee? I say $200. They say okay, like, I don't necessarily take that extra step. All the time about that. I mean, sometimes they'll say, you know, do you have insurance benefits? And do you want me to do courtesy billing or would you like a super bill, but I've not been diligent about For folks that don't seem interested, so at this point, we have to ask the question, we have to know about that. I don't know what we do with that information, but we just have to ask, we have to know, that's probably more of the to be determined. Curt Widhalm 10:12 Well, so from the APA article, what we do after asking if they intend to submit a claim to their insurance is inform them, that they can get a good faith estimate of the expected charges, and that we can provide it to them in a written document if they want. And that needs to include things like a CPT codes, the the billing code for those service sessions that you're intending to do, it needs to include information about the client on it, and the anticipated number of sessions. Yeah, and I think that this is a part where I'm seeing some of the chatter in the therapist community around. Some of the conversations are well, what if people hold us to, you know, you said, this was gonna take 20 sessions, and it took 40. These are not contracts, this is not guaranteeing the therapy is going to end after that many sessions. And I suggest being clear with clients about that, that, yes, as far as I can tell from this vantage point, if you follow treatment, if things go, Well, this should take X number of sessions. Katie Vernoy 11:27 And then I think the other piece, if you truly think it's going to be 20 sessions, I think, put down 20 sessions, if you think it's going to be longer term treatment, I think you you know, you have to do this, it needs to be a good faith estimate for the next 12 months, I think you do it as an annual or to the end of the year. And maybe you do all your good faith estimates in January. But each new year of treatment for each client, you have to do a new good faith estimate. And each time you change the fee, or the cadence of treatment, the way I'm reading it is that you need to then do a new good faith estimate. So if somebody increases the number of sessions, like they go from once a week to twice a week, or they shift from twice a month to one month, you know, like you're gonna want to adjust down. It feels onerous. And I think that there's probably a way to make this pretty streamlined if you have a form and you just are changing that number and that number. But the part up front that I get worried about is that it's supposed to have the clients diagnosis. And we're talking about an intake call where people can request these good faith estimates. And so I'm assuming you put at that point to be assessed or to be diagnosed at the first session or something like to me, it seems like some of the information requested doesn't really hold up when you're just getting a good faith estimate from a potential client. Curt Widhalm 12:51 Sure. So I'm gonna go back two points that you made and then come to where you're talking about here. Katie Vernoy 12:57 Okay. Okay. Curt Widhalm 12:59 Some of us have clients who are lifers, that Katie Vernoy 13:02 yes, they are Yes, both you and I are in that category. Curt Widhalm 13:05 So what I intend to do with those clients is, hey, you generally come 50 weeks out of the year, here's your fee for 2022. Katie Vernoy 13:17 Done, Curt Widhalm 13:17 Done, there you go. Katie Vernoy 13:19 Yeah, I think it's supposed to be in a form. But we can argue if it can be verbal, or if it has to be that whole form. Curt Widhalm 13:27 I'll give them a form. To your second point. I wonder if the implementation for a lot of therapists is very standard going to have the first session be, actually to Bill 90791 as an actual diagnostic interview for your first session, that would have your appropriate rates, go back to our CPT code episode and hear us talk about most therapists don't actually bill for that one. Yeah. But that, I think, actually, if I step back, this whole process might actually make us follow through on things that we're supposed to be doing a little bit better if we're not having formal diagnostic first sessions, if you're concerned about putting a good faith estimate out to a client that you've talked to for about five minutes on the phone, and four minutes of them are about what a good faith estimate is that you can actually create a space to say, here's a good faith estimate of what this first diagnostic session is going to costs. And you'll get a new good faith estimates for our sessions after that session based on what comes out in that diagnostic interview. Katie Vernoy 14:49 So, private pay providers are now going to have to act a little bit like insurance providers and diagnose in the first session and predict how much treatment is going to be needed. Curt Widhalm 15:01 yes. Katie Vernoy 15:03 Welcome! Curt Widhalm 15:05 well into your other points is, if you, misjudge or if services need to continue, it's not like your relationship with the client just has to stop, you do get to provide new and updated good faith estimates Katie Vernoy 15:22 Yes Curt Widhalm 15:22 as anything changes, like you said, if you're going to more sessions a week, if you change your fees mid year, if any number of different things changes, potentially even diagnostics, then you're going to want to provide good faith estimates that are updated. And I would recommend that you put language on those updated ones that this replaces the previous Good Faith Estimate from whatever the previous date is. Katie Vernoy 15:52 And it does say in the language, and I don't know if this is in the APA article or the actual legislation, but it does say that when you provide a new Good Faith Estimate, you do need to identify what is different. And so if it's, hey, everything's rolling along, same fee, same number of sessions next year, I think it's saying, this is continuing. And it's you know, there's no changes in the fees, no changes in the predicted number of sessions this year, this is for this year. I think for folks where you're changing fees, or dramatically changing the cadence of sessions, I think that would be an important thing to put and definitely like your language of this replaces the previous Good Faith Estimate. One thing I'm thinking about with this is that if you've got a niche that that generally you know, or your lifers that generally have this is how many sessions you have per year. And so maybe it's 48, or 27, or whatever it is, you know, depending on the cadence of their treatment, shifting from every other week, to once a week back to every other week to once a month, like assuming you're kind of still in that number of sessions per year, I think you probably are fine. Changing fees, definitely a good faith estimate. But like if you've said, This is what you're what we were looking at this year. I think that could I think that could work. What do you think? Curt Widhalm 17:15 I'm not a lawyer? Katie Vernoy 17:18 Yes, nor am I. Curt Widhalm 17:21 It's probable, and, you know, any challenges to this are still to be determined. This is all, you know, this is what regulations are going into effect. The HHS has not you know, had any opportunities to enforce any things yet. So we'll wait for somebody to get punished, and then we'll be able to tell you what they're doing. But realistically, it seems like a good faith estimate is exactly that. It's good faith that Yes. Hey, you know, you typically come to three out of four sessions a month, in case you come to more, you know, some months you do make a ball. So good faith, I'm going to put that you're gonna make all of the sessions over the next like five months. And we can evaluate at that point, you know, what's needing to be changed. There are certain aspects of this that I think well onerous, as far as communication with our clients have the potential to make us actually talk with our clients about their treatment more frequently? Yeah. And I think that that's part of what's scary to a lot of therapists is that clients are gonna see, I spend how much on therapy each Katie Vernoy 18:40 year? I know, that's the part that I'm like, oh, yeah, that's gonna be rough. Most people don't want to think about it. Curt Widhalm 18:49 I could buy several cars for this. Right? I think if you know, you're not wanting to sticker shock your clients on January 1 With, here's your good faith estimate of 50 sessions at $100 per session, or 200, or 300, whatever your fee is, yeah, that they can see some therapists breaking it down and say, Alright, here's only six months of anticipated treatment. And I'll just put out a new good faith estimate when that one runs out. But I think that that makes us be able to talk about clients progress, as far as what do you think that you need is continued services going forward and to actually review your treatment plans with them more frequently? Katie Vernoy 19:37 Yeah, I think it's actually a good process to to align this with a treatment plan. I think process wise, I see it as being something like every January 1, I put out my good faith estimate. But I think there's an element to that where, you know, someone coming in in December and then giving a new one to them. January feels silly. So but I do think talking to folks at their treatment plan anniversary, or every six months or whatever your timeline is, and then talking about cadence talking about, you know, how they're feeling, you know, what they're thinking about. I think that's a good process. And I know when I was working in community mental health that was, you know, like, you talked about termination. From the beginning, you know, and I feel differently in private practice, like you might a lot of my clients are lifers, but I think it is, it's really easy to get complacent, when you're just kind of meeting every week, and you're not actually taking the time to look at what are we actually working on? What are you getting from this? You know, what is your financial situation compared to what we're talking about? I mean, for folks that do sliding scale, this could also be an opportunity to SPSS sliding scale and saying, okay, you know, my fee is going to be x January 1, and, you know, this is what you've been paying, you know, is that still appropriate? Are you able to increase towards the, you know, can you decrease the subsidy, so to speak, you know, like, you can have those conversations, it's just a money conversation that a lot of people don't like to have. And so I think this kind of thoughtful, you know, kind of transparent conversation about number of sessions length of treatment, Cadence. And money is important and needed, but pretty uncomfortable for a lot of folks Curt Widhalm 21:27 being the optimist that I occasionally am, that I think that there are some providers out there, especially when it comes to things like sliding scales, who don't know how to bring the conversations back of, yeah, hey, you got a job. And now you can afford the fee that we had agreed upon before. This does provides those clinicians with an opportunity to have a better touch point, as far as renegotiating some of those sliding scale things. Katie Vernoy 22:01 It's a natural benchmark. I think the other thing that is interesting on what's being required in these good faith estimates is the client diagnosis. We mentioned it kind of like, you know, do the diagnostic session separate and then a good faith estimate for ongoing treatment. But for some of my clients, they may never see their diagnosis unless I do this, right. And so for folks that don't do super bills, or don't talk about it, don't request their records. And so I think that's another thing for folks, you know, before they provide their first Good Faith Estimate, you may want to be ready to have that conversation because it does show up on the billing, or does show up on this form. And so being able to make sure that your clients understand how you diagnose why you've diagnosed, what you've diagnosed, and what it means how it's impacting treatment or not, it does mean that we need to diagnose our clients. And I think some folks are unlikely to do so when they're completely private pay. Curt Widhalm 23:06 And I think for people who provide super bills, if this worries you, you're already doing this. It's just you're now with the potential of a more explicit conversation with your clients. And helping clients as Katie just mentioned, to understand what this process is. And, again, this is all very good spirited as far as being consumer friendly. And that's, you know, where it does put some of these onerous things on our behalf. But I think it has the potential because of all of these extra contact points in talking about treatment, and talking about monies impact on treatment, that clients are going to get better outcomes, which maybe I was gonna say if clients get better outcomes, that's good for you as the therapist. Katie Vernoy 24:02 Sure, sure. I think there's, there's, there's an element of this that feels very paperwork and could take away from the relationship, you know, like, if you have to explain a tough diagnosis that that, you know, wasn't something that was in the regular conversation that can that can impact the relationship. If you have to really dig deeply into some of this. I think it's life. I think it's it's therapy, it's good therapy, but I don't know that it's necessarily I'm not going to just, you know, rainbows and sunshine about like, hey, you need to do this, because I don't know, I think that there are ways that you can make a benefit your client, I don't know that it's necessarily designed to benefit outcomes. The thing I was thinking about, which is an open question, there are folks who do not take insurance because they don't want a diagnosis and they don't want to have anything on record around diagnosis, whether it's based on their job, whatever some reason, they don't want to have a diagnosis. My assumption I'm not reading anything in here that you have to have a full DSM diagnosis, you could do a V code, you could do something that was subclinical. Is that how you're reading it? Or is this an open question where we have to determine like if people want to refuse a good faith estimate, written in good faith estimate? Are we allowed to do so? Curt Widhalm 25:18 So for those people who are not in network, and if you know, the diagnosis question is a thing. If people, you still have the obligation to ask people, if they are planning on submitting their claims to their insurance company, sure, sure. If they are, you're still required to provide the proper diagnosis to them, you're not not just one that is reimbursable. And so if you are treating somebody for a Z code, if you are treating somebody for something that is traditionally not reimbursed, that is still the diagnostic code that you're supposed to put on there, that has not changed that is already in place. And if you're not doing that, that's insurance fraud. Spanish Inquisition is coming after you. Katie Vernoy 26:07 Okay, so you didn't answer my question. But all of what I said, What you said was, I agree to if someone does not want to submit any claims to insurance, doesn't want a super bill barely wants a record? Can they decline one of these good faith estimates? Curt Widhalm 26:24 Absolutely. Katie Vernoy 26:25 So that they don't have any diagnosis on any paper anywhere? Curt Widhalm 26:30 Absolutely. Katie Vernoy 26:31 Okay. Curt Widhalm 26:33 You as the clinician still need to chart your treatment plans and what it's based on and all that kind of stuff, whether your clients want a good faith estimate or not? Katie Vernoy 26:42 Are we required to diagnose a client? Curt Widhalm 26:44 you need to have a reason for treatment, and you need to have a treatment plan that is based on something other than a client just showing up? And you started a session with? Where do you want to start today and ending it with? You're where you need to be? That? Katie Vernoy 27:03 That may be a whole other conversation. But Curt Widhalm 27:05 I mean, that that is acting within the scope of your license that Katie Vernoy 27:08 Sure, sure. So we can have a conversation about diagnosis, but from what you're reading, we could either put a non clinical DSM code and for this Good Faith Estimate, or someone could decline it if they don't want to have a piece of paper with their diagnosis on it. Curt Widhalm 27:28 Sure, yeah. Katie Vernoy 27:30 So we may also, at some point, need to put together a, I am declining a Good Faith Estimate form that people sign, Curt Widhalm 27:38 you know, that's a great idea. You know, it's not like a subpoena where you have to, like, throw it at a client if they're running away from you. Anyway, there are Katie Vernoy 27:50 Oe I would prefer for an oral, Good Faith Estimate versus a written faith, Good Faith Estimate. I think these are the things that are kind of the to be determined, we'll wait and see if anybody gets sued or or in trouble. But I think there are probably some some reasons why these would not be customer friendly, or consumer friendly, right, is all I'm saying. So we'll we'll table that for now. Curt Widhalm 28:14 So there are some other requirements that I think are important for everyone to be aware of. You have to prominently post that clients can and are entitled to a good faith estimates. And this needs to be put on your website. It needs to be prominently displayed in your office. I'm I'm on Amazon right now, ordering one of those neon like scrolling things, just put it up behind me in session. Katie Vernoy 28:46 Oh, that sounds awful. Curt Widhalm 28:50 Or really just posting a paper a piece of paper that says you're entitled to a good faith estimates. Katie Vernoy 28:57 And the APA article has both samples of the good faith estimate itself as well as notice the language for the notice. And it has instructions on it. Well, we'll link to those in the show notes. But I think it is big enough that it might be not quite a poster, but still a piece of paper on your wall. And then for your website. I think my suggestion What if you have a section on fees, this may be a reason to post your fees on your website. People have different feelings about it. And I think that would be the appropriate place to have it listed. is in that that section of your website. Curt Widhalm 29:36 To be clear. You don't need to put on your website. Just a general I expect people's treatment to last 25 sessions Katie Vernoy 29:46 No Curt Widhalm 29:47 the language that you need to put out there is Katie Vernoy 29:51 You can request a good faith estimate. Curt Widhalm 29:52 Yes, exactly. Katie Vernoy 29:54 And that's in that APA article. I think the other thing that I was starting to get to get in the weeds and I think this is is more kind of standing questions that will be to be seen. There are a difference between convening providers, which is the person providing the primary service and CO providers, from what I can read the convening provider is the person who has been asked for this good faith estimate. And maybe it's a primary provider, maybe it's just the person they thought to ask. And if there are co providers who are providing treatment with you for the identified patient. So for example, you've got a an eating disorder treatment group that, you know, you've got different folks either in your group practice, or that you do a lot of work with, you may end up having to put together kind of this full package of good faith estimates where everybody's services are on there. I think that's a little bit more detailed than we need to get for today's conversation, I think typically, you're just going to be doing your own services. But for folks who have group practices that maybe share an identified patient with another provider, or have a little complexity, you probably are going to want to reach out to your professional association or legal counsel to identify how best to take care of those good faith estimates is my opinion. Curt Widhalm 31:10 Yes. If this sounds like a lot of extra steps, you're right. And some of the things that I'm seeing across the healthcare industry is that this does impact smaller businesses a lot more than group practices and agencies, because it is a lot of extra steps and does have time deadlines that oftentimes you're going to need to provide this in writing to clients who want it within one business day. And if you have a very, very busy schedule, this is something that you're going to deed to accommodate, you're going to have to get these systems in place. And you know, our friends over at simple practice that we've seen some chatter in the simple practice community requesting that some of this stuff be added to their platform, I hope that a lot of the EHR systems, we'll be addressing this so that way, it does help to streamline these things. But this is stuff that whether you like it or not, it's here. And, you know, we're trying to give you just a even if this is a, hey, I have to go and look at this stuff. And I need to make some changes now go and make those changes, because this is things that our world is changing, we have to adjust to as providers and our clients are going to be overall probably better for it even if that means that we're not. Katie Vernoy 32:47 So I want to just before we close up, I want to talk through what I see as a potential path to try to make this as efficient as possible. And so I'm stealing one of your ideas, and then putting together the rest. So I think what Curt Widhalm 33:00 your plan is everybody quits and go find retirement early on some cheaper cost of living base. Katie Vernoy 33:09 No, everybody become coaches... Um, no, the plan is, I really like this idea of having a boilerplate, good faith estimate for your diagnostic session. So your 90791 I think the difficulty unless there is like some sort of a form created in your electronic health record, you may have to create this separately, but putting together that good faith estimate. So it is sent over with all of your intake paperwork. And it's part of the the process. So this is the fee, this is the service. I think that the nuance and you can have all of your information, the nuance is the clients name and those types of things. And so I'm going to look in simple practice myself to see if I can figure out a way to do it if if they don't fix that themselves, or don't put that together themselves. But I think even creating, you know, a form that you can upload and send to them where you can, you know, kind of do that that becomes with your intake paperwork, it goes out immediately you're in compliance. I think the next stage is having that good faith estimate that is for ongoing treatment, has all of your information already in place has all of the services and fees in place and then it goes into you know, there's a little bit that you have to fill out for each client that has their information, their diagnosis, and then the number the expected number of sessions, and that goes out after the first session. Curt Widhalm 34:43 I think it's brilliant, until they change things and that's addressed. In some future episodes. We do know that there is language that is written into this no surprises act that even four out of network therapists might be needing to submit some of this paperwork directly to a client's health insurance company. That part of the law or the regulations has not yet been written. We just know that it's coming. It's reserved in there. And that's what some of the future languages for your member professional association, check out any guidance that they have, as those regulations continue to roll out, we will almost guaranteeing an episode in the future on what that means, especially for those of us who aren't used to talking with insurance companies and what kind of mean now, so we kind of want to hear you lamenting these kinds of things. I can share your thoughts with that in our Facebook group, the modern therapist group, and share it with us on our social media. We'll include links to all of that in our show notes. And until next time, I'm Curt Widhalm with Katie Vernoy. Katie Vernoy 36:02 Thanks again to our sponsors simplified SEO consulting. Curt Widhalm 36:05 These days, word of mouth referrals just aren't enough to fill your caseload. Instead, most people go to Google when they're looking for therapists. And when they start searching, you want to make sure they find you. That's where Simplified SEO consulting comes in. It's founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website or they can do the optimizing for you. Katie Vernoy 36:29 Visit SimplifiedSEOconsulting.com/moderntherapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code MODERNTHERAPIST. Once again, visit simplified Seo consulting.com/moderntherapist and use the code modern therapist all caps. Announcer 36:54 Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
We are taking a break over the holiday, but the podcast goodness is still coming. We are relooking at one of our most popular podcast episodes: Holiday Hungers: What are you really hungry for?If you have not listened to this podcast yet, you are in for a treat. In this episode, we look at the holiday hungers (yes, there is more than one of them). Learning and understanding what the holiday hungers are will help you feel empowered over this AND every other holiday season. Join us in this Feed Your Soul with Kim Podcast where we discuss:What are the 4 Holiday Hungers?Learn about 7 emotional triggers and what you can do about them. Get into action with 5 different ideas to end Holiday Hungers. Discover a new way of increasing your satisfaction over the holidays by joining the Feed Your Soul Community: Join us on Facebook in our Feed Your Soul Community. Join for free here: https://www.facebook.com/groups/1172488142887200/Feed Your Soul; Nourish Your Life! The Six Step System to Peace with Food is available. Get it now: https://feedyoursoulunlimited.com/fysnylbook/Want more information? You can find out more about Kim McLaughlin at www.FeedYourSoulUnlimited.com Kim McLaughlin, MAKim McLaughlin is a licensed Marriage and Family Therapist, inspirational coach, speaker, and writer. She helps people who feel frustrated overwhelmed and overloaded, and it shows up in overeating. She has a Master of Arts Degree in Clinical Psychology. Kim is a certified Intuitive Eating Counselor, and she assists people to gain peace with food. We would love to get your feedback on this show and let us know what you would like to hear in upcoming shows. Email us at info@FeedYourSoulUnlimited.com Thank you for listening.Please be sure to leave a review for others to find us and share this podcast with a friend.https://feedyoursoulunlimited.com/feed-your-soul-with-kim-podcast/
Today's guest is Dr. Christie Kedrian, and she's a therapist, dating coach, and previous matchmaker for eHarmony. Finding love is an art, yet there is a science around chemistry. Knowledge is power, and when you implement specific strategies, you raise productivity and increase the opportunity for success when online dating. In this week's episode, we discuss holiDATING 101 how to navigate dating during the holidays to find the one. When we come back, Christie will share tips that can help you find love during the holiday season and beyond. Dr. Christie Kederian is a nationally-renowned relationship expert specializing in helping clients create the lives they want and find the love they deserve. With an extensive career as a professional matchmaker and relationship expert for eHarmony and Match.com, Christie has helped hundreds of people find love and improve relationships. She is a "Triple Trojan" receiving her Bachelor's, Master's & doctoral degree at the University of Southern California in Psychology and Marriage and Family Therapy. Christie has been a featured expert in ABC, NBC, KTLA, The Wall Street Journal, Los Angeles Times, Cosmopolitan, and many more. She is also a professional speaker and provides training with the California Association of Marriage and Family Therapists.Kerry Brett and Dr. Christie Kederian cover a lot of ground. Topics include:How to navigate dating during the holidays.How relationships impact who we are as people.Dr. Christie's online and offline dating strategies for dating during the holidays.What Dr. Christie's learned about compatibility from working at eHarmony.How to avoid falling into the scarcity mindset.How to reset when you get discouraged with the online dating process.Dr. Christie's Criteria Sandwich and why you should get clear about your core values.Dr. Christie's Silver Bullet Swipe and why you should focus on the main thing you're looking for in another person.Dr. Christie's five messages to meet method.Why face-time pre-screener calls help vet people before the date.Why the holiday season is a great time to be out there.Dr. Christie shares tips and strategies from her HoliDATING 101 program.Why you should utilize the down time during the holiday's to get back out there and date.January 2nd is the highest dating day, so you want to be on an app.Dr. Christie's three dating roadblocks and how to remove them.Dr. Christie's ten dates to finding love roadmap.How important photographs are when online dating and why you should invest in professional headshots.To find out more about Dr. Christie Kederian, you can go to her website www.therapyfordating.com or on Instagram @thedatedoctorchristie.
Haesue Jo, MA, is a Licensed Marriage and Family Therapist with experience providing individual and family therapy in community mental health, school settings, day treatment facilities, and via teletherapy. She is currently Head of Clinical Operations at BetterHelp, which allows her to empower other therapists to be successful at bringing their skills online. Her current clinical focus and interests include AAPI mental wellness, anxiety, relationship, and family dynamics, trauma, and gender identity. To practice self-care, she enjoys spending time with loved ones (including her dogs and cat), yoga & fitness, going to the aquarium, snowboarding in the winter, and seeing live music all year round.Finding professional help such as an online therapist shouldn't be hard. No matter what you are recovering from and regardless of where you are on your healing journey you deserve to easily connect with someone who has earned the right to hear your story. Someone who is there to take every step of your healing journey alongside you. In this episode we learned:How to participate in online therapyHow to sign up and receive therapyAbout the healing benefits and opportunities that we see when therapy can be accessed from anywhere at anytimeHow online therapy can help break barriers for those who may be hesitant or unable to access in-person therapyHow our community members are accessing therapy for themselves and they've benefitedThis podcast episode is Lisa Wall and Haesue Jo's live session of #MentalHealthMonday. They are also joined by SHE RECOVERS community members Suzie and Jessica.Learn more about BetterHelp at http://betterhelp.com/srfThe SHE RECOVERS FOUNDATION is a grassroots movement and non-profit public charity with a community of women in or seeking recovery from substance use disorders, behavioral health issues and/or life challenges. This lifeline organization connects women through its virtual platforms and in-person community networks, provides resources and supports women to develop their own holistic recovery patchworks, and empowers them to thrive and share their successes. All efforts are designed to end the stigma and shame often associated with recovery so that more women may heal and grow.SHE RECOVERS has launched a partnership with BetterHelp to provide accessible and individualized therapy to those seeking healing.We are honored to offer our listeners a 35% discount on the first month of therapy @ BetterHelp until December 31, 2021. Register at betterhelp.com/srf. SHE RECOVERS is grateful to BetterHelp for making a $100,000 donation in support of our mission in 2021.
How Can Therapists Actually Retire? - An interview with David Frank, financial planner for therapists Curt and Katie talk with David about managing finances, including student loan debt and retirement. We look at when to start saving, what to do when you're starting to save for retirement later in life, and how much is too much to save. David also shares his concept of a Money Date and how you should start looking at your financial picture. He also talks about financial planning and when to seek a professional for support. Interview with David Frank, Turning Point Financial Life Planning David Frank is on a mission to ensure every therapist has access to unbiased and fiduciary financial advice! Through the firm he founded, Turning Point Financial Life Planning, he helps therapists navigate every element of their financial lives: from understanding your practice P&L and building a personal budget to managing student loan debt and investing for retirement... and everything in between. Dave earned both his undergraduate and MBA degrees in finance and he also completed a certificate in personal financial planning. He's worked for over twenty years in investment banking, corporate finance and now personal finance. Don't let his love of the tax code and spreadsheets scare you off! You're just as likely to find him with his nose buried in one of Pema Chodron's books as reading up on the latest finance planning techniques. In this podcast episode we talk about: Managing Personal and Professional Finances How perfectionism can get in the way of saving The importance of “just getting started” in saving for retirement Saving money is a practice, not something you figure out once Why it is important to save money as soon as you can Navigating Student Loan Debt Student loan debt and how overwhelming it is to look at these debts The desire to pay off this debt as quickly as possible David's advice to save at least one time your annual income before aggressively paying off your student loan debt The comparison of interest rates on your debt versus returns on investing money Retirement and Investing in your Future “Starting to save and invest young is such great advice… and… it's advice for time travelers” For younger folks, the advice is to save as soon as possible What to do if you are closer to retirement age and you haven't started saving for retirement How to determine when you can retire “No one does this money thing perfectly, even if we start out of the gate pretty strong.” What to do when life happens and you have to start over David's own story of having to start over Societal fear due to 2008 and the Great Recession David Frank's Concept of “Money Dates” Reserve time each week to look at your money Start understanding how much you need to save Idea: go to the Social Security Administration Website to see what you're entitled to in social security How Much Money to Save The money mindset concerns that can get in the way of saving (or even looking at) your money How much money is too much money to save? Emergency funds and the feeling of safety and security The risks of saving too much money Quality of life questions when you are underspending Online tools to identify what you need in retirement, so you know when you've saved enough Actual numbers of what to save for retirement and what you can spend now Financial Planning – When and why to seek help with your money The complexity of the decisions related to paying debt versus investing The number of options available to each person when making decisions on our money Get feedback on how well you are doing on your practice financials and saving for retirement Risk planning, financial planning, estate and incapacity planning The importance of understanding your values when you look at how to spend your money Financial planning when you don't have a lot of money Choosing what you sacrifice when you decide to invest in shiny objects The problem of “shoulds” and getting financial advice from other therapists Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Simplified SEO Consulting Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. These days, word of mouth referrals just isn't enough to fill your caseload. Instead, most people go to Google when they're looking for a therapist and when they start searching, you want to make sure they find you! That's where Simplified SEO Consulting comes in. Founded and run by a private practice owner, they understand the needs of a private practice. They can help you learn to optimize your own website OR can do the optimizing for you. Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code "MODERNTHERAPIST" Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! David's Website for Turning Point Financial Life Planning David's Finance Quickstart Guide David's Quickstart Intensive Coaching Session (use code MTSG for 20% off) David on LinkedIn Social Security Administration Website Relevant Episodes of MTSG Podcast: The 4-1-1- on your 401K Making Bank as a Therapist Overcoming Your Poverty Mindset Don't Take Tax Advice From Therapists Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: www.mtsgpodcast.com www.therapyreimagined.com https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated): Curt Widhalm 00:00 This episode is brought to you by Simplified SEO consulting. Katie Vernoy 00:03 Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. Curt Widhalm 00:21 Stay tuned at the end of the episode for a special discount. Announcer 00:24 You're listening to the modern therapist Survival Guide, where therapists live, breathe, and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 00:40 Welcome back modern therapists, this is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for all things therapists. And that includes money and how we're setting ourselves up for running good practices, taking care of ourselves, both while we're working and towards retirement so that way, we don't have to do this forever. And we can potentially retire someday. And here to help us talk about this is David Frank. He is a financial planner and the founder of Turning Point financial, and he's here to help put the fun back in funds and take the ire out of retirement. So thank you very much for joining us today. David Frank 01:29 Brilliant, thanks so much for that introduction. Kurt. I'm super excited to be here and to talk about, yeah, all things Money and Finance and even the dreaded R word of retirement. Katie Vernoy 01:40 I'm so glad you're here, we had a lot of fun working together around the conference. And we definitely I feel like you're a friend of the show and a friend of mine. And so I'm so glad you're here talking about that. David Frank 01:51 Thanks Katie Vernoy 01:51 Because I think there's a lot that needs to be discussed. On a previous episode Curt and I had been talking about one of the retirement plans that therapists have is suicide, which is horrible. And, and part of that is just not planning not making enough money. And so to me, I feel like this is an important conversation for us to be having. And you're a great person to do it because you're a financial planner, who has chosen to work specifically with therapists. But before I get ahead of myself, the first question we ask everyone is who are you? And what are you putting out to the world? David Frank 02:26 Yeah, so as Curt mentioned, my name is David Frank, and I am a financial planner, and the founder of turning point, financial fat is a financial planning firm that I began and it is focused exclusively on helping therapists or mental health professionals take care of their finances. So that's what I'm putting out into the world. That's what I'm doing. My kind of mission is to help people live better lives to help your listeners, your therapists out there live better lives, and also grow their impact in the world. Because when we get sort of some of this money stuff out of the way, we can be more present for every element of our lives. And I think it's less about the money and more about the actual feelings and feeling better about money and not being so stressed and overwhelmed about it. Curt Widhalm 03:08 What's wrong with you if that you chose to work with therapists? How does somebody be like, You know what there there are people who are easy to work with with money, and I'm up for a challenge. Why? What brought you to the the mental health world as far as your client population here? David Frank 03:31 Yeah, great question. Well, so within the financial planning community, much like within the therapist, community and mental health community, there's this like raging debate going on about whether niching down and really specifically defining your target audience or target market is a good idea or not. And when I started turning point, when I started my own business, the big thing I was worried about is like, is anyone actually going to show up and want to work with me, like actually pay me money for my services? And the other the secondary concern was like, will I be able to add enough value will I actually be able to, like, really understand what's going on for folks and really help them in a meaningful way. And I became super convinced that the solution to both of those anxieties was to define a niche of who I really wanted to work with. And it was a very, what's the right word, I was just very stressed about getting the right niche. And at that time, I was, I was seeing my own therapist, and I had been seeing this guy for several years, and he was awesome. I was working with kind of a life and business coach, and I was agonizing over this decision. And finally, my coach reflected back to me something that was obvious to him, but was invisible to me. And he just said, Why don't you work with therapists? And I was like, Oh, my it was just like a light went off. That's the wrong metaphor, but it just it felt so right. I love talking to therapists, like I sometimes I think like a therapist. I love learning about their business. And it just seemed like a population that I could help and like you say, like, maybe maybe I'm up for the challenge. Katie Vernoy 05:01 What do you think therapists get wrong when they think about retirement or saving money or taking care of their finances? David Frank 05:08 Yeah, I what I see is something that not just therapists get wrong, but just generally most people get wrong. And that's this idea of having to figure it all out or get something perfect, rather than just simply getting started. And when it comes to managing finances, both personal finances and professional finances, like your private practice finances, I think the key really is simply just to get started. And so if we think about saving for retirement, I mean, man, just even saying that makes me feel a little bit overwhelmed, right, like, there's so much there to navigate and figure out. But I think the key is to just sort of get started and meet yourself where you're at and just say, Okay, what you really need to do to save for retirement is just that to start saving. So understanding if you can put away even if it's just $5, every month, just get started, build that muscle, build the practice of saving some money and moving it, even if it's just moving it to a dedicated checking account where you're beginning to build up savings, then like down the road, you can come back and sort of figure out, okay, I should probably be investing this money rather than simply putting it into a checking account or something like that. And it is like it's a practice, this stuff is not a project that you sit down one day and get it all done. And then you're just good. It's kind of like a mindfulness practice is really the way I often think about it and encourage others to think about it is to carve out some time, every week to just spend with your money stuff, both your internal stuff, what comes up for you, when you're dealing with money and finances, and with the external stuff of the accounts that you have in the amounts of those accounts and how you navigate it. So I'm just a huge proponent of just sort of getting started and make taking those small, little steps. And I feel too often people get hung up that like, No, I have to make this big, monumental shift, that perfectionist tendency that so many of us have, can really hold us back. Curt Widhalm 06:57 So I think in your own way, you've answered a couple of the questions that we would normally ask here, which is, when should people start saving? And how much should they start saving, which I'm hearing you say, early, and whatever you can. So that's kind of the first part of this, for maybe some of our listeners who are earlier on in their careers who are facing things like massive student debt, where it's like, well, I should be throwing money at, you know, getting the government off my back or blowing providers off my back. What do you say to somebody in that position where it's very earlier on where they might be kind of death, avoidant, as opposed to starting to think about investing in themselves? David Frank 07:44 Well, yeah, a couple of things I want to say in response to that. And first, Curt, I think you hit the nail on the head, start saving as soon as you can, there's this this magic of compounding what we talked about in the financial world. And that just means the sooner that you get started saving, the longer you have, or the longer you give those investments to grow. So the amount that you need to save can are like the percentage of your income that you should be saving toward retirement, it can change dramatically depending on when you start. So if you're starting to save for retirement, say in your mid to late 20s, from mid to late 20s, all the way through retirement, that's like 40 years for most of us. And so if you start that early, you could save like 15% of your income and be absolutely fine. The longer you wait, the greater percentage of your earnings that you'll ideally need to set aside. Now I don't want anyone to hear those numbers and kind of like freak out and prevent them from from even getting started. Because anything is better than nothing in this sort of situation. So that's part of the answer. And we can probably talk more about that. But the the student loan issue, I think is a huge one. And yeah, I mean, I really feel like it's so it's so easy to want to avoid student loans and not even look at them. And what I would say is that, regardless of the type of debt, whether it's student loan debt, or a mortgage or auto loan, or really almost anything else, I don't encourage people to start aggressively paying off debt until they've saved, you know, roughly about one times their their annual income through a combination of emergency funds, retirement account savings, and even just, you know, ordinary savings and other other investments. The one exception to that might be really high interest rate credit card debt, which you might want to pay off. But student loans, especially, the only way that you can really get into trouble with student loans is to ignore them and not look at them. There are so many amazing options in terms of different income driven repayment plans out there. If you have federal student loan debts, I would encourage you to start saving and start looking at your student loans and considering what might the right path be for you because there are so many good options out there. Unfortunately, because there are many options. It's a little confusing and overwhelming to navigate. But there are definitely great resources out there. So super long answer To your question, allow you guys to jump in. Curt Widhalm 10:03 And if I can provide, you know, maybe a little bit of a perspective on this, you know, if you're looking at student loans, if your rates are like 5 6 7 percent in interest, even that can feel scary. But when you look at like stock market returns over the last couple of years, money that you could be saving 5% on by putting into your loan, you could have been getting returns of 1015, or more percent, depending on how that kind of stuff is invested, where you're using that same money to make your retirement come sooner. This is where having some of the ability to kind of sit and look at some of this stuff. And sitting with somebody like David would, I'm sure walk you through some of these kinds of comparisons of here's how you can make even very little money work for you. David Frank 10:49 Yeah, I think that's that's an excellent point, Curt. And like that's, that's right. Like, it's always great to be investing the money and seeing really great returns from the stock market, like we have seen over the last couple years, really over the last 10 years, it's been an insane period, where there's been really healthy returns. And you're right, like you could have not pay down your student loans whatsoever. Because yeah, they're probably in the neighborhood of 5 6 7 8% interest each year, something like that. And that's just it's so complicated. Like there's so many factors to think through that I think yes, the more you spend some time just sort of looking and learning yourself, the more comfortable you'll start to be with it. And that way you can kind of avoid making more rash, emotional decisions, which is sometimes when folks get themselves in trouble. And yeah, you know, I'm having a conversation with financial person, who you who you trust, and who can help you make the right decision for you. Because there there is no one right decision really ever when it comes to all these things. It really is personal and helping a client or helping the person sitting across from me determine what is the right move for them, given their life's their their life, rather, their goal, their anxieties around money, their worries, how do we manage all those different things? Katie Vernoy 11:59 I like that you're talking about it as individual decisions. I think there are some things we're kind of the cold hard numbers with some therapists are great at math, many therapists are not great at math, that's kind of a trope that I don't actually like, I think it's this thing of, of being able to actually look at the cold, hard numbers of what do I save by paying the minimum payment on my debt? Versus what do I earn from even putting something in a very risk free I mean, the stock market isn't necessarily risk free, you could make 10%, or you could lose 20%. You know, there's, there's so much there. And I think some people can hold that risk and are used to that, and some folks can't. And so I think looking at what, what makes sense for you with the emotional makeup of how you're looking at your money, the amount of bass that you have and can play around with as well as what your debt looks like. It seems like understanding that is really important. I think when we're looking at folks who are first starting out, which is kind of Kurt's question, which is like they have student loan debt, most likely, they are not earning a lot. And so you're saying kind of look at the numbers identify what's going to make the most sense, save a year's worth of salary before you really aggressively attack your student loan debt, I would recommend probably paying minimum payments. So you don't start? Well, yes, fee is as well. But like, I think there are folks that want they want to be debt free. And I think there's also a lot of folks who know that most people are never completely debt free because of mortgages or, or car loans or other types of debt that can be accrued. But when you look at folks who are a little further on, and whether it's age wise, or career wise, they're further along, and maybe they haven't saved for retirement, what would you say to them, because I think for folks who are early on and they can save the $5 a month or whatever, that's awesome. And I think that there is that compounding that you were talking about. But there are folks that I've talked to even that are like, I am in my 50s I'm in my 60s, I haven't done anything. And I just don't want to have to work forever. And so what would you recommend for folks who are further on in their life who are maybe further on in their career? What should you say, you know, how do you determine what you should save? How do you determine how and when you can retire? I mean, for folks who are later on I think there's there's sometimes a bigger question mark than folks for starting out. I mean, the message when you're first starting out when you're younger, and you're newer in your career, like just save, start it, you've got a lot of time it'll grow, we promise. But for folks that don't have that time, it's especially people who have recently seen their parents, colleagues and friends go through, you know, 2008 or, or different times when retirement just dropped out completely. I mean, there's some fear there's some societal fear around investing. Potentially you have to look at too. David Frank 14:47 Yeah. No, I like the way you teed up that question too, because I Yes, starting to save and invest young is such great advice. And I also like to describe it as I'm like, It's advice for time travelers, right? Because it's like yeah, that is a lovely thing, but like who actually does that? I mean, some people do for sure. Katie Vernoy 15:05 Curt and I both did because of the backgrounds that we have. So we both are very fortunate. But not everyone has that. David Frank 15:12 No, well, just like as an aside, like, I also have like that similar background, like I have an undergraduate degree in finance, I have an MBA in finance. And so like, right out of the gate, in my early 20s, I was like, I gotta be saving, I got to be putting all this money in a 401k. And I did that from like, 22, or whatever to like, 32. And I was doing great. Like I was killing it. And then you know, life happened. And like, I went through a really rough period in my life, I ended up unemployed for like, three years. And guess what, like, I burned through all those savings. So I thought I had done all the right things. And I had, but like, life just happens. And so the story that I told myself at the age of 35, when I was like, essentially broke and starting over was, like, there were a lot of nevers like this is I'm never gonna have the same amount of money, I'm never gonna have the security, I'm never gonna feel comfortable. It's just like, it's kind of like it's over for me. And the truth is that life had all kinds of twists and turns in store for me, and that most of what I was telling myself then wasn't true. So why do I even tell that story? I think the point is, is like a no one does this money stuff perfectly, even if we start out of the game strong, so just be kind and forgiving to yourself, number one. And number two, you really don't know what the future holds like there can be tremendous improvements made in a really short amount of time. So with that, as background, I would say, again, I have this concept I call money dates, which is just set aside 30 minutes, every day, every week rather, or so every week or so 30 minutes or so put it on your calendar and just treat it as if it were, you know, a client appointment and be like, I'm going to sit with my money stuff, and just look at it every week, and just see what's happening. So that I think, especially if you're find yourself later in life, and you use the specter, you have worry or fear about retirement, just start that practice, start getting familiar with what's happening, start understanding maybe how much you might need to save. Yeah, and also try to bring someone else into it with you. Maybe that's a significant other, maybe that's someone in your personal life, who you feel comfortable having this conversation with, just to sort of make it seem less private and scary. That could also be someone like me, like a financial professional, that you have reason to believe would be trustworthy, and would give you good advice. Because there are always options, there's always hope. There's so many things, different levers, you can pull. And the last point I'll make on this is that if you're really worried First, I would go to the Social Security Administration website and just log in, create an account, see what your you'll be entitled to in terms of social security benefits, it might actually be a little bit more than you're suspecting. And that's just like so that that can provide a really solid base. It's not like you have to pay for everything yourself in return in retirement, we do have a bit of a backstop. So start there, and then begin to think, okay, beyond that monthly payment that I'll likely get, what more might I need? And how might I start to get there, Curt Widhalm 18:05 I'm imagining these money dates of just sitting around with your financial statements and staring them in the eyes and doing the 36 questions to make you fall in love. Alright. Sounds great. But I don't know also, that it's that far off, when it's actually being able to look at this stuff intently as you're describing, and kind of shifting this from maybe more of the personal finance section to you also work with people as far as their finances towards their practices as well. How did how did those conversations look? David Frank 18:39 Yeah, I mean, they they really run the gamut, you know, you know, what, what most people want to know, is just like, Am I doing okay? Like, is this okay? And I think the answer is, it's kind of this, I'll give like someone like something I read on the cover of a Buddhist magazine, which is like, your perfect just as you are. And you could use some improvement. I feel like that's always kind of like where I kind of began with this. Yeah. It's, it's, it's just like, that's just the truth, you know, and like, so everyone, like, it's a similar practice of just being like, okay, let's, let's look at your practice financials. When's the last time you looked at your profit and loss statement or your p&l? And for a lot of people, it's like, well, the last time I had to, which is when I had to prepare my taxes last year, and like, from there, like I'm not really sure. And so it's like, okay, let's no big deal, a very common experience. And we can and we can do better. So we can just sort of look at it and just sort of spend time with those numbers and just be like, I don't know what any of this means. Right? Like it's they're confusing. These financial statements are confusing. And every therapist that I've ever met, whether they're self described good at math or terrible at math, can understand them. Because this is just simple math. I think it's more about creating room and space for the uncomfortable feelings that come up. When when folks start to, to work with their practice finances, and it's Working to sort of sweep out of the way limiting beliefs around Oh, I'm just no good at this, I'll never figure this out. Because I guarantee like you can figure it out. And sometimes sure you need some support from a professional like me or a peer or whomever. But it's just spending time. And yeah, asking those 36 questions to fall in love with your practice, P&L, I think is, it's not a bad place to begin. Katie Vernoy 20:23 That's funny, I think there's, there's so much emotion around money and security. And, and I think everybody, you know, there's a lot of different episodes, we've done with different folks on, you know, kind of money mindset and stuff. And we can link to those in the show notes as well. But I think that there's this idea, you know, we've got the folks that haven't saved anything and just, you know, they're living in a way or practicing in a way where they're barely making enough money to survive, or they're just not thinking about it, or whatever, you know. And then there's folks I've interacted with on the other side, where they don't pay themselves a lot, they save a lot of money in a, like an emergency fund, or they're investing a lot. And one of the questions that you had suggested we talk about is can you save too much? And so, so I wanted to ask about that. Because I think that there are folks who feel very safe, when they have a lot of money saved or set aside. And then and then they don't touch it at all. And to me, I feel like there there's some benefit to that. But I think to a point, and then there's also I think some potential things that can get in the way if you need a gigantic emergency fund. David Frank 21:41 Yeah, I mean, well said exactly. And I kind of like talking about this too, because having money saved wherever it is, whether it's an a retirement account, or an investment account. It for a lot of people, it feels like safety and security. And I think on some level, but you know, money touches pretty much everything. I might argue everything in life, like every moment of your day, is impacted by money, even if you're just like carving out enough time to not be working or thinking about money. That's that's time, I guess, theoretically, you could be making money, or something like that. So it's so intertwined. And we get so many messages from society around money and why it's important what we should be doing with it. That yeah, that at that end of the spectrum, where it's just like, I want to squirrel away and save, because it creates safety and security, I think, yeah, I think I think there is a risk of saving too much. And it's the question I always ask is sort of, you know, what, what is important? Like, if you find yourself saving a lot of money, ask yourself what is important about having so much money in this account, or what is important about having a big emergency fund, you know, what comes up that there's, there's certainly something going on, and I think it isn't necessarily bad. And yet, I would say if you are constantly finding yourself having to live from a place of restriction or scarcity in that, like, oh, I can't take that vacation. Because I I'd rather be saving money. I can't even maybe take a professional training because even though I feel really passionate about doing that, I need to be saving money. If you find you're constantly saying no to things that would nourish you that would make your quality of life better, then I think there's something there's something you need to look at. And again, it's it's it's likely an emotional issue. And I think that's that's another good opportunity to, you know, work with a professional or also there's like so many, like pretty good tools online these days to help you assess where, where am I really in terms of saving for retirement? How much? Like, how safe do I do I need to be? This is like a personal story about saving so much for retirement, I had a friend who lived in New York, he worked for, I can't remember who he worked for. But he had, he had like a pension, like a really generous pension. And he was putting a ton of money into his 401k. And he was like three years away from retirement. And like, by any measure, he had all the safety and security at least financially that anyone could ever hope for. And he was so looking for forward to retirement, and then the pandemic hit. And he he died of a heart attack, just a sudden heart attack. Totally unexpected. I mean, the reason I share that is like It was tragic. It was horrible. And, and it's life, right? Like we're never we're not promised anything. So I think it's got to be a balance. Yes, save and plan for the future. And just know that there is no such thing as complete safety and security because our life's journeys can end really at any point. And I think we just need to acknowledge both of those facts that yes, we want to be living in the moment and making our current life as good as reasonably possible. And also be planning prudently for the future and then balancing those two and it's tricky. Curt Widhalm 24:50 Besides just like squirreling money away and the places to put that money and how to spend that money. Are there other considerations of how therapy should be taking care of themselves and their assets. You know, like with your friend example here, I'm sure that part of the extension of this is looking at things like wills and power of attorney type things. David Frank 25:14 Yeah. Yeah. All that fun stuff. That's yeah, like, I think of it as like, risk risk planning, and then estate and incapacity planning. And as a comprehensive financial planner, those are things that I that I help folks look at as well. And they're things that many of us don't want to want to look at. But yeah, you know, you know, I think when it comes to like, sort of estate in an incapacity planning, and that's the type of work that I will help clients think through, and you almost certainly need to work with a professional attorney licensed in your state of residence to put a plan like that in place. So many folks think, oh, estate planning, that's something for rich people. And yeah, that's true. And it's also pretty much for all of us. So like, putting in place like a professional will, which really just ensures that your your clients are cared for in the event, you can't continue to show up for them the way you do today in your practice, and also having like personal incapacity and estate planning documents in place, powers of attorney, you know, wills, maybe maybe a trust to depending on what state you live in, these are uncomfortable things to think about. It's not comfortable to think about our own potential, passing our inevitable passing, or our potential incapacity. And I think it's really important. It's really, I think, I view this stuff as like an extension of loving kindness to, to your future self, to your clients, to your family members and loved ones. And having having a thought partner to think through what are the right pieces of that plan to have in place for you, I think is is really important. Katie Vernoy 26:46 The balance between living now and saving for the future, I think is a really tough one. I think along the lines of we could die at any moment. But we also could live longer than we expect. David Frank 26:57 Yeah, Katie Vernoy 26:57 I think the retirement age of 65, which, you know, came into place when people lived to be 70 or 75. You know, I think people living into their hundreds, I think that there is there is a lot longer that people theoretically could be retired. We also know there's a lot of therapists who practice well beyond that, because it's it can be a good quote unquote, retirement career. But to me, it seems like there's there's a lot to consider both in how do I live well, today, but also, how do I save enough to really live a long, long life, you know, like, the hope is that you're going to live and be in retirement for 3040 years. Right. You know, I think that that seems that's what I want. And so, if we're looking at identifying, I don't even know if there's a there's an answer here. And it probably is, you know, appropriately and it depends answer. But is there a percentage of our income that we should say, versus a percentage that we should and reinvest into our businesses? Or a percentage that we should use to enjoy our lives? Like, like, Are there standard typical percentages that people can kind of keep in mind when they're trying to make some of these decisions? If they are currently doing that on their own or with a, a non professional thinking partner? David Frank 28:27 Yeah, that's a great question. And I think you're right, that my answer is going to be prefaced by It depends. Katie Vernoy 28:33 Of course, David Frank 28:34 and yeah, you know, and obviously, nothing we've covered here today, including what I'm about to say is advice for anyone listening, right? Like, I don't know, you personally, listener, whoever you are. So I can't give advice that's, that's tailored to your particular situation. But in general, going back to the theme of it, it also depends when you've started saving. So if you're starting to save for retirement, and you're somewhere in your mid to late 20s, targeting saving 15% of your, of your pre tax income. So a quick aside, like it's difficult to know, like, especially if you're self employed, you have your own private practice, how much money am I even making, the best place I think to go and look for that is on the first page of your federal income tax return. I know that's like a scary place like no one wants to go to unless they're absolutely forced to. But there's so many good numbers on it. And there, you will find your total income on the very first page, I think it's like line 16 or something, and that'll tell you your total income. So I would say find that number. And then say if you're in your 20s, multiply that by 15% or 15% of that, that's ideally how much you should be saving every year. If you're in your late 30s, I would say that number should be closer to 25% of your total income. And then if you're around 50, late 40s 50s, then that number starts to get closer to even 50% which is like a scary number. So that's that's kind of aspirational, like who can really do like that's, that's really, really tough, which is why I don't want those numbers like they're not carved in stone. They're rough guidelines. And if you find yourself for not meeting them, that would be a typical human experience, right? Like most people aren't going to consistently meet those. That's okay, just continue doing the best the best you can. And then like, once, if and when you can hit those numbers, then it's like the rest of your money, you need to figure out like, what, what is the right balance for you, and then it totally depends like is, if you can hit your savings targets of let's like, roughly, for most people, it's gonna be like 15, in the range of 15 to 25%. Like, that's mostly realistic. And that's like a pretty solid number that we can really begin to work with that opens up options for yourself for your future self, then they spend the rest of the money in the way that feels best to you, like, yeah, reinvest some of that. reinvest in your practice, like do do what feels what gives you energy, like kind of like, like, you know, what gives you joy? Like that's, that's really how I think it's important to think about Curt Widhalm 30:53 when you're working with clients, I'm imagining that some of the depends that you're talking about here and getting to know them probably comes very much like therapy, and what do you value would you are hitting some of these financial goals and how you should spend it that for some clients, it might be, alright, you need to start spending this money, let's talk about buying a second house. Whereas for somebody else that might be, you know, what's you know, and see what kinds of, you know, charitable contributions that you can make? Do you ever find yourself in those very, very positive positions, but also on the flip side of that, like, hey, maybe you shouldn't get that doctorate, because it doesn't fit within your financial plans, or any kinds of other like, hold up like, this doesn't seem to fit with the lifestyle and values that you've talked about? David Frank 31:46 Yeah, I mean, what I like to say, and this is not an original phrase that borrowed it from someone else in the personal finance industry, but I like to say like, you can have basically anything you want, you just can't have everything. So if you really want to do something, for whatever reason, I always encourage a little bit of self reflection, just sort of asking what what is it about, for example, getting a doctorate that feels so important and vital to you? And then if you answer that question to your satisfaction, like that's not it's not my life, it's not up to me what the best use of your money is, if it's really something that's vital and important to you, then the question is, well, what are the right trade offs? So let's, let's just look with some clarity and say, This is how much this is going to cost. In the case of a doctorate, there's student loans and options like that, and just be as clear eyed as we can about the future and say, Okay, here's why you want to do this, here's the why it's important, or here are the elements about it that are important for you. And here's the numbers associated with that, let's just figure out how to make it work well. And sometimes when when, when folks see the other the sacrifices and other areas of their life that they might have to make, suddenly they realize, actually, maybe this isn't what I want, because there are competing employer priorities that are actually more important. And I just, I sort of forgot. So sometimes what I do is just remind people just reflect back to them, what they've told me, or what they've demonstrated to me is important to them. Because as human beings we do with like, we see like a shiny object, and we want to chase after it. And sometimes that shiny object is like really something you should be pursuing. And other times, it's something that's just a distraction, and we just need to be reminded of what's more important. Katie Vernoy 33:23 I love that I think it's really important, I guess that's the right word, I can think of here to understand yourself your values, and put put an individual plan together, I see a lot of shoulds you should be making this much money, you should be doing this, you should be doing that. And I think being able to really talk through with a knowledgeable person, you know, what, what actually are my values around this? What are my life goals? And how do I actually plan for those life goals versus someone else's, and and even really looking at individual circumstances, I've had folks that have told me that they don't want to take insurance because they get $5 less than their full fee. And I'm like, you're listening to advice from people in California where they get half of their full fee, you know, and so, like, you know, all of these shoulds and the kind of impromptu financial advice from other therapists and Facebook groups I think is something that we really need to fight against so that people can look at their own numbers, their own situation and make their own plan and so I love everything that you've said. And I appreciate your your thoughtfulness and your understanding of the emotional aspects of it that really make it hard for some folks to do this in a clear eyed way. David Frank 34:43 Yeah, well thank you that's very kind and and yeah, I just think that word should I hate that it's just like stop shooting all over yourself like there is no once i Mister like they're just there is no right answer really for any of this and Yeah, like advice. I just like, I get so triggered Maybe is there I don't know what the right word is. But like when people give advice, I heard this in a webinar I attended the other month. And the speaker said, All advice is autobiographical. And I'm like, what does that mean? And what he meant was that anytime someone is giving you advice, they're speaking from their own experience. So they're really giving advice to themselves, like, oh, I should have done this in the past, or I should be doing this right now. But I'm actually not, or, or whatever it is. And so advice can be good. But whether it's coming from a professional, like a financial advisor, or a colleague that you know, somewhere, or someone you don't know, but in a Facebook group, just ask them to explain. They're like, Oh, okay, interesting point. Why do you why do you say that? Like, what, what is the thinking behind that? And you may discover that, oh, that, that that piece of advice applies for them, because it's autobiographical, but it's sure doesn't apply to me. Um, or you might find it does apply to you, and great if it does, but it is also individual, Curt Widhalm 36:01 where can people find out more about you and turning point financial, if they want to reach out to you and work with you? David Frank 36:10 Yeah, so the best thing for people to do is to navigate to my website, and access my finance quickstart guide for therapists. And that'll give you a sense of what you should be thinking about in your fancy financial life. And it also gives you a good sense of what it might be like to work with me. And my website is turning point hq.com. So that's like turning point, a bridge, the abbreviation for headquarters. And yeah, there's a ton of good resources on there. And I think I will even by the time this airs, we'll have a little simple worksheet that folks can work through to help them determine how much they might, they ought to be I don't, I'm gonna use the word should how much they might want to consider saving for retirement so so they can navigate to the website and find all that good stuff. Curt Widhalm 36:51 And you've got an offer for our listeners as well. David Frank 36:56 I do for just a special offer. For the listeners of this great podcast, I'm offering 20% off my QuickStart coaching intensive. So navigate to my website, under the Services description, you'll find more information about that. And when they're scheduling that meeting, if they just enter the code, MTSG, or something like that, I will offer them 20% off when it comes to pay me. Katie Vernoy 37:18 Yay. That's awesome. Thank you. Curt Widhalm 37:20 And we'll include links to all of that in our show notes. You can find those over at MTSGpodcast.com. And make sure to join our Facebook groups, modern therapist group, and follow us on our social media for updates on everything that we're doing and connecting you with some of the other wonderful people in our community, much like David. So, thank you very much for joining us today. And until next time, I'm Curt Widhalm with Katie Vernoy and David Frank. Katie Vernoy 37:48 Thanks again to our sponsor, simplified SEO consulting. Curt Widhalm 37:52 These days, word of mouth referrals just aren't enough to fill your caseload. Instead, most people go to Google when they're looking for a therapist. And when they start searching, you want to make sure they find you. That's where simplified SEO consulting comes in. It's founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website or they can do the optimizing for you. Katie Vernoy 38:16 Visit simplifiedSEOconsulting.com/moderntherapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code MODERN THERAPIST. Once again, visit simplified Seo consulting.com forward slash modern therapist and use the code modern therapist all caps. Announcer 38:40 Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
Top 5 Tips for Custody Charlotte Family Law Attorney Caroline Wingate Strauss joins Law Talk for a year end (December 2021) review of family law and custody issues in Charlotte Family Court. https://charlotte-divorce-lawyer.com/blog/surviving-the-holidays/ (Surviving the Holidays) can be a challenge. There are a lot of custody exchanges take place during the holiday season that may differ from the ordinary custody and visitation that may in place during the year. What are the Best Interests of the Child? In any custody and visitation analysis, the child's well-being is the Polar Star consideration by Courts (judges) in North Carolina. The "guiding light" involves focusing on the Best Interests of the children. Helpful Tips for Child Custody: Try to Keep it Out of Court Shared Custody is Preferred Keep Kids Out of It - Don't Use Children as Intermediaries, Weapons, or Confidants Engage Professionals if Needed - Attorneys, Mental Health Counselors, Psychologists, Family Therapists, Physicians, Clinicians, Experts Get an Order or Parenting Agreement BONUS: Consult with an Attorney who is an experienced parent Is a Lawyer Required for Divorce? Ordinarily, a lawyer is not “required." Judges rarely demand attorneys be retained or get involved. At the same time, family law issues can get pretty complicated. While not required, a lawyer may be very helpful in explaining the processes and how things work in Family Court. https://charlotte-divorce-lawyer.com/blog/is-a-lawyer-required-for-divorce/ (Is a Lawyer Required to Get Divorced?) Does Collaborative Law make sense? Collaborative law allows spouses to resolve family law disputes outside of court. Rather than going through trials and sometimes emotional proceedings, the parties work through the https://charlotte-divorce-lawyer.com/blog/what-is-a-collaborative-divorce/. (collaborative process) to solutions to disputes.
Save $100 on your new Simple Practice subscription! Save 10% on your professional website with Media Queeries! Learn more about them here. In todays episode, Ariel talks with us about geek therapy, how to use media in sessions, combining art with gaming, and a bit about narrative therapy. Check out the episode to learn more! Ariel Landrum is a Licensed Marriage and Family Therapist and Certified Art Therapist. She is a proud Filipino American currently practicing teletherapy out of Reseda, California. She is a self-identified "geek therapist" who uses her client's passions and fandoms to create connection, strength identification, and support of their individuality. She provides the service of assessing and certifying emotional support animals and letters for gender-affirming treatments. She has worked with children ages 3-17 years old, adults 18-61 years old, and senior citizens 62-83 years old. Populations she specializes in working with are: military members and their families, the 2SLGBTQIA+ community, and survivors of sexual assault and childhood sexual abuse. When she is not performing her clinical duties, she can be found playing Animal Crossingor petting her pup while watching Disney+. Check out Ariel's private practice website, Guidance Therapy. Take a listen to her podcast called "The Happiest Pod on Earth" on the Geek Therapy Network! Join our newsletter for free downloads, creative ideas, and exclusive access to our materials! Follow Creative Therapy Umbrella on Instagram or on Facebook! Have feedback? Fill out our anonymous survey to let us know your thoughts, concerns, questions, suggestions, and feedback. For us to serve you better, we need to hear YOUR voice!
There are so many ways a relationship can go wrong... Arguments, values conflicts, broken promises, exhaustion, busyness, the list goes on and on... With so many things working against your relationship, you have to be proactive to help things go right. Today I'm going to talk with Emma McAdam, LMFT. Emma loves helping people change and is willing to be creative in how she helps that happen. With her solution-centered approach and emphasis on building relationships, Emma works hard to help people find love, purpose, and joy in life. Emma is a Licensed Marriage and Family Therapist and the host of the Therapy In A Nutshell Youtube Channel: https://www.youtube.com/channel/UCpuqYFKLkcEryEieomiAv3Q
Jenny Black is a Licensed Marriage and Family Therapist in the State of Tennessee, the founder of Media Trauma Care and the author of Inner Technology: How to be Human in a Digital World. She is currently writing a new book, Our Digital Soul: mental health, media trauma and our relationship with the digital world and in production on a documentary about the same topic. Jenny specializes in training and education about how mental health is impacted by our use of media. She was selected to present a Media Trauma workshop at the 2019 AAMFT Annual Conference. She was recently featured on the nationally syndicated television show, “Lifestyle Magazine.” Join us in the Authors Alley on December 15th 1pmET/10amPT and then in podcast anytime. Reach out to Jenny at MediaTrauma.com. Thanks to our sponsors at StadiumBags.com. Enjoy a KIDFUN Minute and we continue to shine the light on No Such Thing as a Bully. Thanks to Smith Sisters and the Sunday Drivers for our theme song, She is You. Connect with Word of Mom on Facebook, Instagram and Twitter and email us at firstname.lastname@example.org for more info. WordofMomRadio.com - sharing the wisdom of women, in business and in life.
Heather and Brittany talk to Sarah McLaughlin, a Marriage and Family Therapist, about protecting your mental health in motherhood during this time of turmoil and in the upcoming holiday season. Also discussed- how anxiety manifests in motherhood, how to handle holiday stressors, and the often discussed self care. The post 89. Mental Health in Motherhood With Sarah appeared first on Okayest Moms.
Why do women consistently make poor choices in men? Do you think before you leap... into marriage?Dr. Trillion Small tells her own experiences of how to make the right choices with the right expectations.You won't want to miss her candid, sometimes humorous advice!Tune in Monday at 12:30pm Central!TPOVS:-Do not marry potential.-Set expectations from the beginning.-Nobody has the same "Normal".-To grow, you must be willing to change.-Inconveniences aren't that bad.
The Kathleen Riessen Show What happens when you mix the holidays, family gatherings, year-end projects at work, children, and, oh yeah, a pandemic all together? A disaster! On today's show marriage and family therapist and incredibly talented superwoman, Sarah Bernson joins us to share some tools we can use both at work and at home so that we can actually enjoy the people around us during this holiday season. Sarah Bernson is a certified Marriage & Family Therapist, relationship coach, facilitator and board member of the youth empowerment non-profit, All It Takes. She holds a bachelor's degree in behavioral science and a Master's degree in educational psychology. She worked with special needs children and their parents at Cedar's Sinai hospital in their therapeutic classroom, and has had a private practice since 2008. During the pandemic, she collaborated with All It Takes on a documentary called a Trusted Space, which explores a socio-emotional paradigm that supports students returning to school after the pandemic. She is also the staff therapist for Boston Breakthrough Academy, which teaches leadership skills to people from age eighteen onward. Her goal in every endeavor is to provide environments in which people of all ages feel safe to express their feelings. email@example.com https://www.sarahbernson.com/ Join in the Live Chat Room too!!! https://inspiredchoicesnetwork.com/chatroom Kathleen's Book: Joy in Uncertainty: A Guide to Creating a Meaningful Life Purchase on Amazon.com *Listen now on the Inspired Choices Network app! https://linktr.ee/inspiredchoicesnetwork ~ More About The Kathleen Riessen Show ~ As a former Certified Public Accountant turned marketing strategist turned serial entrepreneur, Kathleen has coached and consulted with over a thousand executives and entrepreneurs. What she's learned is that the number one strategy to grow a business and create what you want in life lies in your ability to be vulnerable and authentic and to surrender. As the Queen of Possibility, Kathleen showcases what you can create in your world with joy and ease. https://bookwithkathleen.com/ https://www.kathleenriessen.com firstname.lastname@example.org To get more of The Kathleen Riessen Show, be sure to visit the podcast page for replays of all her shows here: https://www.inspiredchoicesnetwork.com/podcast/the-kathleen-riessen-show/
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.
What happens when anxiety around sleep becomes a nightly ritual? In this Flusterclux In Session episode a parent is becoming all too aware of how her worry about sleep shapes bedtime for her son…and it is probably showing up elsewhere. Listen to Lynn coach a mom on how to make a few key adjustments to the worry routine at bedtime and beyond.Would you like to apply for an upcoming Flusterclux in Session episode? Join the Facebook group and complete the form.Parents and Teen Retreat Announced!Save the date for the weekend of April 9th! Join the Facebook group for first access to information and registration coming this month! The retreat will be held at the Woodstock Inn in Vermont.NEW Course for Parents!Managing Anxiety in Children: A Guide for ParentsThis self-paced course covers the core tools a family needs to manage their anxiety, the same principles Lynn teaches to families in her private practice.This course includes 6 video modules from Lynn Lyons, LICSW, and 9 additional Q&A videos from Lynn and Robin of Flusterclux.What you'll get:Understand how anxiety works so that you can help manage your kids and your own.Learn what to say when anxiety shows up for you or your kids.For Kids: A special video that explains how anxiety works suitable for those ages 6 and up.Follow UsJoin the email list to get news on the upcoming courses for parents, teens, and kids.Follow Flusterclux on Facebook and Instagram.Follow Lynn Lyons on Twitter and Youtube.New episodes arrive Friday at 12:00AM EST.Show Less
Conversations with our partners become very high stakes after children are born. We come from different upbringings with different ideas of what parenting looks like, yet need to learn to work as a team. This can be a recipe for tense conversations or conflict with those we love. Licensed marriage and family therapist Elizabeth Earnshaw is here to introduce key skills that strong and thriving couples use so we can learn to disagree in a way that strengthens our relationships rather than weakens them. Show Notes: https://bit.ly/3GrI1vc
Today's guest is Jacent Wamala. Jacent is a Licensed Marriage and Family Therapist turned Money Mindset Coach and founder of Wealth & Wellness University. She also hosts the Jacent's Gems podcast where she provides “been-there-done-that” guidance to help women of color write the best chapter of their lives. She helps women overcome debt, level up their income streams, and achieve impactful, life-changing financial freedom. In three years, she paid off over $90,000 in credit card and student loan debt and saw the link between financial stress and mental health issues for her clients. Her goal is to help her community become aware of the limiting beliefs and fears getting in the way of their financial freedom and empower them to create a plan to reach their goals. Today Jacent shares with us steps you can take to address the root cause of your money mindset challenges so you can make lasting financial changes in your life. In This Episode We Discuss: How calculating her net worth led to her “aha moment” Why so many people revert back to poor financial habits over and over again The importance of getting to the root cause of your negative money mindset challenges Actionable steps you can take if you've felt financially stuck The importance of taking ownership for your current situation How to build the right money team Learn more about Jacent Wamala by following her on social media: Instagram: @jacentsgems Twitter: @jacentsgems Facebook: https://www.facebook.com/groups/wwustartsheree Website: https://www.wamalawellness.com/ If you want to further connect with Lauryn Williams at Worth Winning, follow us on social media: Instagram: @worthwinning Twitter: @worth_winning Facebook: @worthwinningfp LinkedIn: @lauryn-williams RESOURCES: Episode 125: Financial Self Care for Couples with Guest Amy Scott Episode 126: Achieving Mental Wealth with Guest Rich Jones No Excuses by Brian Tracy The Lies We Tell Ourselves by Jon Frederickson
When Clients Have to Manage Their Therapists Curt and Katie chat about the work (or mental load) therapists often give to clients that is really ours. We talk about requiring our clients to do things that are not helpful to treatment like: manage our time, do excessive paperwork, negotiate through our money stuff, be guinea pigs, or teach us about their culture or other differences. We also look at the impact of these abdications of responsibility on the therapeutic relationship and the clinical work. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. In this episode we talk about: When we give more work to clients (that isn't really good therapy) The mental load or emotional labor that therapists can unwittingly add for clients Time management and the impact of poor practices on clients Being late, managing the shape of the session, scheduling The difference between being authentic and being irresponsible The care you show when managing rescheduling and the impact on the relationship What can come up, especially related to attachment wounds The problem when you consistently forget to get back to your clients Paperwork as a burden on clients, especially when clinicians don't read the paperwork The message you give when you don't follow up on a client's homework When outcome measures feel like paperwork that is solely for the benefit of the therapist, rather than something that feels relevant to the client Feedback Informed Treatment (FIT) poorly implemented Delayed billing, not providing superbills timely Allowing a balance to accrue The power dynamic and power imbalance when clients owe therapists a sizable amount The labor we're giving to our clients when don't have structure on payment (sliding scale fees and payment plans) How our own money stuff might come into these conversations Adding new theories or trying new interventions on clients without a strong clinical rationale The danger to the client's trust in the process if we throw new interventions in each week The mental load of asking our clients to teach about their own experience or navigating therapist bias Identifying a lack of fit or when treatment is over (rather than forcing our clients to do so) Own our humanness and set ourselves up for success Why this work sometimes gets handed to clients (rigidity, therapy culture) Our Generous Sponsor: Simplified SEO Consulting Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. These days, word of mouth referrals just aren't enough to fill your caseload. Instead, most people go to Google when they're looking for a therapist and when they start searching, you want to make sure they find you! That's where Simplified SEO Consulting comes in. Founded and run by a private practice owner, they understand the needs of a private practice. They can help you learn to optimize your own website OR can do the optimizing for you. Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code "MODERNTHERAPIST" Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Very Bad Therapy: A Clinical on Unprofessionalism Relevant Episodes: Work Harder Than Your Clients Clinical Versus Business Decisions How to Fire Your Clients Ethically How to Fire Your Clients Ethically Part 1.5 Diversity and Cultural Competence Special Populations Connect with us! Our Facebook Group – The Modern Therapists Group Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript (Autogenerated) Curt Widhalm 00:00 This episode is brought to you by Simplified SEO consulting. Katie Vernoy 00:03 Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. Curt Widhalm 00:21 Stay tuned at the end of the episode for a special discount. Announcer 00:26 You're listening to the Modern Therapist's Survival Guide, where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 00:41 Welcome back, modern therapist, this is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about therapy about our practices, things that we do to have more successful practices and leave our clients in better places promote healing in the worlds. And today's episode is inspired by a client's comments about the work that therapists make clients do outside of the work that therapists make clients do. And this is the ways that we make our clients do some of the practice stuff for us, or that our bad practice habits end up giving people bad therapy experiences. So this is not necessarily about the clinical work, but things that we do that potentially start to affect the clinical work. And going through kind of some brainstorming on this. And we posted this question the night before recording this out on our Twitter feed, we got exactly zero responses from anybody. So this is a list of things to Katie Vernoy 01:55 Maybe we should have put it in our Facebook group, where we get responses. Next time guys next time. Curt Widhalm 02:01 But we came up with a list of things, this is probably a non exhaustive list. And you can go to our effort mentioned Twitter or Facebook group and continue to add meaningfully to this list. But things that clients have identified are also the importance of being on the other side of the couch things that we've identified, the end up just being bad therapy experiences. So Katie, what first comes to your mind on this. Katie Vernoy 02:33 I think the the thing that comes first to my mind is probably the way that we manage time. Because for me, I worked in a clinic mental health clinic, a mental health clinic where time seemed very dynamic and fluid and things just never started on time. And it was something that bothered me, I equally participated in it. But it's something that I found is important for me, I want to make sure I'm on time that if I tell my client that we're going to reschedule that I have a time available for them and, and that I manage time properly within my session. But I have heard from clients that that is not always the case. In fact, I'll link to this in the show notes, there was an episode that I supported very bad therapy on where a client who reported on their story was given tons of paperwork after their therapist was 30 minutes late to the intake session. And just the types of things with that are just hugely problematic. But like if we're not respecting your client's time, if we're not rescheduling and like managing the rescheduling process, if we're going over which I have to admit, sometimes I go on that one where we don't manage time properly. In this session, we're forcing our clients to kind of work around us or manage the time for us. I know as a therapist, I'm always tempted to manage the time for my therapist, she actually is good with it. But like I still am like, oh, well, I know we need to finish. You know, like, I feel like when that's happening there is there's work that the client must do that doesn't seem fair. Curt Widhalm 04:21 And the way that this plays out is I've had people describe this to me as we understand that therapists have their own lives, have their own reactions have their own shit that just comes up and a lot of things that we encourage therapists to be out about, you know, hey, I'm going to a conference that's gonna affect our sessions that we need to reschedule things. But I've heard statements around this as far as like, Oh, I'm going to a conference. I need to reschedule. I'm needing to move a couple of people around I'll get back to you in a couple of days with what your options for rescheduling for next week might be. And then not following up with the clients that ends up putting the clients in positions of do I need to call back is my therapist actually going to follow through. So these are really kind of small afterthought things that can have a great deal of impact on our clients as far as pushing some of the scheduling responsibility back over to them. Now, parts of the ways of getting around this is if you have a good, you know, scheduling system that allows for clients to be able to put themselves on your schedule, hey, you know, I'm going to this conference next week, we could spend a few minutes right now doing this or set a reminder for, you know, tomorrow to check back and I'll have my availability up there, and you'll be able to book an appointment for what's available. And that can be one way of helping to alleviate this problem. Katie Vernoy 06:08 Yes. And I think that the message that we send, if we don't immediately take care of it, or, or have a solution for it, I think is one of I don't care about your session. I mean, to me, it's respectful to take the time to to do the rescheduling, especially if you've got a couple of minutes that aren't going to take away from clinical time. And I think the the message of I've got a few things to move around, and then I will get back to you and not getting back to kind of put somebody in a in a hierarchy of how important they are to you. And to me, it just feels, I think it hurts the relationship when you disregard them. And you don't get them scheduled immediately. Or you don't show the importance of getting them scheduled and taking care of their time immediately. In my opinion. Curt Widhalm 07:00 You know for some of the clients that I've seen that have described this, it's their people who seem really high functioning in many areas of their lives. Katie Vernoy 07:11 Sure. Curt Widhalm 07:11 But this does bring out a lot of attachment wounds, especially if there's been relational traumas in their lives. And it might not be something that is at the forefront of your mind as a practitioner, when you're managing your practice of looking at just how deeply impactful those between session contacts or absence of contacts can end up happening with clients from all walks of life, but particularly from these clients. Katie Vernoy 07:41 And I want to cover another element of this because there was a period of time, not lately because of the pandemic. But when I was traveling a lot, or I was doing a lot of things, I did reschedule a lot. And some people would say that de facto is disrespectful to clients, and you set your weekly time and you keep it and that kind of stuff. And for me, and maybe that's why I've gotten very comfortable with rescheduling. But if the communication is open, and there's a clear value that you hold for them and their session time, I think you can reschedule maybe not as much as you want. But I think that you can still do it. But I think if you forget to call them back, and you make them be the ones that reach out, I think that's when it gets problematic. I think folks can live their lives travel all they want, do what they want. I think it's just take care of your clients in the process. Hold those times make sure that you make it available for them, and help them to reschedule don't make them do it. Curt Widhalm 08:36 So is kind of shifting gears here a little bit. But also speaking on responsiveness. You brought up paperwork. So first of all, there's just the sheer amount of paperwork. Yes, and depending on the kind of practice that you have, sometimes agencies are going to have mountains and mountains of paperwork. And from a bureaucratic standpoint, it might be because there's multiple people within the agency who are interacting with a client if there's a medical component of the agency justifying paperwork, and I don't want to do that. But for, you know, more private practice II type places that there can be a lot of good intentions with paperwork, but a complaint that I hear from some of my students, some of my clients about other therapists experiences is does that paperwork ever actually end up getting used for anything or is it just filling stuff out for filling it out sake? Katie Vernoy 09:42 Yes, yes. I think that's the piece that I that really bothers me. I know. Like when I go to a doctor's office, you know, whether it's an intake or an annual appointment or whatever, so much paperwork, and they clearly don't have time to read it and then they asked Be the Same questions right afterwards. And I know that that happens with therapists as well. I personally probably have a couple too many pieces of paperwork that I feel like I need to have. And they are really just kind of forms that people sign. But all of the assessment stuff I do read, and I am, it's clear when I see my clients that I read it, but I think there are a lot of folks that feel like they have to have all of this information. But there's arguments about having it at intake before intake after intake, you know, like people can argue clinically when they want to ask for all this information, but having so much paperwork to get through to walk in the door, and then have it clear that my clinician has not read it drives me bonkers. Curt Widhalm 10:46 I was at a presentation several years ago at this point that the speaker was a psychiatrist who was talking about the last days of one of their parents being in a hospital, end of life sort of things. But every doctor that was making their rounds, they learned after a couple of days that they just needed to ask the doctor before saying anything like have you read the chart that. So this is this is not just particular to therapists experiences that overall in healthcare we can get, especially when we're busy really into that habit of just kind of making our clients catch us up on things rather than going back through notes, you know that that P part of SOAP Notes of even just going back and following up on what I also hear from a lot of clients, which is following up on homework, that we assign clients to do things. But if we don't bring it back up in session, we're giving them a pass to not do it. But yeah, it also backs up the quality of our work, or the emphasis on the suggestions that we make when we do ask and follow up on referrals on homework tasks on different ways of doing things that if clients are like, alright, I don't need to do this, or if they're the ones like I did the homework, do you want to talk about it? But the answer, probably Yeah. Katie Vernoy 12:19 Yes, yes. And I know I've had that happen, where I either failed to write down the specific homework assignment in the progress section of my note, or the plan section of the notes, sorry, or I was kind of waiting to see if it was relevant. And I think in truth, that means that the client may feel responsible to bring it up and feel like they have to manage it, and or they just start start disregarding it. So I think that's a really good one. And I think being able to manage our own documentation properly, so that we can have that continuity of care from session to session, I think is really important. And if we're not managing the continuity of care, you know, I think we joked and a few probably in a few different presentations and conversations about self care, just like, Oh, what was most you know, what was most, you know, resonant with you last week, you know, when you don't remember what you talked about like that that's really making the client, it puts them in the driver's seat? I think there are clinical reasons to do that. But I think if you're structured enough that you're actually asking for homework, follow up. Curt Widhalm 13:33 And you don't want to be that therapist, it's kind of doing the, you know, the psychic out in front of the audience, like I'm sensing, sensing an H over here. Was there something in your last week that that starts to age? Hey, speaking of things that we can overload clients with your this is from your list, lots of outcome measures without either buy in about it, or showing what you're doing with those outcome measures. Katie Vernoy 14:06 Yes, yes. Yeah, I think the thing for me is on my therapist for a while was doing feedback, informed treatment. And I was like meh and and she did drop it. So that's good. Maybe I shouldn't say that outloud Curt Widhalm 14:21 maybe they weren't doing feedback, informed treatment. It was just feedback informed treatment flavored therapy. Katie Vernoy 14:28 Maybe No, I we did talk about it a little bit. But I was also anyway, that's a whole other conversation that I can have with my therapist. But I think when I'm thinking about that, that was my experience of like, I don't want to do feedback informed treatment. I'll tell you if I need something different. Stop asking me questions. Stop spending time in my session on this paperwork that you want me to fill out is kind of how it felt to me. So I'm, and I knew what it was like I didn't need her to explain it to me. So I also was having my own experience of it. But back in Community Mental Health, there were tons of outcome measures that were put together to, for funding streams, like we had to show progress, we had to do this stuff. And, you know, we had to do them quarterly or different things like that. And theoretically, if you actually use those, clinically, I could see the benefit. But most of the clinicians didn't, they just had to get it done. And so it had that piece of like, here, fill out these 27 different scales. And then we'll be done. And we can get back to the business of therapy versus actually using them clinically. And so to me, first off having 27 different scales, and I exaggerate a little, I think is is overkill, and I think not using them clinically is is just bureaucracy at its worst. Curt Widhalm 15:48 And don't just blame this on agencies. There are people who, if you are some of my fit people out there, you know what I'm talking about, but it's for the people who think that they're doing fit that aren't, that are just kind of taking up session time, they're not explaining how they're using this information with clients that really just ends up Compounding this problem. Yeah. Now, on the opposite end of too much paperwork is maybe not giving enough paperwork, and not necessarily just assessments, but this is following through on things like super bills. And yeah, letting you know, months and months stack up before clients are reaching out to you and saying, Hey, I'm thinking that, you know, my insurance company isn't going to reimburse me for things that happened last year, that you're getting that far behind. Yeah, you know, the this is things that now start to impact potentially the the contracts that you got clients into your practice with, as far as, you know, if part of clients decision making processes, I'm coming to you because at least I'm getting a few dollars back on my therapy sessions, because of a super bill. This is something that starts to have a financial impact on clients. Katie Vernoy 17:20 Yeah, I definitely have had clients that I forgot I was doing a super bill for and they reminded me fortunately, it was not too far out. And we were still able to get it done. But I think that's, that's hard. I mean, that's part of the process that we say we're going to do. And if we don't do it, and they and they have to remind us, I mean, granted, this is them getting their money back. But if we've said, Hey, I will provide you with a super bill, we need to live up to that into the bargain. I think there's also courtesy billing and different things. We talked about some of this stuff in work harder than your clients on ways that you can show up better and and maybe even in some of the other conversations we've had on kind of the highest level of customer service, I'll look back and see what we've actually done episodes on, then put those in the show notes. But I think, to me, I think if we're not billing timely, and like with insurance, billing, if we're not billing timely, and we don't get paid, I think we just hold that. Like, if we didn't do it, we don't get paid. But if we're billing really late, and we're also not collecting payments until we know what the copay is going to be, or until we know how much has been covered. We can end up with big balances that clients have. And we know there's there's a lot of guidance around that. But I think that can start to happen. Even if you don't bill or don't charge them a reasonable copay. Like, except like once a month. That means for some clients, that's fine, and you can figure out the cadence with them. But I think if we're not doing things timely, and all of a sudden a client owes like 1000s of dollars or hundreds of dollars for some clients, it's it's overwhelming, and it creates a little bit of a rupture within the therapy relationship. Curt Widhalm 19:02 It really does heighten the power imbalance that not only are the traditional therapist client power balances there, but then it's also this is somebody that I'm indebted to, and especially if it's multiple sessions that for whatever reason, that therapist hasn't built the client, then clients might not actually be bringing that up. And, you know, not everybody's great at budgeting their money. So if they get hit with multiple sessions of Yeah. You're then putting yourself into, at best trying to work out a payment plan with them. versus, you know, potentially, it being the end of the therapeutic relationship and somebody that owes you money just as potentially gone. Katie Vernoy 19:56 Yeah, I mean, I think that is loss of money for clinicians, and I think we should be pretty motivated to not do that. But I think about like setting up payment plans or even like a sliding scale when there's not any structure to it's like kind of pay what you can. There is a clinical element to this, I think. But I think there's also some emotional labor that we're giving to our clients to try to figure out what they can say they can afford that feels acceptable to you, or what their timeline is for the payment plan, or whatever it is, and all of a sudden, this relationship has become very different. And I feel like the more structure that the therapist can give, the less we're putting our money stuff on our clients, because I think sometimes sliding scales and pay payment plans and stuff like that are very needed. And sometimes they're because clinicians aren't willing to turn folks away or refer folks to appropriate resources. And so then it becomes this weird push pull of, well, if you can get high enough, then maybe I can see you. And, you know, it's it really becomes this weird dynamic. And maybe that's overstating it, but it feels really strange to me, I feel like it's been a lot, it's a lot easier when someone has a specific copay, or I say, This is my fee, and they say yes or no. Curt Widhalm 21:13 Why longer that I practice, because of some of these points, the more that I look at things from a practice management, and that it simplifies things. And I look at it from a legal and ethical end to that, it's acknowledging that as the providers, we have the responsibilities to set boundaries, especially around kind of more taboo sort of things in polite society that we don't talk about money in this way. It puts us in the position of even if we're very equal, driven in the way that we approach the work that we do with our clients that this is just kind of handing off all of that responsibility as you described. Katie Vernoy 22:02 Yeah. I mean, I feel like there's probably a mechanism to have a Pay What You can practice, and I am thinking of someone in particular, and I have a sense that she's probably doing it very well. And so maybe I'm gonna reach out to her so you know who you are, I'm reaching out to you. But I feel like it has to be handled very, very well. And there needs to not be kind of this ulterior motive around it, because then it's like, I'm putting my stuff on you versus really opening up my practice to exactly what you can pay. If you can pay $2, or you can pay $250, you're in the door is a very different thing, then, what can you pay? Can you pay this? Can you pay that? Well, I can only do this, can you do that? Like it just this the bargaining, I feel like just creates a completely different relationship. And maybe maybe I'm too in my own money stuff and need to solve it. But I feel like that's putting our stuff onto the clients. Curt Widhalm 22:58 So switching gears here, some, a lot of us love to add new skills to our practice, add new tips, add new interventions, add new theories, and you're encouraged to practice them. Yes. But clients who know that they're the ones who are being practiced on, it should be done in a way that they are buying into, it's not just, I came from this workshop this weekend, and this is the first time that I am using all of these interventions, that that is doing therapy that is not practicing therapy, and that is doing therapy poorly. And Katie Vernoy 23:40 yeah, Curt Widhalm 23:41 go ahead. Katie Vernoy 23:41 I was just gonna say, I know that I've been guilty. Sometimes I'm like, this is such a cool intervention. And I was thinking about you the whole time. And I think it would be great. And then we try it. And sometimes it's cool. And sometimes it's like, Oh, I was way more excited about that than I really thought about it. So I know I'm guilty of this. Curt Widhalm 24:01 And I think it's natural, especially earlier in our careers to want to try out and especially as you're trying to find what your theory is that part of getting a theory is just trying things out and being able to see what works for you. But I've had clients respond back or heads supervisees clients that this ends up becoming discussions and supervision of, well, that's nice, but what's your success rate with this that makes them even just question the effectiveness, whether they're, whether the clinician is good at it or not. That just kind of devalues the belief that it's actually going to work from the clients end. Katie Vernoy 24:47 Yeah. Yeah, I think the longer I work with a client, the more we're able to kind of play around with new things, see what's happening, but like if it's especially a newer client, where it feels like I'm coming in each week with a completely new theory. Without a lot of understanding, yeah, it feels like I'm just grasping at straws. And so I think it is important, regardless of how excited you are of an orientation, or a new new intervention that you really, how does that flow into the work that's already happening? Is it relevant? Or is it just does it just sound like fun? I think some of the folks who read us putting a mental load on our clients will probably think this is what we were going to talk about. So I want to make sure we do talk about it. This is what we talked about all of the podcasts, I didn't want to miss it. What I put together my little list, which is us, not having knowledge, especially cultural or specific demographic kind of information, and asking our clients to teach us, I think this across all of our clinical episodes is basically what every clinician who's talking about a population of folks that we didn't necessarily learn about in grad school, says is that what they get wrong, is that they make clients teach them. And they also make bad assumptions and all of that. And so then the clients, if they stay has to do the work of teaching us they have to do the work of navigating our bias, they have to determine if it's if we're the right therapist for them. And so I think, I don't know that we have to go deeply into this topic, because like, probably three quarters of the episodes of our podcast, maybe that's an exaggeration, half of the episodes of our podcast on this very thing. But I think what we're requiring our clients to teach us about that, all that makes them them from the ground up versus coming from a place of I have some knowledge, and how does that impact your life? And tell me a little bit more about your particular perspective? I think that is an emotional load that I think is extremely harmful for us to put on the clients. Curt Widhalm 26:56 And I think if you approach that as more likely to be harmful than not from that approach. Yeah, it's not to say that it doesn't work. And you know, despite all of the experience that I have in my career, that sometimes it's even just owning my side of the street of here's my experience with this particular presentation, this particular culture, even sharing with them from session to session. Here's what I've been reading about since last time, as it pertains to this area that demonstrates a better way of handling this, as opposed to, hey, why don't you teach me about your fill in the blank difference of culture from mine, that assumes kind of that dominant thing. So if that dead horse is not already beaten. Katie Vernoy 27:54 But we'll, we'll, a link to a section of our podcast episodes that has a lot of those types of beginning beginner information that you can start with if you've got a client that has some differences that you don't know much about. Curt Widhalm 28:09 And I think that that goes into the next thing on your list here, which is identifying a lack of fit overall, yeah. With and this doesn't have to be just immediately before the first session, but even in the first session or so appropriately, being able to say, I don't think that I can help you. Or there's somebody who is better at helping you or my skills, don't line up with what you need out of therapy at this point. And then providing a warm handoff to somebody who can, that, you know, it's hard enough for many clients to, especially first time therapy seekers find a therapist that meets many of their requirements, costs, location, specialty, this kind of stuff. And then to just kind of throw those clients back to the beginning of the process is a very difficult aspect of just where our healthcare system is. But this is part of why we build the networks that we do to say, Hey, I know somebody who might be a better fit for you on this than I am. And being able to own that in a non shaming way. Katie Vernoy 29:27 We've talked about this a few times, and we have a couple of episodes on how to fire our clients ethically, if you've started down the path and recognize that you're not the right therapist for them. And so being able to, you know, whether it's identifying that you're not a fit anymore, or they might need somebody else at this point, I think that's our responsibility and not our clients kind of fading away. And to that point, we need to be the ones that identify the end of treatment, when it's clinically relevant. If it's like, Hey, I've got what I need. I'm going to come back later, or those types of things that can be either collaborative, or the clients choice, the client can always choose to end treatment. But if you're recognizing it's time to end treatment, and you don't say it, because you don't want to lose a client, then the client has to say it later. And that's not fair to them. Curt Widhalm 30:19 So all of these are extra considerations for helping your clients having good experience with your management of your practice of being able to come to therapy for the reasons that they think that they're coming to therapy for. And, you know, I think that we've probably got a upcoming episode here to be recorded, but helping to talk with clients about what realistic expectations of therapy are, yeah, that if we're really honest about it, it's, you know, realistic expectations. If your honest list is, I'm going to be late on emailing you things, or I'm going to be chaotic and scheduling you. But we encourage you to own your stuff. If you wouldn't feel comfortable owning that to potential clients. These are ways of being able to consider the impacts and really being able to look at your own therapeutic relationships with your therapists of what goes beyond just what's happening in the therapy room. Katie Vernoy 31:31 And I think there are many of these things that probably each of us, you know, I'm talking about you and me, as well as, as all of our listeners, we there's many of these things that we've all done at some point. And I think part of it is being human, we get excited about a treatment and we try it before we really think through the whole clinical plan, or we're late or we forget to get back to our client or whatever it is like I think all of us have at least a few if not all of these somewhere in our history. I've been a therapist for 20 years. So of course these things have come up. But I think if we can own our humaneness and set ourself up for success, we minimize these things. Yes. And I think if we don't get overwhelmed, we don't, you know or don't aren't consistently in a state of overwhelm, I think we can manage these things a lot better. I think the reasons that I came up with it, sometimes these things happen that I think are worth investigation, and maybe in another conversation about clinical orientation, or how we view ourselves in the profession. But I do feel like there is a rigidity that sometimes happen. And I've seen this in in some different kinds of topics. And we talked about it a little bit in some recent episodes. But when we feel like our clients need to take on this emotional load, because it's their responsibility, or it's part of the clinical element of things, you know, clients must do this, because it's their thing. I just, I feel like I need to remind folks like, therapy is a weird beast, we do things in a particular way. And is there's a culture that we've created around what therapy is what the relationship looks like, all of these things that our clients may not know. And so the fact that they should remember their appointment time, or they should do, they should always be the one managing their scheduling, or whatever it is, you know, like, if there's something that they should do that if they don't do it, then it's clinically indicated. And I create sometimes there's clinical communication that can happen there. But when we when we put our filter of what a good therapy client does over someone who maybe has never had therapy or has never had therapy with you, you're putting stuff on them that I don't think is necessarily accurate. Curt Widhalm 33:54 So, we'd love to hear your thoughts on all of this stuff you can let us know on our social media or come join our Facebook group, the modern therapist group. And until next time, I'm Curt Widhalm with Katie Vernoy. Katie Vernoy 34:08 Thanks again to our sponsor Simplified SEO Consulting. Curt Widhalm 34:12 These days, word of mouth referrals just aren't enough to fill your caseload. Instead, most people go to Google when they're looking for a therapist. And when they start searching, you want to make sure they find you. That's where simplified SEO consulting comes in. It's founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website or they can do the optimizing for you. Katie Vernoy 34:35 Visit simplified Seo consulting.com forward slash modern therapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code modern therapist. Once again, visit simplifiedSeoconsulting.com/moderntherapist and use the code modern therapist all caps. Announcer 35:00 Thank you for listening to the Modern Therapist's Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
Relationships of any kind are never easy. You have to have a deeper understanding not only about yourself and the other person but also your relationship dynamics. Today hosts Kevin Palmieri and Alan Lazaros are joined by Licensed Marriage and Family Therapist, Elizabeth Earnshaw. They talked about relationships and how to work through them with the people you value most. She also shares tips on how certain situations like setting boundaries and addressing needs in a relationship should be approached, so take all the information and advice you can get and use them to better your relationships with everyone you love.Over the last decade, Elizabeth Earnshaw, LMFT, has become one of today's most trusted relationship teachers. Elizabeth is a Licensed Marriage and Family Therapist and Clinical Fellow of The American Association of Marriage & Family Therapy. She is the Head Therapist at Actually, where she is working to make relational wellness mainstream & accessible. She also owns A Better Life Therapy in Pennsylvania & New Jersey, where she supports clinicians who are helping couples every day. She trains and supervises therapists as an Approved AAMFT Supervisor. In addition to making couples therapy more accessible, she is the author of “I Want This To Work.” Elizabeth is also the host of Hash it Out on Good Risings, where she offers advice to everyday relational conundrums. Where you can reach Elizabeth:Website: https://www.elizabethearnshaw.com/LinkedIn: https://www.linkedin.com/in/elizabeth-earnshaw-lmft-cgt-5093b818/IG: http://www.instagram.com/lizlistensGet a copy of her book I Want This to Work at https://www.amazon.com/Want-This-Work-Navigating-Relationship/dp/1683647955/What are you waiting for? Grab this FREE COURSE now! https://next-level-university-courses.teachable.com/p/what-it-takes-to-get-to-the-next-levelGroup coaching details: https://nextleveluniverse.com/group-coaching/We love connecting with you guys! Reach out on LinkedIn, Instagram, or via emailWebsite
Claudia grew up in the San Francisco Bay Area on occupied Ohlone land. She completed her Bachelors at San Francisco State University Latinx Studies Program and a Master's degree in Integral Counseling Psychology, training in humanistic approaches to therapy. She has a passion for working with people of color to remember and reimagine the way they heal together in today's world. Claudia uses eight years of holistic life coaching experience and six years of apprenticeship in Mesoamerican tradition to support clients uncover their own inner wisdom around what health and healing mean for them. She strongly believes in working in a non-hierarchical, collaborative, holistic coaching approach where together the practitioner and client can co-create new learning. Claudia works with an integrative approach using Divine messages from the Universe and Mother Earth, the sacred elements Fire, Wind, Water, Earth, the Four Directions, Chakra Energy Centers, energy clearing (limpias), and energetic reading with claircognizance (empathic sense) and clairsentience (psychic sensory) to help recommend ritualistic practice to aid healing and uncovering your sacred self-knowledge. Social Handles IG @itsclaudiaparada https://www.instagram.com/itsclaudiaparada/ website www.claudiaparadaenergy.com
Gratitude does not have to be challenging! In this episode we discuss ways to challenge yourself and others to get in the gratitude mindset. We have been focusing gratitude on our blog and on the Feed Your Soul with Kim Podcast. Gratitude is not just for Thanksgiving time, and it should be practiced the whole year. In our Feed Your Soul six component system: body, emotions, mental, lifestyle, mindfulness, and self-love- gratitude can bring positive outcomes in all areas. Join us on this weeks', Feed Your Soul with Kim Podcast we are looking at creating a gratitude challenge where you challenge yourself to experience more gratitude. In this podcast we will explore:Three different gratitude challenges. What is the benefit of bringing in more gratitude? Step by step plan on how to increase your gratitude- easily! Here is your access to the Gratitude eBook that I talk about in this podcast. Get it here: https://go.feedyoursoulunlimited.com/gratitude Have you taken the quiz? If not, get it NOW!Get the Am I an Emotional Eater Quiz that I mention in the podcast here. Emotional Eating Solutions- 8-week coursehttps://feedyoursoulunlimited.com/emotional-eating-solutions-self-study/ Check out last weeks podcast: Gratitude as a Practice How you can find Kim:https://feedyoursoulunlimited.com/https://www.youtube.com/channel/UCTuSnNrSDhLvbhxoTMXZgog Join us on Facebook in our Feed Your Soul Community: https://www.facebook.com/groups/1172488142887200/ Kim McLaughlin, MAKim McLaughlin is a licensed Marriage and Family Therapist, inspirational coach, speaker, and writer. She helps people who feel frustrated overwhelmed and overloaded, and it shows up in overeating. She has a Master of Arts Degree in Clinical Psychology. Kim is a certified Intuitive Eating Counselor, and she assists people to gain peace with food. We would love to get your feedback on this show and let us know what you would like to hear in upcoming shows. Email us at info@FeedYourSoulUnlimited.com Thank you for listening.Please be sure to leave a review for others to find us and share this podcast with a friend.https://feedyoursoulunlimited.com/feed-your-soul-with-kim-podcast/
What needs to be disclosed (e.g., having a colorful background, health problems, addictions)? When and by whom? How should we respond to shidduch inquiries when asked? Should references disclose everything? Can they lie? Are people typically lax in disclosing? Do certain segments of Judaism fail to disclose more than others? Can things be patched up when problems are discovered after marriage? ***Guest Hosted by Ari Wasserman *** Author of "Making it Work", "Making it ALL Work" (for women) and 10 other Seforim, Maggid Shiur, Yerushalayim with Rabbi Moshe Mordechai Lowy – Rav of the Agudas Yisrael of Toronto – 8:41 with Rabbi Daniel Stein – Rosh Yeshiva at REITS and Rav of The Ridniker Shteibel – 33:16 with Mrs. Elisheva Liss – Licensed Marriage and Family Therapist, Lecturer and Author – 1:00:07 with Dr. David Pelcovitz – Renowned Psychologist – 1:20:02 with Rabbi Daniel Travis – Rosh Kollel, Toras Chaim and prolific author – 1:32:40 מראי מקומות
A midlife divorce is one of those life transitions that can be really jarring, especially when you've been married for 20+ years. Many don't think it's possible to survive and thrive. My guest today is Debbie Goin. Debbie is a certified life coach and licensed Marriage and Family Therapist with over 20 years of experience. Learn more: https://suzyrosenstein.com/ep-229-how-to-survive-and-thrive-after-a-midlife-divorce-with-debbie-goin/
Leah Lopeteguy-Hoffman is a Licensed Marriage and Family Therapist and Licensed Professional Clinical Counselor who is passionate about people. As a jack of all trades, and ace of one, Leah has been able to utilize the knowledge and experiences gained from her employment within the service industry to work with diverse populations including senior and aging adults, students and families, spectrum disorders, law enforcement, and veterans. Leah currently works in private practice where she continues to engage with clients promoting positive change and compassion for all. Leah's most recent accomplishments include Certification in Eye Movement Desensitization and Reprocessing (EMDR) and becoming an EMDRIA approved EMDR Consultant in Training (CIT). Leah is a lover of learning and continues to expand her growth in the field of therapy for the benefit of those she serves. Leah holds a Master of Science in Counseling degree from University of Phoenix, Bachelor of Arts degree in Religious Studies from California State University of Bakersfield, and an Associate of Arts degree in Liberal Studies from Bakersfield College. She lives in Bakersfield, California with her charming husband, Patrick, their six children, and their cat, Gracie Lou Freebush. Kyle and Leah discuss the common misconceptions surrounding mental health and the barriers that prevent many from seeking professional help. They dive into Eye Movement Desensitization & Reprocessing (EMDR) Therapy and how it can significantly help those suffering from Post Traumatic Stress Disorder (PTSD). LEARN MORE ABOUT LEAH L. LOPETEGUY-HOFFMAN: Website: Simple_Practice Email: email@example.com Phone: 661-412-4291
Carrie is joined by Marriage and Family Therapist, Milton Jones of Access Nevada Therapy, whom she met on Tik Tok, for another episode of Everyday Mental Health. Carrie and Milton enjoy discussing tough topics, in their "keep it real" style and vulnerability in sharing, creating a learning experience for all, in a relatable manner. The conversation focuses on trauma and relationships and how to navigate these uncomfortable situations. You can follow Milton on Tik Tok @atalkspace where he is known for giving his followers a guided breathing mental health break. #mentalhealthmatters #trauma #relationships #hwcarepodcast #vulnerability #datingaftertrauma #therapy
Relationships take work - we all know that! But, sometimes doing the work is easier said than done especially when we don't always know what to do or how to do it. We need help! Our girlfriend guest Jewel Spencer, a marriage and family therapist with the Center of Relational Empowerment ("CORE"), is putting us on the right path to work on ourselves and our relationships! In this episode, Jewel shares with us: 1. How to make the most of your 1st couples therapy session, 2. The key to preparing for couples therapy, and 3. What to do to find your voice in therapy. Girl, you do not want to miss this conversation! You're Grown! You Got This! Our girlfriend guest Jewel Spencer is a Licensed Marriage and Family therapist with the Center of Relational Empowerment located in Chicago, Illinois. Her clinical areas include communication issues with couples and families, infidelity, substance use, and adults in transition. Jewel is passionate about working with women of color, Black women in particular. Jewel's practice is sex positive, LGTBQ+ and Kink -affirming. Jewel is a firm believer in that, by building oneself, you contribute to the building of strong relationships and strong families. Her passions are to help her clients grow their self-esteem, become better listeners and communicators, and stronger teams. To learn more about Jewel Spencer, please check her out at www.core-chicago.com. Please be sure to subscribe to this podcast and follow us on Instagram @growngirldivorce!
A Winning Cup: http://awinningcup.weebly.com. Please donate to Ask Win by going to Payment Venmo Win1195 at https://venmo.com/. Win Kelly Charles' Books: https://www.amazon.com/Win-Kelly-Charles/e/B009VNJEKE/ref=dp_byline_cont_book_1. Win Kelly Charles' MONAT: https://wincharles.mymonat.com. On A Winning Cup today (Monday, November 29, 2021), Best-Selling Author, Win C welcomes Shari Foos. Shari is a licensed Marriage and Family Therapist who holds a Master of Arts in Clinical Psychology from Antioch University Los Angeles, and a Master of Science in Narrative Medicine from Columbia University. As a sought-after expert on the subjects of relationships and meaningful connection, Shari's writing and commentary have appeared in a range of online and print publications, including Real Simple, Huffington Post, Thrive, Shondaland, Women's Health, and Bustle. To learn more about Shari visit www.TheNarrativeMethod.org.
Jill Phillips is a singer-songwriter and the star of the Gullahorn Happy Hour along with her husband, Andy Gullahorn. She's also a Marriage and Family Therapist. Jill will soon be releasing a new album called Deeper Into Love, a collection of songs that take a journey through grief, healing, and redemption. In this episode, Jill and Jonathan talk about the gap between the truth and how it feels, integration and disintegration, and going boldly into the house of grief. Support the show: https://therabbitroom.givingfuel.com/member See omnystudio.com/listener for privacy information.
David is back! We dive deep into the world of relationships and explore some of the underlying causes of why relationships end and how to foster a long-lasting, healthy relationship.
How to Be Accessible Beyond the Sliding Scale An interview with Lindsay Bryan-Podvin, LMSW, about how therapy can be accessible (and not just financially). Curt and Katie chat with Lindsay about capitalism versus money exchange, the social enterprise model, and how therapists can make a good living without feeling like greedy capitalists. We also explore the many different types of accessibility and the importance of setting your fees based on your needs and values rather than as a mechanism to single-handedly fix the broken system or to meet an artificial money goal. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Lindsay Bryan-Podvin, LMSW, Mind Money Balance Lindsay Bryan-Podvin (she/her) is a biracial financial therapist, speaker, and author of the book "The Financial Anxiety Solution." In her therapy practice, Mind Money Balance, she uses shame-free financial therapy to help people get their minds and money in balance. She's expanded her services to help private practice therapists with their money mindset, sustainable pricing, and authentic marketing so they can include financial self-care in their work. She lives with her partner and their dog on the traditional land of the Fox, Peoria, Potawatomi, and Anishinabewaki peoples also known as Michigan. In this episode we talk about: How therapy can be more accessible (and not just monetarily) The money “shit” that gets in the way of us thinking about other options for accessibility Decreasing stigma and the notion that therapy is by and for white folks Are we making our practices accessible for all sorts of folks? ADA compliance, supporting neurodivergent and disabled folks Cultural competence, the ability to apply that in sessions with clients who are different than us Being embedded in our communities Taking therapy out of the shadows The challenges in getting out and having a larger voice How accessibility is intertwined with therapist visibility How to become part of your community in effective and impactful ways Financial ways to make your practice more accessible beyond sliding scale Social Enterprise Model: intersection of what you do well, what values you stand for, and what can you get paid well to do Feeling like a greedy capitalist What it means to be paid well How to think about setting your fees Fee-setting based on what you need to survive and thrive (not capitalist principles) The problem with “know your worth” The big cognitive shift required to move from community mental health pricing and work-life balance, fees Tying money to quality of life, not specific monetary goals Getting to “enough” not more and more Capitalism versus money exchange The wealth of knowledge we have as therapists (and how therapists take it for granted and/or devalue it) Sharing your knowledge as a mechanism of accessibility to your whole community To practice self-care, you have to be able to afford it Our Generous Sponsor: Trauma Therapist Network Trauma is highly prevalent in mental health client populations and people are looking for therapists with specialized training and experience in trauma, but they often don't know where to start. If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There are so many types of trauma and so many different ways to heal. That's why Laura Reagan, LCSW-C created Trauma Therapist Network. Trauma Therapist Network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work and what they specialize in, so potential clients can find them. Trauma Therapist Network therapist profiles include the types of trauma specialized in, populations served and therapy methods used, making it easier for potential clients to find the right therapist who can help them. The Network is more than a directory, though. It's a community. All members are invited to attend community meetings to connect, consult and network with colleagues around the country. Join our growing community of trauma therapists and get 20% off your first month using the promo code: MTSG20 at www.traumatherapistnetwork.com. Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! www.mindmoneybalance.com https://www.instagram.com/mindmoneybalance/ Lindsay's podcast: Mind Money Balance Relevant Episodes: Lindsay's previous podcast episode: Financial Therapy Katie Read: Therapists Shaming Therapists Negotiating Sliding Scale Making Access More Affordable Asking for Money Reimagining Therapy Reimagined Connect with us! Our Facebook Group – The Modern Therapists Group Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript (Autogenerated) Curt Widhalm 00:00 This episode is sponsored by trauma therapist network. Katie Vernoy 00:04 Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit traumatherapistnetwork.com to learn more, Curt Widhalm 00:27 listen at the end of the episode for more about the trauma therapist network. Announcer 00:31 You're listening to the Modern Therapist's Survival Guide, where therapists live, breed and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 00:47 Welcome back modern therapists. This is the modern therapist Survival Guide. I'm Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists about things that we do things that we don't do things that maybe we should do. And both Katie and our guests today are looking at me like, where is this going? And honestly, this is just one of those rambling intros that we have. So rather than making this more awkward, we're joined once again by Lindsey Bryan Podvin. She's been a guest to the show before spoken at therapy reimagined with us, talking to us about money and ways that we could be looking at it for our practice. So thank you for joining us again. Lindsay Bryan-Podvin 01:35 Oh, yeah, I'm really happy to be here. This is my favorite thing to chat about, and to be in community with you guys. Again, it's fun. Katie Vernoy 01:43 Oh, we're so glad to have you back. And we'll definitely link to your previous episode in our show notes. But for folks who haven't heard from you for a while, or for our new listeners, tell us who you are and what you're putting out into the world. Lindsay Bryan-Podvin 01:57 Yeah, so as Curt mentioned, my name is Lindsay Bryan-Podvin. I'm a social worker, and financial therapist, and I have kind of two arms of what I'm putting out there into the world, I have my clinical arm, and then I have my consulting arm. So in my clinical world, I'm doing financial therapy, which is helping clients with the emotional and psychological side of money, which spoiler alert is all of it, I think. And then, on the consulting side, I know you all know that therapists have money, shit, and we have a lot of hang ups about it. And so in my consulting arm, I help mostly other therapists, though, over the past year, I'll say that other kind of helping professionals have woven their way in, whether it's dietitians, acupuncturist, Reiki healers, because I think a lot of us get similar messaging about what money is and what it isn't. And so I help them work on their emotional and psychological relationship with money so they can have sustainable and profitable businesses. And I do, like outside of the the hands on work, or the zoom work, I suppose I have a podcast and Instagram, a pretty active blog and an email list that keeps me using my creative side of my brain. Katie Vernoy 03:13 Nice. I love it. Curt Widhalm 03:15 One of the big discussions that's been in the social justice aspects of our field, especially for private practitioners, and admittedly also here on our show, is talking about things like accessibility and being able to make our services go beyond just those top paying cash pay clients. Can you walk us through kind of what you hear in these discussions about accessibility for practices, and especially as it relates to some of these monetary issues? Lindsay Bryan-Podvin 03:50 Yeah, I think as therapists we get really stuck on accessibility being only a monetary issue. So we think about solving for that problem by sliding our scale or by offering pro bono spaces. But we forget about all the other ways in which we can and should be accessible if that works in alignment with us. So as I think you guys were talking with Katie read about like the the the money talk that comes up on therapists forums and how there's so much guilt and shame and, and judgment about what people do or don't do, whether they do or don't take insurance, whether they do or don't slide their scale, but that's where most of us get stuck. And there are so many things beyond sliding our scale and the fee that we charge that can bring about accessibility for our practices and in our communities. Katie Vernoy 04:45 What are some of the things that we can think about beyond sliding scale because I think I get stuck there as well with and maybe this is just our focus is that we're so focused on the monetary aspects and our own money shit as you described it, and We aren't thinking about what else isn't making us accessible. Lindsay Bryan-Podvin 05:03 Yeah, I think taking a few steps back before a client even finds our website or finds us on a therapist directory, really thinking about how can we make our field more accessible by talking about what is therapy, I think in a lot of communities, we still have these stigmas that therapy is buy in for white people. And it's done on a couch with, you know, a person who's got reinforced elbows and they're smoking a pipe, right? You know, like, we have that imagery. And if we are not talking to our communities about what therapy is and who it is for, and how it can be helpful by not just talking about what it is, but also the stigma reduction, we don't even get people landing on our websites or knocking on our, you know, figurative door, right. So being in our communities and talking about what it is and who it's for, and how it can be helpful. And also talking about just the ins and outs of therapy, that it is confidential. I think in a lot of communities, there's a fear that if I go to a therapist, then you know, my mom's cousins going to find out about it, or that my employer will be told about it, or that my partner will be told about it. So I think there's some education that has to happen on the backend before people even get to our doors. And then in terms of other measures of accessibility outside of this scale. Let's get really granular on on what is accessibility? Do our clients see themselves reflected in the way that we practice therapy? Can clients who have disabilities, either neurodiversity or physical limitations, do they have actual access to our offices? Are they ADA compliant? Do we offer you know, nowadays, so many of us offer basically zoom therapy? Which makes it so much more accessible? Are we operating on bus routes and public transportation? Is there easy parking, like the literal accessibility piece? And then the cultural competency piece? Can they speak my language? If I don't speak English? Do I have somebody sitting across from me in the therapy room? Who gets what I'm talking about? When we talk about cultural competence? Not just thinking about, you know, whether or not you took a class on Southeast Asian Studies. But what does that mean? And how does that show up in our spaces, and being embedded in our community beyond just like, hiding in this little bubble, where we're kind of shrouded in mystery, I think, taking therapy out of the shadows and making it more commonplace in our communities, like we are healers in our communities. And we shouldn't be hiding behind the walls of like mystery what when there are community events, I would love to see more therapists out and they're out and about, as sponsors, as networkers and things like that, like, we also have to take ourselves out of the shadow. So there's, there's a lot of different ways we can talk about accessibility. Curt Widhalm 07:59 So I love what you're saying, I completely agree with getting out there. There's some some stumbling steps that can happen in putting ourselves out there, because so much of our history is in being shrouded to the, you know, the shadows. And sometimes the responses that I hear from clinicians is, oh, that person went out and was talking about this, but didn't represent themselves. Well, it isn't representing the field. Well, do you have any advice as far as taking some of these steps? You know, look at you, and all of the things that you post in your newsletters and social media and this kind of stuff, money seems to be kind of like a fairly neutral ground as far as being able to talk about relationships with money. For those who are looking to maybe take some other steps as far as making this accessibility happen, that might be around more unique issues to communities. Do you have any suggestions on how people might find the confidence to be able to make those steps? Lindsay Bryan-Podvin 09:03 Yeah, I really like this question. Because I think that accessibility and visibility are are intertwined. And visibility isn't just social media. So let's say you do want to be more accessible in your community and you do want to be more visible in your community, but you're talking about something that is more sensitive, like you know, sexual trauma, then yeah, maybe going on in doing an Instagram live about it isn't probably the most appropriate way because you don't know who's on the other side of it, you really can't create a container of people to make sure that it's safer or at least safer. So maybe in that instance, it's going to, you know, a high school and pulling a you know, having a group of 30 kids that you are talking to about this in like a speaking engagement setting or maybe it is going to the healthcare system and sitting down and talking to the medical social workers about what you know, or to the nurse midwives about what you know, right there. Different ways to get out and become a part of the community that don't involve these kind of one way one sided communication methods. Does that make sense? Katie Vernoy 10:11 It does, I think this idea of making the whole profession more accessible to folks and all folks, and not just the kind of historical white people and the, the, the patches and the pipes. I think that to me is, it's really, really important. And I think it also is only a first step. Because when they get to our door is there still is I think, you know, financial accessibility concerns for a lot of folks. And so are there financial ways to be accessible that don't involve involves sliding your scale? Lindsay Bryan-Podvin 10:48 Yeah, of course. So, undoubtedly, money is a real accessibility issue. I'm not just saying like, Oh, you know, just get out there. That's it sounds it? All. Right, exactly. Exactly. An email newsletter is not going to fix accessibility. But as you guys have also talked about on this podcast, it's not the responsibility of an individual therapist, to fix the broken medical system salute here. And at the same time, there are more creative ways to provide services to people in your community that are might be easier on their pocketbooks. So group therapy is also a really great option, because you as the clinician are still generating the revenue that you need to, and the people on the other side are usually paying you less dollars per session. Insurance, I know there's a big again, it's not your job to accept insurance if they don't reimburse you well, but accepting insurance is a measure of accessibility. And even if you aren't accepting insurance, helping your clients out, walking them through what a super bill is, you know, spending a little bit of time in session, making sure that they know what that means and how to actually get it done. That, to me is incredibly helpful. So providing a bit of space in the in the session to talk through how you can do that, particularly if they have anxiety, or they've got some ADHD, you know, they might need a little extra hand holding to get those things done. There are depending on your licensing board, I've seen some people do sponsored therapy spot. So it's a little bit different than a pro bono. It's Think of it like a scholarship for therapy. So the way that I've seen this work is for clients who pay a full fee, you essentially tell them look by you paying a full fee, a portion of your fee goes towards sponsoring somebody who would not be able to afford therapy with me. So you're still getting income, but you're also having the clients who are able to pay your fee, kind of some buy in that they are also kind of helping out other people in the community. So those are some different ways to be accessible, that don't involve sliding your scale doesn't mean you have to do all or any of them. It's just different ways to think about it. Curt Widhalm 13:04 On of the things that you talked about in your presentation at the therapy reimagined conference, this social enterprise. Lindsay Bryan-Podvin 13:12 Yes. Curt Widhalm 13:14 Can you tell us more about that, what it means for people who maybe didn't attend the conference and what the social enterprise model is and how this might fit in for therapists? Lindsay Bryan-Podvin 13:24 Yeah, I think so many therapists struggle with this idea of charging for services because we've internalized so many things about what money is or what it isn't. And the social enterprise model essentially says, look, there are three things to provide something that you can feel good about doing. And also know that you are being compensated fairly for it. And it exists at the intersection of these three things. One, what do you do well, what values do you stand for? And what can you be paid? Well to do, and as therapists I think, if we can think about ourselves at the intersection of that, of existing, and I do this really well, these are in alignment with my values, this type of therapeutic intervention is in alignment with my values, and I can be paid well to do that. You know, that you are contributing to the greater good of the community by making sure that you're not just wringing out your clients for the most dollars you can get right? I think so many of us think that if I charge money, then I'm a greedy capitalist, but it's also about am I being compensated for the skills that I offer and the transformations that I'm able to help facilitate in a meaningful way? Katie Vernoy 14:41 I know that there are a lot of different perspectives on how you decide how much money to wring out of your client. And, and and you mentioned the episode with Katie Read and we've had other conversations as well, just about the shoulds. And you know, how I should set my fees and those types of things. Yeah, and to me, it feels like there's so much nuance. It's it's a wide open space, there's a lot of shit. So people feel like it's not wide open, but I feel like it really is. What advice do you have on on setting those fees? Because when we're in that space where I can be paid well for it, it's aligned with my values, and I can do it well, like, it can be hard to figure out like, and what does being paid? Well mean, that I can feel good about? Lindsay Bryan-Podvin 15:30 Yeah. And I think that's such a good question. Because this idea of what does it mean to be paid? Well, is so skewed in our field, my first job, I was making $32,000, you know, with a master's degree, and I don't think that's an unfamiliar number or salary for people to hear. And so when a lot of people go into private practice, they hold themselves to that standard, oh, well, I was making 40k or 50k. I think that's a reasonable salary. I think that's what I'll try to make. So we haven't thought beyond what do we actually need to survive and thrive. And that's where doing things in alignment with your values can be really beneficial. So when it comes to fi setting, you're not just thinking about what are you charging your clients? You're also thinking about? Does that fee sustain me and allow me to practice financial self care? Which means Can I take care of my financial needs? Yes, but do Am I also able to support my mental, my emotional and my spiritual self. With that? I know, I was, I was loving your episode on burnout. And I love the modeling that the two of you did by saying, Look, we're going to hit pause on the therapy reimagine conference, we also have to build in time off and time for restoration, there is a study that says we need, I think, oh, shoot, I'm going to botch it. Now. I think it's eight or 10 consecutive days off in a row to actually unplug from work. So making sure that you have that built in to your time off. So making sure it covers your time off making sure it covers your health insurance. Unfortunately, we live in a society where your healthcare is tied with your employment. So when you're self employed, you have to make sure that you can cover your health insurance, you have to also make sure that you're thinking about your future self in traditional employment, we often have access to retirement plans or programs. And when we move into entrepreneurship, we are our own 401k or four, three B plan. So we have to make sure that all of those things are taken into account. And we don't want to be overworking ourselves. When we show up exhausted and burnt out and watching the clock, we are not being good clinicians we just aren't. And just taking stock of our own energy, my full pre pandemic was 18, I could comfortably see 18 clients a week that felt like a good fit for me, I wasn't burnt out, I wasn't presenting my clients, I had downtime to get the things done, I needed to do and I charged accordingly. Now, my max is 12. I have found that doing zoom therapy. While there are so many advantages of it, like I genuinely really like it, I find that literally the physicality of sitting still and staring at my screen and just what really watching so much harder for nuances through the screen takes so much more energy out of me and I can no longer comfortably and competently feel like I'm a good practitioner when I'm seeing 18 clients when I've had to scale that back to 12. And then what do I have to do to make up for that income? So that was a long answer of saying it depends. You have to figure out what money you need to be bringing in and you need to make sure that you're not just thinking about comparing it to what you use to earn an agency job because you were likely being underpaid there. Katie Vernoy 18:47 It's hard not to feel like a greedy capitalist. With that it means you have to charge a premium fee mostly Lindsay Bryan-Podvin 18:56 Yeah, yeah. Curt Widhalm 18:59 Give me advice for people making that jump to those premium price because I'm sure that there's a lot of our listeners who might be considering leaving an agency job and being like, you know, I know you know my session value in this agency and this aligns maybe with my values but in going out and charging somebody three four or five times that fee in order to meet my money goals seems like it has a lot of opportunity to bring up some that imposter syndrome and really being able to balance that for those individuals you have any guidance on what to really look at hopefully beyond just kind of know your worth. Lindsay Bryan-Podvin 19:43 Yeah. Oh my god. Thank you for saying that because also the Know your worth thing. That's a trope I used to find myself repeating. And then a friend of mine who's a behavioral economist, she shared with me Jaquette Timmons and she's goes Lindsay You have to stop saying that because we as humans We don't have a worth. So instead, she invited me to reframe it as charged the value of what your services are worth to give yourself a little bit of psychic distance there between like, I'm worth $300. Now it's like no, the value of my services are worth $300 an hour. So anyway, tangent aside, how can you come into charging fees for your services, I think there is a pendulum swing that I see happen when people try to get out of the mentality of sliding their scale as low as possible to charging premium fees. And so they go from being in spaces where being a good therapist means charging very little into spaces that are like, You need to be a six, seven figure business owner, and you need to be charging premium fees, which can be as we know, a big jump cognitively. And so I always invite people to come back to your values, your lifestyle needs, your unique financial goals. And I'm not about bashing the people who are saying, Oh, you need to make six figures or seven figures. My practice does generate six figures. But I don't think that is a magical goalposts where all your problems are suddenly solved. I think this chase this money charge, the premium fees, you have to work more can backfire. In that it forces us to work more meaning when you have that mentality of I have to work harder, I have to chase this x figure goal or this premium fee number. What happens often is you get into this space where I'll just use myself for an example that that 12 clients Oh, I saw 12 clients a week, I made enough money to hit my goals. I started to cultivate work life balance. But now what if I saw twice as many people, I could make twice as much money? What could I do it twice as much money. And then all of a sudden you forget about why you did it in the first place. So coming back to how much do I need? How much do I desire and is the money that I'm charging, allowing me to do things in alignment with my values, let's say family is like the most important value to me. And I want my 10 consecutive days off in a row with my family. And I want to go somewhere where I don't have to worry about you know, finding activities for us to do or cooking a bunch of food, I want to make sure that I have enough money to pay for that Airbnb to pay for takeout and that Airbnb is conveniently located to a lot of like outdoor activities. That's a goal that I can kind of reverse engineer my way. And to me, it's also modeling for your clients, you don't necessarily have to say to your client, like, Oh, my financial goal was this, this and this, and I was able to achieve it. But you're also modeling for your clients the importance of taking time off of adhering to your boundaries and practicing self care. So again, that's a tangent of an answer. But I guess the long and short of it is as you move towards charging premium fees come back to like, what your WHY IS, and when you feel that anxiety to work more and charge more and go harder, you actually may already have enough. Katie Vernoy 23:02 I like that I think the piece that resonates for me is this, the letting go of I must get to this number, I must make more money. And I think for me, there's also this big push of like we must leverage we must, we must continue to grow and expand. And I think there's a point at which we have enough I mean, there, there may still be challenges that we need to do. But there's this, this freedom and not having to constantly grow and, and make my business bigger and make my business more successful. Like there's each person has to decide where they land or where they land for a time and you know, different seasons of what I need and what I want and what's most important to me, but it feels like it and this is kind of circling back to the the social enterprise model and kind of this idea of capitalism versus money exchange and, you know, clarifying all of that, but but it seems like when it's completely tied to values, what you're positing is that feels better than just making money for money's sake. And so, so tell us a little bit more about this. Because to me, I feel like I'm just starting to grasp the idea I was I was too caught up in the greedy capitalism, to understand kind of what what we were what we were starting to talk about with a social enterprise model. Lindsay Bryan-Podvin 24:24 Yeah. So to bounce off of this idea of what is the difference between capitalism and money exchange? I think it's important to note that capitalism is a is a political economic system that we we know the dangers of right it is propped up by the unpaid and underpaid labor. So the person or people who are in charge, get the greatest amount of profit available. And as such, as we kind of touched on earlier, it's a system where we give all the praise to the people who Make a lot of money because they must have worked hard and simultaneously shamed the people who didn't make a lot of money because they must have not been hard workers. And we've we bought into that idea as a society so much so that you know, at the time that we're recording this, if you're on Twitter right now, you can see people rallying around Elon Musk saying like, yeah, he shouldn't have to pay taxes, he worked really hard. So we've got all these people saying, like, yeah, we save the billionaires instead of let's make sure we have a safety net that people can't fall through for the greater good of our society. So that's capitalism. And there's a lot of problems with it. And even if you disagree with it, unfortunately, we live in that society. Yeah. And money exchange, on the other hand has been around since the dawn of time, whether it was literal dollars or coins, there has always been an exchange of things for other things, or things or other services. And when we think about small business owners, which is most private practice owners, if we can think about ourselves as kind of the community farmstand, it helps to shift that mentality. So for example, if I go down to the farmers market, and I purchased a half a dozen eggs, I'm helping to support sustainable agriculture in my community, I get to know the person who grew my crew, my eggs, I don't think we're growing eggs, but you don't I mean, maybe if you're vegan, actually, you're growing your eggs. So you're growing your eggs substitutes? Got it? So we want to think about as therapists, how can we kind of fit into that model, where what we do in charging for services, and helping people in our community is a win win. Because when we have a healthier person in our community, because we are helping them with their mental health, what is that ripple effect on the community? And how can that be beneficial? Curt Widhalm 26:57 It sounds like, you know, this is what a lot of practitioners do by going out into the community and sharing even some of the things that you were talking about at the top of the episode of just going and talking about mental health and about their practices and doing some, I guess, pro bono work and in the way of psychoeducation, or community education that helps to make that Win Win happen. Lindsay Bryan-Podvin 27:25 Yeah. Yeah, absolutely. I think it's so so powerful. I think when we are in our spaces where we're surrounded by other mental health, folks, we forget what the baseline is of mental health knowledge. Oh, yeah, forget, just like what a wealth of information we have, like the other day, I did a presentation for non mental health care providers about what financial anxiety is, and tips to cope with it right. And for anybody in the therapy field, they'd be like, that's like, entry level CBT, maybe if you're lucky. But for this group of people, it wasn't that they don't, it's just we forget how much knowledge we have, and how valuable explaining some basics of how our minds and bodies and thoughts are connected, can be a huge value for other people in our community. So just don't take what your knowledge is for granted. Get out of your academic kind of echo chambers and go talk to people who aren't in the mental health care field. And that is really where you can offer a lot of wisdom and value in your community. Curt Widhalm 28:33 So once again, echoing stop hanging out with therapists. Lindsay Bryan-Podvin 28:41 That might be a theme. Yeah. Katie Vernoy 28:44 Maybe it's stopped just hanging out with therapists Lindsay Bryan-Podvin 28:47 That's a good reframe Katie Katie Vernoy 28:49 I know, I just it's really hard. I know, for me, and we've all spoken for therapists, we've all kind of done that thing. And I'm sure, just from the way you described it, Lindsay, you've got the thing. Like, that was a really nice reminder. And like, it is so dismissive. When a therapist comes up and says that to you, you're like, Yeah, but why did you need that reminder? You know, so I think it's that piece of when you start talking to folks who are not therapists, you recognize this is really important information. And it's not going to be discarded as Oh, I already knew that because it is this new piece that's coming in, that then allows, and this is, I guess, going to do accessibility thing. It allows this information to be disseminated more widely widely. It's something where they then are able to implement it, and maybe some people wouldn't need therapy if this information are readily available and was there first and so I think I'm putting the pieces together, Lindsay, I'm starting to see but it's it's really sharing the knowledge. It's making sure that you're available and that you've set up a fee system that makes sense for the folks that you're Working with but it's, it's this additional piece of you know, maybe you get creative and you do sponsorships or I mean there's people that have whole mechanisms for nonprofits to donate for, for scholarships for therapy. So I, there's, there's so much creativity that doesn't require an individual to slide their scale to an unsustainable fee. But this notion of just be accessible for all with all of these other pieces, I think is is hard to do. If you're not making enough money to survive, and you're seeing 40 clients a week, Lindsay Bryan-Podvin 30:33 Ding ding ding that is exactly it. We cannot care for other people in our community when we don't take care of ourselves. And it's, you know, we hammer on this message as therapists but we forget that in order to practice self care, we need to be able to fucking afford it. Like we just do. Katie Vernoy 30:48 Yeah, exactly. Curt Widhalm 30:52 And it's not just kind of the big luxurious, affording things like yeah, you know, that eight to 10 days, go and do a vacation if that's your jam, but it's also being able to afford the consistent little things of and you know, it's going home at a decent time of night. It's being you know, not spending your your off hours catching up on notes, or it's having all of the other systems and everything else that we've talked about on this podcast of being able to have the convenience of being able to afford shutting off at each and every day. Lindsay Bryan-Podvin 31:30 Yeah, absolutely in in those are the things that we know, make. The biggest difference is that consistency and that predictability, that predictability that you can power down the predictability that you can pay your bills that helps to give us that mental space to rest and to be safe. Katie Vernoy 31:51 Where can people find you? Lindsay Bryan-Podvin 31:53 My website is called Mind money balance. It's the same name as my practice. My podcast is of the same name. My Instagram handle is of the same name so people can find me on any of those places. Curt Widhalm 32:08 And we'll include links to Lindsay's stuff in our show notes. You can find those over at MCSG podcast calm and also follow us on our social media and join our Facebook group, the modern therapist group. And until next time, I'm Curt Widhalm with Katie Vernoy And Lindsey Bryan-Podvin. Katie Vernoy 32:26 Thanks again to our sponsor, trauma therapist network. Curt Widhalm 32:30 If you've ever looked for a trauma therapist, you can know it can be hard to discern who knows what and whether or not they're the right fit for you. There's so many types of trauma and so many different ways to heal. That's why Laura Reagan LCSW WC created trauma therapist network. Trauma therapist network therapist profiles include the types of traumas specialized in population served therapy methods used, making it easier for potential clients to find the right therapist who can help them. Network is more than a directory though it's a community. All members are invited to attend community meetings to connect, consults, and network with colleagues around the country. Katie Vernoy 33:07 Join the growing community of trauma therapists and get 20% off your first month using the promo code MTSG 20 at traumatherapistnetwork.com Once again that's capital MTS G the number 20 at Trauma therapist network.com Announcer 33:23 Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
The Dr. John Delony Show is a caller-driven show that offers real people a chance to be heard as they struggle with relationship issues and mental health challenges. Let us know what's going on by leaving a voicemail at 844.693.3291 or visiting johndelony.com/show. We decided we're done having kids and I'm grieving the end of this chapter of our lives John talks to BetterHelp Licensed Marriage and Family Therapist, Haesue Jo MA, LMFT I don't feel as close to one of my sons as I do with the other I'm concerned my husband's phone usage is affecting our kids and our marriage Lyrics of the Day: "Perfect Blue Endings" - Counting Crows Support Our Sponsors: BetterHelp DreamCloud Churchill Mortgage Resources: Questions for Humans Conversation Cards Redefining Anxiety Quick Read John's Free Guided Meditation Listen to all The Ramsey Network podcasts anytime, anywhere in our app. Download at: https://apple.co/3eN8jNq These platforms contain content, including information provided by guests, that is intended for informational and entertainment purposes only. The content is not intended to replace or substitute for any professional medical, counseling, therapeutic, financial, legal, or other advice. The Lampo Group, LLC d/b/a Ramsey Solutions as well as its affiliates and subsidiaries (including their respective employees, agents and representatives) make no representations or warranties concerning the content and expressly disclaim any and all liability concerning the content including any treatment or action taken by any person following the information offered or provided within or through this show. If you have specific concerns or a situation in which you require professional advice, you should consult with an appropriately trained and qualified professional expert and specialist. If you are having a health or mental health emergency, please call 9-1-1 immediately.
Modern relationships face some pretty unique challenges, and sometimes it seems like those challenges are only growing. Thankfully, there are people out there like Liz Earnshaw! This was such an enjoyable discussion, and we go heavy on modern dating and marriage problems, "pathologizing" your partner, the shifting meaning of things like marriage and partnership, the need for flexibility, even the changes in gender roles. If you're with someone currently, dive in together! Over the last decade, Elizabeth Earnshaw, LMFT has become one of today's most trusted relationship teachers. Elizabeth is a Licensed Marriage and Family Therapist and Clinical Fellow of The American Association of Marriage & Family Therapy. She is the Head Therapist at Actually, where she is working to make relational wellness mainstream & accessible. She also owns A Better Life Therapy in Pennsylvania & New Jersey, where she supports clinicians who are helping couples every day. She trains and supervises therapists as an Approved AAMFT Supervisor. In addition to making couples therapy more accessible, she is the author of “I Want This To Work”. Elizabeth is also the host of Hash it Out on Good Risings where she offers advice to everyday relational conundrums. She is frequently asked to talk about relationships with media outlets like Mind Body Green and The Huffington Post and has been featured on numerous podcasts. Connect with Liz -Website: https://www.elizabethearnshaw.com/ -Instagram: https://www.instagram.com/lizlistens/ -Facebook: https://www.facebook.com/lizlistens -Book; I Want This To Work: An Inclusive Guide to Navigating the Most Difficult Relationship Issues We Face in the Modern Age: https://amzn.to/3lh0T7W Did you enjoy the podcast? If so, please leave us a review on Apple Podcasts, Stitcher, or Podchaser. It helps us get into the ears of new listeners, expand the ManTalks Community, and help others find the self-leadership they're looking for. Are you looking to find purpose, navigate transition, or fix your relationships, all with a powerful group of men from around the world? Check out The Alliance and join me today. Check out our Facebook Page or the Men's community. Subscribe on Apple Podcasts | Google Podcasts | Spotify For more episodes visit us at ManTalks.com | Facebook | Instagram | Twitter Editing & Mixing by: Aaron The Tech See omnystudio.com/listener for privacy information.
Gelly Asovski, LCSW-R RPT-S is a mother, grandmother and Yiddish speaking Child and Family Therapist practicing in Monsey, NY for the past 20 years. She s a Registered Play Therapy Supervisor and EMDR Consultant, bringing the best of cutting edge therapy to the frum community. In addition to her private practice, Asovski runs her parenting program, Playful Parenting, both as a 6 week heimishe telecourse and as an online yearlong program.She enjoys being a grandmother and loves reading, learning, traveling and having fun time with family and friends. Find out more about her work at parentingwithgelly.com.
You may have heard about how sex + orgasms affect mental health, but what about when mental health affects sex? Depression affects so many people not only in the US, but globally. Especially since the start of the pandemic, we've seen the sexual health of individuals + couples alike struggling because of it. Sex therapist Nicoletta Heidegger is here to talk to us about the complications of depression + sexual desire, what medications could be doing to contribute, + how you can empower your own sexual + sensual pleasure to help. In this episode you'll hear: How does depression affect desire for sex in different people? What are symptoms of depression + how do they can manifest in life? Tips to support yourself or your partner in sex while experiencing symptoms of depression What medications for depression impact the libido + which ones do not Post Coital Dysphoria --the experience of sadness, anxiety, anger, depression after sex + what to do about it Treatments for depression + sex + what working with a sex therapist on these challenges looks like Struggles around sexual initiation + tips for having an effective conversation to support How sensual practices can be powerful strategies for improving your sex life. LINKS FROM THE SHOW www.yonipleasurepalace.com code: DRCAT for 10% off any order THE SKINNY ON OUR SEXY GUEST Nicoletta von Heidegger is a Licensed Marriage and Family Therapist and Sexologist (#110256) practicing in Los Angeles. Nicoletta received her BA in Psychology from Stanford University, her MA in Clinical Psychology from Pepperdine University, and her MEd in Human Sexuality from Widener University. Nicoletta is currently pursuing her PhD in Human Sexuality from Widener. In addition to seeing clients in private practice, Nicoletta also works as an EAGALA-certified equine assisted psychotherapist at Stand in Balance. Nicoletta believes in embodied practice and is certified in levels I and II of The Trauma Resiliency Model. When not working with clients, Nicoletta creates and hosts the growing hit podcast Sluts & Scholars and teaches educational seminars and classes to help others learn about sexual and mental health. In her self-care time, Nicoletta enjoys nature, biking, horse riding, her pit mix dog Stevie, and playing the drums in her band. You can find out more about Nicolettat at nicolettavheidegger.com WANT MORE? Start your journey to coming back home to your body + developing a sensual relationship. Grab my FREE Sensual Sundays Guide full of all my favorite products + Sunday ritual to reconnect with your pleasure once again. If you're desiring a deeper dive into the lifestyle of sensual pleasure, come join me for a 14 day initiation into Sensual Awakening. Learn the foundations of activating your pleasure senses, creating luxury without expense, + cultivating a lovership with your body, again. --- Send in a voice message: https://anchor.fm/eatplaysex/message
Carrie kicks off a series of conversations with Marriage and Family Therapist, Milton Jones of Access Nevada Therapy. The two met on Tik Tok and have enjoyed discussing “Everyday Mental Health” as it relates to trauma, relationships and more. You can follow Milton on Tik Tok @atalkspace #hwcarepodcast #mentalhealth #justbreathe #tiktok #mindfulness #trauma #therapy
Grammy nominations are out! What you need to know about this year's surprises and snubs. Plus, we break down Tori Spelling's new holiday card, which features all of her children and none of her husband. Then, family therapist, Dr. Laura Tejada shares tips for how to stay sane this holiday season. Learn more about your ad-choices at https://www.iheartpodcastnetwork.com
Peer Support Specialists An interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFT on what peer support specialists are and the value they bring to treatment teams, as well as the challenges and best practices in implementing these roles into clinical programs. Curt and Katie talk with Kemisha and Amparo about their experiences in these positions, exploring how their lived experiences created the successful integration of a more holistic approach to support clients. We also talked with Jeff about his journey in implementing one of these programs from scratch. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFT Kemisha Fields, MSW: Kemisha Fields was born and raised in South Los Angeles, CA. As a former foster youth, she has taken a professional interest in the commitment to serving the needs of children and families as a Children's Social Worker working in Dependency Investigations. She has studied many modalities to bring healing to those in need. Kemisha is a life, long learner inspired by the abundance of opportunities available to enrich the lives of the people she serves. She earned her Bachelor of Science Degree in Psychology from the University of Phoenix. She received her Master of Social Work degree from the University of Southern California. Currently, Kemisha is a Doctoral Student of Business Administration with an emphasis in organizational leadership. She has extensive experience working with children, families, and individuals as an agent of support and guidance. Kemisha has a strong background in case management for an array of populations inclusive to at-risk youth, individuals with intellectual disabilities, commercially sexual exploited children, victims of trauma, and families within the dependency system. As a lead Dependency Investigator with Los Angeles County Child and Family Services, she has direct practice with assessing for child abuse and neglect in hostile environments. Kemisha works directly with County Counsel to investigate and sustain infractions of the Child Welfare and Institutions Codes. Jeff Kashou, LMFT: Jeff Kashou, LMFT is a manager of clinical product and service design for a mental health tech company that provides telemedicine to those with serious mental illness. Previously, he ran a county mental health program where he helped develop the role fo peers for adolescent programs county-wide and collaborated with peers to create management practices to support their professional development. In this position, Jeff developed a practice guideline for the utilization of peers in behavioral health settings for the County of Orange. Jeff has also served on the Board of Directors for the California Association of Marriage and Family Therapists, where he helped lead the association to support the field of Marriage and Family Therapy and those with mental health issues. He consults as experts in mental health for television productions, to ensure the accurate and helpful portrayal of mental illness and treatment in the media. Most recently, Jeff and his wife Sheila wrote a children's book, The Proudest Color, that helps children of color cope with racism that will be on shelves this Fall. Amparo Ostojic, MPA: Amparo Ostojic is a mental health advocate with personal lived experience. After working for the federal government for ten years, she decided to pursue her passion in working as an advocate to help promote recovery in mental health. She has worked as a peer specialist for a mental health clinic as well as volunteered leading peer support groups. Amparo has a close connection with the Latino Community and feels it is her duty to do everything possible to prevent and reduce the suffering of individuals living with a mental health condition. Amparo created a Spanish speaking support group in East Los Angeles to offer free peer support to members of her community. Amparo has a bachelor's in business administration and a Master of Public administration. Amparo is a certified personal medicine coach and is working on becoming a National Certified Peer Specialist (NCPS). In this episode we talk about: What a peer support specialist is, how they work What peers can uniquely bring The hiring process, qualifications, and what that means for individuals seeking these jobs The difference in perspective that peer and parent partners can bring to treatment teams The importance of lived experience Comparing holistic versus medical model treatment The medical model and the recovery model complement each other The importance of advocacy for individuals (with the support of the peer support specialist) How peer support specialists are best integrated into treatment teams and programs The potential problems when the peer support specialist role is not understood How someone can become a Peer Support Specialist Certification and standardization of the peer support specialist role SB803 – CA certification for Peer Support Specialists Legislation Ideal training for these professionals How best to collaborate with a peer support specialist What it is like to implement one of these programs The challenges of hiring a peer support specialist Exploring whether there are systems in place to support peer support specialists with their unique needs The recommendation for a tool kit and a consultant to support programs in implementing best practices The Recovery Model and peer support specialists in practice Multidisciplinary teams may have pre-existing bias and prejudice against folks with lived experience, the role of stigma in the interactions The shift that happens when peers become part of the team (specifically related to gallows humor and the separation of “patients” and “providers”) Demonstrating the value of this role and the use of the recovery model Prevention and Early Intervention How to be successful with peer support programs and the benefits at many different levels Our Generous Sponsor: Trauma Therapist Network Trauma is highly prevalent in mental health client populations and people are looking for therapists with specialized training and experience in trauma, but they often don't know where to start. If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There are so many types of trauma and so many different ways to heal. That's why Laura Reagan, LCSW-C created Trauma Therapist Network. Trauma Therapist Network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work and what they specialize in, so potential clients can find them. Trauma Therapist Network therapist profiles include the types of trauma specialized in, populations served and therapy methods used, making it easier for potential clients to find the right therapist who can help them. The Network is more than a directory, though. It's a community. All members are invited to attend community meetings to connect, consult and network with colleagues around the country. Join our growing community of trauma therapists and get 20% off your first month using the promo code: MTSG20 at www.traumatherapistnetwork.com. Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! RAND Report: How to Transform the US Mental Health System Los Angeles Times Op-Ed: Our mental health laws are failing Wise U Training for Peers Advocacy through Cal Voices ACCESS Program SB-803 National Certified Peer Specialist NCPS Excellent guides and toolkits on how to integrate peers in clinics: Association of Home Social Rehabilitation Agencies Meaningful Roles for Peer Providers in Integrated Healthcare Toolkit Philadelphia Peer Support Tool Kit Relevant Episodes: Fixing Mental Healthcare in America Serious Mental Illness and Homelessness Psychiatric Crises in the Emergency Room Advocacy in the Wake of Looming Mental Healthcare Work Force Shortages Connect with us! Our Facebook Group – The Modern Therapists Group Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript (Autogenerated) Curt Widhalm 00:00 This episode is sponsored by Trauma Therapist Network. Katie Vernoy 00:04 Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit traumatherapistnetwork.com To learn more, Curt Widhalm 00:27 listen at the end of the episode for more about the trauma therapist network. Announcer 00:31 You're listening to the Modern Therapist Survival Guide, where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 00:47 Welcome back modern therapists. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is part four of our special series of fixing mental health care in America. And today, we are shining a spotlight on peer support specialists and the role that they have in our behavioral health care system. And a lot of the advantages that these kinds of roles bring in, as well as some of the difficulties of getting peer support implemented despite a lot of very positive evidence in their role in treating mental and emotional disorders that happen in our world. Katie Vernoy 01:27 I'm really excited about this particular episode, we've got two sections. The first one is we're joined by two folks who've worked in the peer support specialist role who are both still in social work and in advocacy. First off, we've got Kemisha Fields, who's a Master of Social Work who is was actually somebody I worked with, and she did a great job in one of the programs I was running. And then also person I was introduced to by one of our amazing friends of the show on Amparo Ostojic, who is an MPA and also someone who works in advocacy specifically about peer support specialists. So I'm really, really looking forward for all of you to listen to that and learn about what that role is. And we recognized also and I, I had a little bit of this, but Jeff Kashou LMFT is someone who has in the past actually implemented one of these programs, and he was able to talk with us about what it was like as a director, putting those things together. So take a listen. Kemisha Fields 02:30 So my name is Kemisha Fields. I enter social services call for like 17 years ago, I took a entry level position at a homeless shelter. So that was my entry into social services. And from there, I've just kind of progress and work my way up. And I've worked with different populations. So I've worked with the homeless population. I've worked with individuals who are struggling with substance abuse. I worked in recidivism. I've worked in community mental health, and now I'm working in the child welfare system. Amparo Ostojic 03:10 So my name is Amparo Ostojic. And I've been in mental health advocacy and peer support. For the last four years, I have worked to increase awareness about mental health, especially in the Latino community. And I worked as a peer support specialist for a mental health clinic for about seven months, I currently still do advocacy in the mental health space. And I work with individuals that want to know more about how to live, a quote unquote, normal life, even with my severe mental health condition. Curt Widhalm 03:50 A lot of mental health clinicians, they may have heard of a peer specialist. I have found that a lot of my travels and talks in therapist communities that many people don't know what a peer specialist does, can you help us understand what a peer specialist does what their role is in the bigger part of the treatment systems. Amparo Ostojic 04:13 So a peer specialist is basically a role model of positive recovery behaviors. So it's meant to give hope to someone living with a mental health condition and help them not feel as alone in this recovery process. So, in essence, a pure specialist will share their personal lived experience of mental health and oftentimes offer examples of what it's like to deal with a condition. And you know, what they've done to get better, such as tips or a really useful tool is, for example, the living successfully plan or the wrap plans, where you go over with a client what it is like to be in a healthy space, what it's like to see warning signs, and when it's time to call your psychiatrist or go to the hospital. So kind of teach them about themselves and guide them in their self determination of managing their their health condition. Katie Vernoy 05:17 So you're really talking about from a place of your own experience and knowledge helping someone to plan for themselves, Amparo Ostojic 05:26 right. And a lot of it is teaching them to self advocate for themselves, and put themselves in the driver's seat of their health condition. So for example, a lot of times, it's kind of directed from the top as if the psychiatrist or therapist is telling them what to do, or kind of teaching them what they should do. Whereas if your specialist is on the same level, and there's no sort of hierarchy of who knows more, there's a relationship of learning from each other, and really sharing what it's like to live through this. I was given the example where it's like, Is it someone that you want to work with, like someone that's like a biologist that knows about like the forest or something or someone that lives in the forest, because that personal lived experience is really key to understanding things that someone else that hasn't experienced them wouldn't really know, or perhaps hasn't dealt with. Curt Widhalm 06:26 When you started in this, you started as a parent partner, how was that process of getting hired? Kemisha Fields 06:34 So the qualification for a peer partner or parent partner would be a life experience in one of the systems of DCFS, Department of Children and Family Services, probation, and I believe education, like do individual education plan. And so my entry into being a parent partner was through my son's IEP, Individual Education Plan. And, you know, it just kind of happened by chance, a friend of mine recommended me for the position and I follow through with it, the interview process, or the application process, they I was asked what my qualification to being a parent partner, so I did have to disclose some important information regarding my own experiences with my son. And we just, I remember asking, like, anybody could have kind of said, like, oh, yeah, I have this child that has a special needs, like, how did they confirm that information? So I was looking for them to kind of want some sort of documentation from me, and they didn't. And so, at the time, the executive director says, usually confirmed based on the series of questions they asked me during the interview about different programs that may have been introduced to, to my son, which I found quite interesting, like, Okay, Katie Vernoy 08:07 how was it for you to disclose personal things to get a job, because that seems like that would be a pretty vulnerable way to enter into a position. Kemisha Fields 08:19 Very much so and because it's the opposite of what we've always been told, typically, in interviewing process, you don't share too much personal information, just your professional history. So it was a little different. But I always been transparent with my struggles with my son. So it was it was just a little different in I didn't know this person, but it was okay. I you know, I feel comfortable through the process. And I didn't, it was okay for me to, you know, share my experiences. Being a parent of a special needs child. Curt Widhalm 09:01 I have to imagine, and this is prior to being hired in this position. Did you have somebody serving in that kind of a role for you, somebody that you relied on while you were going through your child's IEP process and all of the struggles that that usually entails? Kemisha Fields 09:19 That is... I love that question. I absolutely love that question and Yes, but very informal. So I did not have a formal being like, Whoa, this is your parent partner, and she or he's going to help you through this process. What I have was professionals who kind of just stepped up I had one of the very first school psychologists who helped me through the process of my son's assessment, what to look for what questions that I should ask and she helped me not on a professional level but a personal level. She kind of walked me through that process. So I was grateful for that. So I've had a lot of support with my son, just from individuals who cared enough to show me what this looks like and what questions I should be asking. So I appreciate that. Curt Widhalm 10:20 I have to imagine that working with the mental health systems, the people in those roles, there has to be some difficulties in getting integrated into the more professional sides of the organizations, what kinds of challenges to peer specialists end up having, trying to help clients be able to advocate for themselves and fit into this professional system as well. Amparo Ostojic 10:45 The professionals, such a psychiatrist, therapist, they usually operate from the medical model, which is very top down, like I mentioned, and it kind of has this perspective that I no more in teaching the patient how to, you know, work with medications, or live with this condition, where as peer specialists work from the recovery model, that look at everything, the main four points are home, community health, and purpose, that's really important, like your reason to get up in the morning, right? That sometimes the recovery model is not taking us seriously, it's a more kind of holistic approach, looking at the person. And in the medical model, you're looking at the condition like it's a problem to be solved. And I'm looking at the person as the whole and how their whole life could be better. So my focus may be different than a psychiatrist, their focus may be to reduce the symptoms, and let's say get rid of hearing voices, things like that, or as my role is really to make that person as a whole better. So for example, I usually medications is a big thing must take medications, or as my role may not necessarily say that I typically never tell the client, you know, don't take medications, but I really allow the client to the side that and some other parts of the medical team may not like that. But also, my role may not be taken as seriously because, for example, in my experience working with a mental health clinic, they worked with people that were homeless, and I would say extreme cases. So as someone with bipolar disorder, they kind of put me in this category that, you know, I probably couldn't offer as much. And my perspective wasn't as valuable. So it was really hard. Working with therapists or psychiatrist that saw me as someone that was in the space of like, part of the problem. I don't know how to describe it. But it was really hard, because at the beginning, I definitely felt like I wasn't taking seriously. And it took a while to gain trust, and get there super for me clients. And those were one of the challenges, Curt Widhalm 13:01 I have to imagine some of the providers are like, you're just completely undermining all of the treatment by using trust, none of this professional experience that we've learned. How did those conversations go? Because it seems like so much of a treatment plan would be developed from, you know, the scientific and medical model sorts of approaches. And then for somebody to come in with lived experience to be able to be like, maybe the medication thing is something that you want to talk to your doctor about. Amparo Ostojic 13:33 Well, I take medication, and there was five years that I didn't from when I was 20 to 26. And I was fine. I think, you know, I used to run marathons, I was super fit. And there was a time that I didn't think I needed medication. But then having more episodes, I realized that it does benefit me. So I never really tell a client, don't take medication. But I'm not as I guess pushy into that they may need I needed something to happen for me to sort of learn my lesson and realize, you know, it's it's easier, my life is a little easier with medication. And that may not be the case for everybody. So I definitely don't think they see it as me undermining them. But the recovery model and the medical model are supposed to complement each other. And I think that's the hesitation at the beginning. There's no better treatment or a they say they're supposed to complement each other and offer a level of understanding and acceptance and validation that sometimes the professionals can't offer because they haven't lived through that. So for the most part, I'm never, you know, moving them away from medication or therapy and validating their experience but perhaps they may tell me, you know, I didn't like my psychiatrist. And this is what happened. And I will be honest and say I've had psychiatrist that didn't work with me and didn't work for me. And I had to find a different one. Or I had to advocate for myself and say, you know, this side effect is, is not working for me, you know, maybe this is working, like, the symptoms are, you know, improving. But, you know, it's, it's making me sleepy, and then I can't get to work on time, things that are important that sometimes I think clients are afraid to say, because, you know, like, the main symptom that they're after is maybe under control. But other aspects of your life have completely lost balance now. Katie Vernoy 15:42 Yeah, I think for me, and I was that person at one point. So Kemisha Fields 15:46 You were! Katie Vernoy 15:48 But I think the thing that felt very powerful when I entered into that program, and saw how it was set up was that the team had set up this structure to make sure that each member at the table was heard that each person was allowed to share ideas. I had been in other programs where folks were subjected to that hierarchy, where the therapist or the psychiatrist got the most air time, they're the ones that were making the decisions. And to me, I think, whether it was making sure that the parent partners were supervised by the director, and or really having a culture of, we are all here supporting the family. And we all equally bring important things to the table, I think it was really effective. I think we just get worried because I did see even with programs that were and maybe it was because it was intense now that I'm thinking about it, because like less intense programs, sometimes folks were using either parent partners or bachelor level providers to do like, copying and filing. And it's like, no, no, these are mental health providers, these are people who are at the table. And so to me, I think when when people are able to integrate into the team, it can be really good. Kemisha Fields 17:05 My personality type wouldn't have allow for that, if I'm honest. Like no. And I think when you come in and you kind of demand a level of respect, you get that level of respect. So I've never had a problem, I think, in my whole career of value, my experience as a parent partner, it laid the foundation for so much of the work that I do now. So I'm still connected to a lot of those colleagues, who at the time were clinicians and I, at that time, I wasn't even I had not completed my undergrad studies yet. And we're like the best of friends. So my experience as a parent partner is one that is really great. And had you know, a lot of good things have come out of that for me, Curt Widhalm 17:59 I want to change the conversation here a little bit to talking about how people can become peer specialists and what the certification process is like. And I understand that that's quite different in many different parts of the country. Amparo Ostojic 18:15 Yeah, and even within California, each county has different guidelines. So first of all, California just passed SB 803, which is going to allow pure support specialists to have a certification, which will hopefully increase the use of peer specialists in mental health clinics. So 48 states now have peer certification, including California. And the, the principles are pretty much the same. But how a peer support is used in different parts of a state or country is going to vary. So it's difficult if someone moves to another state or another county, and they try to use the same principles. It may not work as effectively. And it's basically it's not standardized right now. So it's hard for someone working in that field to have many options of going to different places, and even like a client that's moving from another county and experiencing pure services in a different way. Katie Vernoy 19:26 So if someone were to want to jump into this, where it sounds like it's starting to become more regulated, there's certification in 48 states, that's great. What does it look like? How does someone become a peer support specialist? Amparo Ostojic 19:39 There's a few organizations that are considered certified to train for peer support. And, for example, the training that I took was an 11 day course, where, you know, like 40 hours a week, and you learn the principles of peer support. And then To become a certified peer specialist, you need 3000 hours of supervised work or volunteer experience providing direct peer support. And you need a letter of recommendation from a professional and from supervisor that has overseen your peer support. And then there's an exam that you would take and pass. And that's how you would become national certified peer specialist. And on top of that, like I said, California is still in the process of creating their peer support guidelines. So in addition to that, you know, whatever guidelines that they'll come up with will be the California guidelines for certification in California, Curt Widhalm 20:45 a lot of research gives you more credit than being a middleman, that when we look at outcomes for treatments, when we look at treatment, we see that peer counselors, we see that parent partners are more effective towards client outcomes than even just working directly with licensed professionals. And a lot of it is due to a lot of the problems that therapists just kind of face and being approachable themselves for the mental health system themselves that there is a down to earth Ness that having that lived experience really does embody that, yes, you can get through this. And I've got some experience to be able to say that not only do I actually demonstrate that I know what you're going through, but that you can get through it, there's a way through this, that there is a light at the end of the tunnel. How do you think that peer partners, peer counselors can be trained should be trained to best exemplify that part of treatment, Kemisha Fields 21:51 I would say they should be trained the same way that any other team members trained in I know, from a clinical perspective, there's a different type of training that comes into play. But for our child and family team specialists that you know, we have trainings, usually agencies are sending you out to different trainings, and I I believe that parent partners should be a part of those trainings, if they are not already a part of those trainings. And that should and will help them in their role as a parent partner with the life experience on top of that, Katie Vernoy 22:32 how can therapists psychiatrists, other people in mental health clinics, support peer specialists? Amparo Ostojic 22:38 one of the most important parts is understanding and learning to see how we can be used. I think, once you collaborate with a peer specialist, and notice the different perspective that they offer, I think both psychiatrists and peers, and mental health professionals, other mental health professionals can learn from each other. And I really appreciated that with one of the psychiatrist that he like, I could see that he really learned from me, and that gave me a lot of confidence. And I learned a lot from him. And it didn't feel like a top down relationship. And it really felt like he valued my perspective as a professional. And that helped a lot because basically just have faith in in something even if you don't understand how it works. You want to try and see how you can work with this person and encourage them to do actual peer support. If at first you don't know what to do as far as how to work with them. There's really good guides. There's one that I really recommend, that is put out by Castro. And they are basically recovery organization. And they have it's called the meaningful roles for providers in an integrative healthcare. And they really break down the different positions that peer specialists could do the different roles so like a peer navigator peer advocate, wellbeing coach is sometimes what they call it. And it really spells out things that a peer specialists can do. And it helps both the pure and the professional because they will say, you know, they could serve as a bridge between the community based organization, they could help clients in enrolling with health insurance programs, they it really spells out things that a client can do with a pure specialist, and that helps both the pier and the clinic. Katie Vernoy 24:53 How about letting us know a little bit about if someone's interested in this I think from many different angles I wanting to advocate for better utilization of peer support specialists within mental health programs advocating for swift implementation of SB 803. For California, you know, or even this advocacy for individuals who are navigating mental health concerns themselves or with their family members, and how they can advocate like, it seems like there's a lot of lot of potential calls to action for our listeners here. What resources would you recommend that they look into, and we'll put all of those in our show notes. Amparo Ostojic 25:33 So definitely the I would guess, I guess, I would say, one of my favorite organizations that I worked with for the past two and a half years is Cal voices. And they have different programs, the advocacy space, is access. So access stands for advancing client and community empowerment through sustainable solutions. So they're kind of a systems change perspective. And they have really great e learning toolkits that give you tools on how you would advocate for yourself and for systems change within your community. One of the great resources that Cal voices has is their Ys program, which stands for workforce integration, support and education. And they have what they call the YZ University. And it's created by peers, it's taught by peers. And this is where I got my training for becoming a peer support specialist. And they basically provide a lot of support in what a peer does. And like they have wise Wednesdays, where they provide information about something related to peer support and learning about how to, you know, either be a peer specialist or work with a peer specialist. And that's everyone's they. And so, it's a great program, because like I said, it's peers that are teaching and creating the curriculum. And I think that's just wonderful because receiving that information for someone with the lived experience is very powerful. Curt Widhalm 27:21 Switching gears here and talking about the implementation of peer support specialists, here's our interview with Jeff Kashou. We are joined by Jeff Kashou, a licensed Marriage and Family Therapist. He's a former Service chief who oversaw collaborative behavioral health program in Orange County, and had opportunities to oversee the implementations of peer counselors into some of the programs. Jeff Kashou 27:51 Yeah, well, first off, thank you for having me on. And I'm very much appreciated that you guys have this podcast and give the opportunity for topics like this to be covered. Katie Vernoy 27:59 The thing that I find very interesting about these roles that I know you and I both have hired these roles, but people have to claim lived experience in order to get these roles. And so it's it's a very interesting line to walk. There's there's very interesting things there. But what do you see as the difficulties that are associated with hiring peer counselors? Jeff Kashou 28:20 Yeah, so I think, very specifically, what makes the role unique and special also makes it kind of a unique challenge in the interviewing process? How do you ask about one's lived experience as a direct, you know, in theory qualification to have that job is what makes it a unique role to a to an organization or an agency. So I would, you know, really encourage anybody who is looking to start a peer program to bring on a consultant who can really help you think the process all the way through and how to have those conversations without inadvertently walking into equal opportunity ramifications or accidently discriminating against someone while also being very mindful that you're bringing into the room into the interview room and process someone's vulnerabilities. And so being able to manage that very tactfully and professionally, while also ensuring that this person, you know, feels comfortable to share that as well. That's your first introduction to somebody and they're interviewing you in that, that process and they want to ensure that your program has really thought through how they're going to be not just added to their system of care, but how your entire system of care embraces and is made better by having peers on board. Oftentimes peers are looked at as very client facing but really in the best situations for them are those for the entire service model is made better by their presence. Curt Widhalm 29:48 A lot of the talk that we've had on this show about how programs barely take care of their mental health professionals within the work systems. Is there any management that is actually being put towards looking after peer counselors in this way without infantilizing them. I mean, if we're not doing this with the brunt of the behavioral health health workforce, are there other implementation problems when it comes to ensuring this kind of stuff or incorporating them into treatment teams, Jeff Kashou 30:19 when I created a practice guidelines of like best practices for the entire Orange County systems, and not just County, but the entire behavioral health system for how to conduct supervision with peers, I leaned very heavily on a toolkit that I found from the city of Philadelphia, that there Department of Behavioral Health and intellectual disability services put together on how to create a peer support system, from the first moment you decide you want to all the way through to supervising them to managing disciplinary things to supporting their growth. And looking at it even from you know, how is the entire system set up to support them, even the interactions that they have within the multidisciplinary team, you know, they face an additional layer of potentially of scrutiny or challenges by constantly having to explain who they are, why they have any authority to work with patients or clients. So there's, there's added stress to the question or the systems in place to actually take care of them. You know, I would really look at that toolkit that the city of Philadelphia put together as sort of a way to evaluate if your system is there, I'd say, it's certainly lacking just to be completely blunt, the county that I worked for, from the children's behavioral health side was not equipped at the time to take them on effectively. And it required a lot of having to build the plane while you fly it, which I think for some roles, it's okay. I think for peers, it can add additional stress. And it means, you know, workplace ambiguity is stressful enough. But when it comes to all the other challenges of integrating them and supporting them and explaining their role, and giving them the right training, and so on, and so on. There's just another level that needs to be thought all the way through. Curt Widhalm 32:11 How are pure counselors implemented into treatment teams, and how are their voices in actual practice, kind of placed into the role where there's a bunch of other potential licensed professionals across a wide variety of interdisciplinary systems? Jeff Kashou 32:30 Yeah, so I can speak to my experience, and then also kind of broadly to and the research that I've done on the topic. So it's often implemented as a top down approach, it's, you know, people in leadership, saying, we're gonna add this program to our larger organization, without ever really embracing maybe the full scope of what it means to engage in a recovery service model, which is really antithetical to the principles of the peer program, you know, which is meeting people where they're at. So a system of care, really understanding from the bottom up what's happening on the ground level, that's really where the entire program began with. But the ways that they're being implemented, we have that additive approach that systems of care will take. And from a very top down perspective, oftentimes, systems need a way to recoup revenue by bringing on this workforce and, you know, supporting the work that they do. And so when it comes to Medicaid, for example, it's involving them in the billing system. So it requires choosing a diagnosis for the person from the list that the other providers have diagnosed the individual with, which is sometimes very new and a bit challenging. I think, sometimes for peers who don't want to necessarily see someone as a diagnosis. But you know, our current system of billing practices and documentation practices requires that also, multidisciplinary teams really don't know about peers, and can have a lot of prejudice as they go in. So systems need to really be thoughtful and do a self assessment before they decide to bring on this very important role, you know, on are this system set up? Or what are the prejudices or preconceived notions that other providers on the team have of people that come in with lived experience? Right, you know, oftentimes, we have that sort of gallows humor as providers when we talk about our patients or whatever. But, you know, now you have to be very mindful of that, not just because you don't want to upset somebody, but due to having that internal shift of like, you know, I actually really maybe need to check myself when it comes to that, and why I engaged in something like that in the first place. So really thinking about decreasing the stigma and helping the rest of the team even before peers come on, understand what it is that they do, the value that they add, and how they're going to be just as important of a member of a treatment team. So really leading with the why through this process. They're often brought a board you know without much structure I Which, you know, leads to them being assigned a lot of admin tasks as well. One of the things that I learned a lot when working with pure forums was that peers are often assigned, you know, a lot of filing tasks or, you know, paperwork kind of tasks, because the program wasn't really trained or made to be aware of what appear is going to do. And so managers will get, you know, assigned X amount of peers and hire them on but not really know what to do or may not have the bandwidth to train them and think through that whole job requirement. Similarly, what I experienced was, sadly, even partway through the interview process, we found out that we were actually interviewing for peers, but the program was set up, they had to find a job title or job classification that they could fit these folks within, so that we can hire them in a timely manner. And so when we were hiring mental health workers were actually supposed to be hiring peers. And so we found out midway, that we were hiring peers, which meant as managers, then we had to shift and reevaluate what we were doing which we put a lot of emphasis and fervor and figuring out and making it a smooth process as much as we could. But it was by no means ideal. And the cohort that we hired, certainly struggled with a lot of the ambiguity and sometimes just having to sit around and wait while we figured things out for them. Katie Vernoy 36:16 You've mentioned a couple of times the the money element of it, that oftentimes these are folks who are hired to do an important service that isn't always reimbursable. And it makes me think about the value. And this speaks to the prejudice as well. But it makes me think of the value that people hold for this role. You know, they're not generating revenue, typically, or not generating a lot of revenue. They're not seen as experts, although they're oftentimes more expert than the folks in the room that are doing the treatment planning. And so what are the ways that you have found whether it's best practices or what you were able to accomplish in your program, of integrating these folks more successfully into, you know, kind of explaining the role? Like, why is it so important? What is the value of this? Because I feel like, and maybe you've already said this, and maybe this isn't needed, but it does feel like there's a case for this role. There's an importance to this role. And I just feel like maybe we need to be more direct and saying it, I don't know. Jeff Kashou 37:25 So yeah, so there's really two directions to think of when it comes to how do you demonstrate the value, there's two those who would be, you know, deciding to bring on this role, which would be those key stakeholders. And then you also have the provider teams as well. And then I guess, there might even be a third group, which are the patients or clientele that you would be serving. So when it comes to demonstrating the value, I think the message needs to be pretty clear all the way through, which is when you're working with, you know, with individuals with serious mental illness, or those with CO occurring disorders, some of these more serious conditions, we know we preach about prevention and early intervention. And this is the rule that really helps with that. And this is the rule that allows us to make that big shift towards a recovery model, and not just pay lip service to saying that, you know, we meet our patients where they're at, and, you know, we want to, you know, improve the quality of their lives and help them reach their full potential. Now, that's, you know, a bit more idealistic and trying to sell it maybe to those that population level into the stakeholder level, but to the provider team, it's also a matter of, you know, recognizing that they will complement the services that, say, a therapist or psychologist or psychiatrist provides as well. And so it's more of like a meshing of gears versus like, people running off into separate directions, you know, where we know that metod here, it's a very important thing. Medications is a very important aspect of treatment. And if individuals, you know, go to their psychiatrist and they prescribe them an antidepressant, we oftentimes know that adherence drops off very quickly, either because the person has some sort of side effects, or because they start to feel better, and they decide they don't want to take the medication anymore. What you know, for multitude of reasons, here, the peer can actually meet with that person, you know, right after they meet with a psychiatrist, or maybe even be in the room with them when they meet with a psychiatrist. And help them ask the questions that are there might be uncomfortable asking, or ensure that they're asking the questions they didn't think to ask, creating that plan afterwards with them for how they're going to fill the prescription, how they're going to, you know, lay out their medications for the week, how they're going to make sure they maintain their motivation to take it or communicate changes that they need with their medications. When it comes to treatment adherence, you know, we assign individuals journaling to do for example, but I don't know about you guys and how often we assign tasks to to patients to do in between sessions, it's extremely hit or miss. And then you end up spending your next session processing, why they didn't do it when you'd rather be processing what they did. And so it's not to say it's 100%. But a specialist can really help with complementing services in those ways. I think ideally, we know that there's attrition, oftentimes with this population. So here's how we keep people engaged in care. I think the other thing is we think about completing goals or completing treatment plans. But that's not really the case. Again, it's not like that broken leg where your leg gets mended, and you don't have to really do anything afterwards, you have to maintain those gains for the long term to allow you then to get to those next levels of functioning, or satisfaction or fulfillment, whatever they might be. And that's where the period specialists can help somebody in the sort of aftercare discharge planning or even long, long term support through their maintenance of their goals. Katie Vernoy 40:56 I think another element for the treatment team, and this is something where, you know, we had the conversation with Kemisha about this, but they're also an expert on the lived experience. I mean, obviously, each person's experience is different. But there's so much that I think my treatment teams anyway, we're learning from our peers, because they just hadn't been in the situation themselves. And so I think there's, there's also incorporating in that way, like here is another member of the team who has really valuable and valid feedback that you need provider. Because I think it's I think it's hard, I think it's hard to understand this. And I think that we've hidden behind a hierarchy that clearly doesn't work, we need to have, we need to have a whole bunch of human beings working on this on a level playing field. Jeff Kashou 41:47 Yeah, I'm really glad you brought that point up, Katie, I remember, and you guys probably had to do this in your grad programs as well, where we were assigned the task of attending a 12 step meeting to understand what the recovery community is like. And we can see what these you know, non therapeutic support systems are like, and it's a way to get that experience. But we were only assigned that at one point in time, and there is so much value that appear can add in terms of to use your your point expertise in these areas, you know, the approach, I think a lot of us take in the recovery systems, you know, I will get asked oftentimes, you know, well, are you in recovery yourself? And I think as a therapist, you make your own call in terms of self disclosure. And I would say the while I can tell you yes or no, it's more important for you to tell me what your experience is like, rather than me telling you all about what your experience is like. But I think there's a way we can sort of fast track that by having peer specialists add that level of detail to us upfront so that we're not always taxing individuals to have to educate us each and every time if that's not something that supports their care in the short term. Katie Vernoy 42:52 Exactly. Curt Widhalm 42:54 There seems to be a lot of mixed evidence on the effectiveness of pure counselor type programs, with the United States in particular lagging behind a lot of other countries when it comes to the implementation of this, some of which is highlighted by some of the funding stuff that you're talking about within things like Medicaid, and we even see some of this going on and private insurance type programs where this stuff can't be implemented. What do you see is the difference between a successful incorporation of pure counsellors versus the ones that kind of fizzle out, Jeff Kashou 43:32 it's going about it with a systematic approach. And that's I'd really emphasize either, you know, utilizing one of those toolkits, like I mentioned, the city of Philadelphia created, which is extremely comprehensive, and very much focused on the existing org and not necessarily on what peers need to be doing. But I think in the absence of that, it's really identifying just like with any big change that you want to make for a business, it's identifying, you know, what, you know, doing your SWOT analysis, and then looking at what is your measure? What's your success metric going to be? And how will you know you got there and then be flexible, to iterate and improve upon things as you move forward? Again, to that authenticity point, it's just like how we work with our, you know, our clientele, it's, you know, we don't expect perfect, but, you know, let's talk about what didn't go well, and let's improve upon it, we need to be able to do that authentically, as well. I think, unfortunately, in healthcare, and especially behavioral health care systems, where we're kind of the afterthought in terms of funding and attention and resources, you know, we just have always learned to make do and stay the course. And then on top of it, you have folks in power, who don't necessarily understand what we do, and they just kind of keep adding more and more stipulations and regulations and so on. And so it's also a matter of like, can you cut through some of that maybe sometimes even through the side door, like in California, we have our mhsaa funding that peer programs are oftentimes Funded there, which is very nice, and that they don't have to be capturing revenue through Medi Cal. This is through funding that has less requirements to it. But it's also pushing back and saying, do they really need to do this level of documentation? You know, so I do think it's a matter of like, thinking things through from bottom to top, like doing that assessment and really assessing yourself like, can we take this on, and being very brutally honest with yourself as a system of care, it's an exciting program, it's an exciting idea. It's one that can bring a lot of benefit. But you have to really understand what it is that you're bringing on. There's other companies that I've worked for that have said, you know, hey, we're, you know, one day down the line, we'll have peers and that way our current clientele can engage and give back, it'll be kind of a lower level service line. I think if you're thinking about it from that perspective, only, and really seeing the dollar signs as part of that image. It's not to say that, you know, money isn't the driver here, but it can't be that upfront. Otherwise, what you're doing is you're commoditizing, a service provider who is designed really to add value simply by them being there and engaging with clientele in that way, without necessarily generating dollars by increasing retention by increasing engagement in services. We know outcomes improve, when systems can demonstrate improve outcomes. Oftentimes, they're the ones that get the next grant are the ones that get the renewed contract, sometimes even a larger contract. So it's really, you know, credenza question in a short way. It's, it's all about approaching it systematically. And not just Yeah, that sounds really exciting. Let's do this. Katie Vernoy 46:43 I think it has to be baked in, it can't be like, let's add this on to the program. It's almost like you have to build it from the ground up, to have these truly integrated into whatever the treatment program is. Jeff Kashou 46:56 Yeah, there's kind of three different approaches that that Philadelphia tool toolbox outlines, just like that additive approach that I discussed, there's that selective approach. And then it's really taking on the one that has the greatest level of success is what's called a transformative approach, which a lot of systems are understandably nervous to take on. But to make a program successful, you have to be willing to transform things, sometimes top to bottom to make it work. Katie Vernoy 47:21 Yeah, it's interesting, because the the program that I had, it was, it was baked in, it was like, my agency decided to do a wraparound program. And at the time, it was called an FSP. Program. And so as, you know, maybe you move clinicians into it, but it was like, here is how you do it. And it was baked in. So it wasn't like, Oh, you're already doing services, let's add this on. Functionally, maybe it looked that way. Because we had clients who then you know, like, followed their therapist, and then got these other services added on. But the program itself was well defined by LA County. And so there was discrete roles, there was training that was required. And like, especially with wraparound, there was like, a week long training where you, everybody went, and there were people from all different roles, and you went when you just first started and all the managers had to go to, so I had to go to it as well. And we would sit there for a full week and interact with other people in our same roles or in the in the peer or the you know, the all the different specialists roles. And so to me, it was, it didn't feel as chaotic because it was like it was completely structured. And it was baked in. Jeff Kashou 48:31 Yeah, and a wraparound program is oftentimes very much set up for that, you know, they traditionally will have either bachelor's level providers as PSCs, or personal service coordinators, which truthfully appear would be phenomenal at which it sounds like that was the role that you had at your program. And because Katie Vernoy 48:47 No we had we had bachelor's level folks, we had peers, we had a facilitator, and we had a therapist, so there was four or five people on the team. Jeff Kashou 48:56 That's a tremendous program. You know, and we're the approach, you know, you've probably experienced this as well, the approach of a wraparound program is like whatever it takes, you know, this is a child, an individual, a family in such a challenging situation that we have to throw everything at this person that they need, and and some to get them to the, you know, to a better place. Katie Vernoy 49:17 Yeah, yeah. I think it just is a good way to think about it as if you actually create a program from the ground up that includes these roles. I think that is stronger. I'm really glad that we're that we did this episode that we're talking about this related to our fixing mental health care in America. I know that it was mentioned in the RAND report, but I also recognize that one of the elements of this is it has been viewed. I think we did this in one of our more recent advocacy and workforce episodes as a way that we take away work from licensed credentialed mental health professionals and I really see this as an important adjunct a positive step forward. And I think we were able to really see that in the conversations that we had with our three guests today. Curt Widhalm 50:08 And I mentioned a couple of times in the show, both this episode and recently about how little using supporting roles, like peer support specialists is actually taught as part of therapists education. Katie Vernoy 50:22 Yeah. Curt Widhalm 50:23 And there's a lot of emphasis on therapists education that's on what we as individuals can do to help with clients, but don't help us to look at the overall workforce system. And I'm echoing your happiness of this episode. And being able to amplify that really good. Mental, behavioral, emotional health treatments, takes a village. And it does take people from a lot of different viewpoints to really help create healing. And especially those people who have that lived experience and have a really great way of helping to help our clients interact with the system to be able to navigate it in ways that makes sense for them. So continuing to emphasize this will be part of our ongoing role in bringing mental health advocacy to the world. And we encourage you to do so as well. Katie Vernoy 51:24 And for folks who were really interested in this, there are a lot of links in the shownotes that will help you with some of the some of these concepts, we've got the the guides and those things both onpattro and Jeff sent stuff over that are very helpful for folks who either want to be a peer support specialist or who want to implement those programs. So definitely feel free to reach out to us if can't find it on our show notes. But those things are just the really amazing resources that we were able to put down there. Curt Widhalm 51:55 You can find those show notes over at MCSG podcast.com. And check out our social media out give us a like or a follow and schrinner Facebook group modern therapist group to further these discussions. And until next time, I'm Kurt Wilhelm with Katie Vernoy. Katie Vernoy 52:11 Thanks again to our sponsor, trauma therapist network. Curt Widhalm 52:15 If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There's so many types of trauma and so many different ways to heal. That's why Laura Reagan LCSW WC created trauma therapist network. Trauma therapist network therapist profiles include the types of traumas specialized in population served therapy methods used, making it easier for potential clients to find the right therapist who can help them. Network is more than a directory though its community. All members are invited to attend community meetings to connect consults, and network with colleagues around the country. Katie Vernoy 52:52 Join the growing community of trauma therapists and get 20% off your first month using the promo code Mt. SG 20 at Trauma therapist network.com Once again that's capital MTS G the number 20 at Trauma therapist network.com Announcer 53:09 Thank you for listening to the Modern Therapist Survival Guide. Learn more about who we are and what we do at MTSGpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.
In this episode, we're speaking with Audrey Schoen, a California based License Marriage and Family Therapist. Audrey specializes in working with the spouses of Law Enforcement Officers in private practice. Within her practice, Audrey's goal is to help her clients achieve a sense of steadiness and confidence in the face of life's ups and downs, both within themselves and their relationships. As the wife of a Law Enforcement officer herself, she will talk about the triad of reality checks that led her to absolutely raise her fees. In this episode, Audrey will share: How being the wife of a Law Enforcement Officer forced her to get real about how much she needed to make in private practice; How charging Premium Fees allowed her to be a better therapist for her clients; Her current anxiety about charging more, despite making leaps and bounds from where she started; 3 mindset shifts to consider if you are currently struggling to raise fees. Resources mentioned: Fun with Fees Lean In. Make Bank. 4 Steps to Raise Your Fee Workshop More about Audrey: Audrey is a Licensed Marriage and Family Therapist in Northern CA with an exclusively online practice working with adults and couples seeking to create a more connected and congruent life. As a police wife herself, She especially enjoys supporting partners and spouses of law enforcement and first responders. She brings a real-life, even-keeled approach to counseling, coming alongside her clients as they shine light into the dark and challenging places in life. To Contact: https://www.audreylmft.com/
We all want a relationship that's more than just functional, we want one that's truly fulfilling. On today's episode Forrest is joined by a wonderful therapist and author who focuses on giving people the tools they need to communicate, navigate hard times, and create deeper connections with other people: Elizabeth Earnshaw. They explore: How the pandemic impacted our relationshipsThe Gottman approachThe stages of a relationshipBalancing differing needs for intimacyHow to request, and give, repair. They then close the episode with a fun game focused on debunking common relationship myths.About our Guest: Elizabeth is a Licensed Marriage and Family Therapist, the founder of A Better Life Therapy, and the author of I Want This to Work. You might also know her as @lizlistens on Instagram, where she's helped countless people transform their relationships.Watch the Episode: Prefer watching video? You can watch this episode on YouTube.Key Topics:0:00: Introduction.1:45: Elizabeth's background.5:30: How did the pandemic impact relationships?7:30: Responding to stress in relationships.9:00: Co-regulation.11:15: Punishing others for our unpleasant emotions. 13:45: The four stages of relationships.17:50: What to look for in a partner. 20:10: The “Four Horsemen” of bad relationship communication. 24:25: Key skills for navigating conflict together. 27:00: How to request repair from your partner.34:10: Deciding if you should leave.37:45: Interdependence.41:30: Balancing differing needs for intimacy.46:30: The Instagram Meme Game: Common misconceptions about relationships.47:30: “Partners should share everything with each other.”50:30: “Your partner should be your ride or die.”52:15: “Never go to bed angry.”54:50: “My partner is my missing piece.”56:35: “If you can't handle me on my worst day, you don't deserve me on my best day.”1:02:05: Recap.Support the Podcast: We're now on Patreon! If you'd like to support the podcast, follow this link.Sponsors:From Boston Globe Media comes a new podcast, TURNING POINTS, a show about navigating mental health. Listen on Apple, Spotify, or wherever you get your podcasts.Find the new CBD+ performance gummies and the whole dosist health line-up today at dosisthealth.com. Use promo code BEINGWELL20 for 20% off your purchase. Join over a million people using BetterHelp, the world's largest online counseling platform. Visit betterhelp.com/beingwell for 10% off your first month! Want to sleep better? Try the legendary Calm app! Visit calm.com/beingwell for 40% off a premium subscription.Connect with the show:Subscribe on iTunesFollow Forrest on YouTubeFollow us on InstagramFollow Forrest on InstagramFollow Rick on FacebookFollow Forrest on FacebookVisit Forrest's website