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

What is Play Therapy?: An Interview with Ofra Obejas, LCSWCurt and Katie interview Ofra Obejas, LCSW, RPT-S, about working with children in therapy. We look at what therapists often get wrong, important factors to understand, specialized training required (including play therapy), and what you actually do in therapy session with children. Transcripts for this episode will be available at mtsgpodcast.com!An Interview with Ofra Obejas, LCSW, Registered Play Therapist - SupervisorOfra Obejas, Registered Play Therapist - Supervisor level, is a professional player. She works with elementary- to middle-school aged children. She’s been called by some of her clients a “kid grownup.” (That’s her rapper name.) She’s taught at the University of San Diego Play Therapy program and presents webinars and courses on clinical topics related to children’s issues.In this podcast episode, we talk about Play TherapyWe reached out to our friend, Ofra Obejas to talk with us about how to work with kiddos and what additional training is needed to work effectively with children.What do therapists get wrong when working with children? Treating children like mini-adults Not understanding the skill involved in play therapy What are important factors for therapists to understand when working with children? Children have a different culture (i.e., the tooth fairy is real) The therapist’s role as translator for what children are saying Children will make you feel what they feel (e.g., powerlessness, never getting anything right) The importance of showing feelings to children as a therapist (versus remaining a blank slate) What do you do with children in therapy sessions? Psychodrama and re-enacting situations Therapists can use any theoretical orientation Ways to interact with the child Paying attention to transference and countertransference Case conceptualization, including family therapy and work with parents What specialized training is most effective for working with children? There are specialized protocols for working with children with many different orientations Identifying which orientation suits you How to understand what is being reenacted and how to respond: Notice it, sit with it, make meaning of it; Observe it, name it, model how to cope with it What boundaries should therapists set when working with children and families? Unit of treatment (family, individual, who was showing up to the session?) Treatment goals (what are we working on?) What children are allowed to do in the session Interactions with caregivers and the responsibilities caregivers have during sessions What does online therapy look like with children? The challenges with working with children online Online sand tray, online dollhouse, online puppet theater Creating a virtual play room New trainings for VR therapy for children Watching children play video games online How has the pandemic impacted children? This was dependent on how well parents were able to self-regulate and stay within the window of tolerance (was there someone who could help the child to regulate) Lack of socialization and difficulty in having conversations 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! Ofra Obejas’ website: redondovillagecounseling.comOfra on YouTube UCSD - Play Therapy Program 

How Therapists Can Really Help Kids Who Are Being BulliedCurt and Katie chat about how therapists can support the targets of bullying. We explore what bullying actually is as well as what can be problematic in how it is typically addressed. We also discuss individual therapy strategies for kids who have been bullied. Curt and Katie also debate about whether the targets of bullying should change what makes them different to avoid getting bullied.   Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about how therapists can effectively treat bullying in therapyFor Bullying Prevention month, we decided to dig into what bullying actually is and how therapists can treat bullying in therapy.What is bullying actually? The definition of bullying and how it is described currently (i.e., teasing versus bullying) Target and aggressor (versus victim and bully) as more appropriate language to describe participants Three essential elements of bullying: ongoing behavior, behavior is intended to be harmful, and there is a power differential between the aggressor and the target The relevance of impact versus intention of behavior Numerous types of power imbalances that can be present Types: physical, verbal, social or covert, cyber bullying What is problematic in how bullying is typically addressed?“Aggressors have a more robust set of social skills. And it's being able to adapt more quickly to things that are socially changing, even in the moment. This also plays a role in the reporting on the people teasing them because the more socially adept kids are then better able to convince the adults around them. Oh, no, we were just playing. We were teasing back and forth.” – Curt Widhalm, LMFT Most bullying is not observed by adults Not moving past holding space Looking toward community interventions rather than individual Lack of understanding of what cyber bullying actually looks like (when you haven’t grown up as a digital native) Aggressors have a more robust set of social skills Strategies for kids who have been bullied“I think we also need to recognize that if we go too far in telling people not to be different, we are invalidating their identity. And if we don't go far enough, and we don't help them to be part of society, they may continue to get really harshly bullied, but either one is damaging.” – Katie Vernoy, LMFT Beyond ignoring (especially if there is an audience) Understanding what the target’s response means to the aggressor Not playing into what the aggressor is doing, escalating to forceful “stop,” seeking out a trusted adult (or multiple adults) Debate on whether a target should shift their behavior and change what makes them different Building confidence versus masking Safety now versus identity development Practicing responses to potential bullying statements in session Including targets in the planning process with adults The challenges with mediation within school settings (and the importance of follow up) Systemic or prevention programs that also address bystanders OResources 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!Article: Parent-Assisted Social Skills Training to Improve Friendships in Teens with Autism Spectrum DisordersArticle: The 411 on BullyingConsultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute HourConnect with the Modern Therapist Community:Our Facebook Group – The Modern Therapists GroupModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/

What Modern Therapists Should Know About Law Enforcement Mental Health: An Interview with Cyndi Doyle, LPCCurt and Katie interview Cyndi Doyle on the mental health of law enforcement officers. We look at how being a cop impacts their mental health as well as specific incidents and the chronic desensitization. We also explore the feelings in law enforcement related to calls to defund the police and how society views the cops. Content warning: potentially traumatic incidents (violence, death)Transcripts for this episode will be available at mtsgpodcast.com!An Interview with Cyndi Doyle, LPCCyndi Doyle is a Licensed Professional Counselor, group practice co-owner, founder of Code4Couples®, podcaster, and author of Hold the Line: The Essential Guide to Protecting Your Law Enforcement Relationship. She has spoken nationally and internationally including at the International Association of Chiefs of Police Conferences (IACP), the FBI National Academy Association (FBINAA) Conference, keynoted at police spouse conferences throughout the country, and at trained various police departments. While much of her work focuses on first responders, Cyndi’s stories of embracing and wrestling with living her own bold and authentic life have resulted in her being a sought-after speaker for other mental health professionals. Her message of humanizing struggle, compassion, courage, and resilience has resulted in her speaking nationally and even keynoting at the 2020 Texas Counseling Association Professional Growth Conference. That same year, the American Counseling Association awarded her the Samuel Gladding Unsung Heroes Award for her work with first responders and contribution to the field of counseling.In this podcast episode, we talk about Law Enforcement Mental HealthWe reached out to our friend, Cyndi Doyle to explore a population of folks who we typically don’t think about as our patients: Law Enforcement Officers (LEO).What should modern therapists know about the mental health of Law Enforcement Officers and their families? Different dynamics than typical couples The definition of cynicism How training impacts the mental health of officers Misinterpretation of control versus abuse Over diagnosis of trauma The negative impacts on police officers of the heightened scrutiny and criticism Hypervigilance and the impact of cameras on police offers performing their jobs The lack of support from the community (or the legislators or even law enforcement leadership) for officers Lack of compassion satisfaction, considering quitting their job, PTSD The impact on Law Enforcement Officer (LEO) families Exploration of the calls to defund the police and fund other resources Looking at the law enforcement response to defunding the police Exploring community policing and how that could help decrease abuses The cultural shifts and education happening at police departments The potential for mental health resources being added to policing When staffing is down, there is less time to recuperate and be prepared for work Mental Health Concerns that bring law enforcement officers and their families into therapy Stress, Anxiety, Depression, Addiction Relationships, family and couple Incident, critical incident, trauma Desensitization to violent incidents, injuries, and death The personalization in incidents that can cause more of a trauma response The insufficient training to build resilience for law enforcement officers The shifting culture that is now recognizing mental health as health, but the ongoing stigma for seeking support Cynicism, lack of empathy, and bias in Law Enforcement The mindset that narrows down to “everyone” behaves Working to make officers more human, so they can see more good in the world The importance of supporting the resilience and empathy within LEO (while recognizing that some of these things are not helpful “on the job”) Cyndi Doyle.com

Medical Assistance in Death (MAiD) in Canada: Mental Illness and Assisted SuicideCurt and Katie chat about assisted suicide related to an upcoming expansion of the MAiD laws in Canada to include mental illness. We discuss what these laws seems to say as well as how they might impact patients, medical providers, and therapists. We explore the moral and ethical questions as well as what other countries have done to put in further safeguards to protect patients and doctors.  Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about the expansion of Medical Assistance in Death laws in CanadaWe have been watching the MAiD laws in Canada that are soon going to include assistance in death for folks with mental illness. We talk about the law and the concerns we have related to the safeguards (or lack of safeguards).What are the updates coming to the Medical Assistance in Death laws in Canada? With the approval of 2 medical professionals and a 24-month waiting period (for psychological illness), individuals can get medication or an injection from a medical provider to end their lives Requirements for application include chronic, “grievous and irremediable” conditions Information on requirements are here: Final Report of the Expert Panel on MAiD and Mental Illness The differences in laws in other countries that seem to have more safeguards in place What are the moral and ethical questions facing medical and mental health providers?“Do we have the right – the moral right – as therapists, mental health professionals of any sort of background or license, to tell clients that they must live or that it is okay for them to end their life?” – Curt Widhalm, LMFT What responsibilities do mental health providers have to their clients related to end of life? Who will be negatively impacted versus who will be positively impacted? Who would qualify and who would seek out assistance in dying? “I'm not worried that someone that's a little depressed is going to decide they want to die by suicide… I think it's more that there are going to be folks [diagnosed with serious mental illness who are receiving insufficient mental health care] … who really don't feel like they have options (and maybe they don't) and they choose to die by suicide versus advocating for stronger treatment.” – Katie Vernoy, LMFT What is mental illness? Is it only what is in the ICD or DSM? What are the impacts of these laws on physicians? Concerns raised by First Nations groups in Canada 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! Final Report of the Expert Panel on MAiD and Mental Illness NY Times: Is Choosing Death Too Easy in Canada? Medical Assistance in Dying in Canada: Too Much, Too Fast? Canadian and Dutch doctors’ roles in assistance in dyingRelevant Episodes of MTSG Podcast:Part 1: Risk Factors for Suicide: What therapists should know when treating teens and adultsPart 2: What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive intervention What's new in the DSM 5-T-R? An interview with Dr. Michael B. First When Clients Die: An interview with Debi Frankle, LMFT Therapists Struggling with Darkness Suicidal Therapists: An interview with Norine Vander Hooven, LCSW Therapist SuicideConsultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute HourConnect with the Modern Therapist Community:Our Facebook Group – The Modern Therapists GroupModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/

What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive interventionCurt and Katie chat about suicide assessment, safety planning, and how to keep clients out of the hospital. We reviewed the Integrated Motivational Volitional Model for Suicide, we talked about what therapists should be assessing for in every session, what strong assessment looks like (and suggested suicide assessment protocols), and why the least restrictive environment is so important when you are designing interventions and safety planning. This is a continuing education podcourse.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about suicide assessment, safety planning, and interventionWe continue our conversation on suicide, progressing from risk factors (from last week’s episode) to how to assess and safety plan with the least intrusive interventions at the earliest stages. Review of the Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley Continued to review the IMV model (graphic in the show notes at mtsgpodcast.com)What should therapists assess for in every session, related to suicide?“When clinicians are burnt out, when we have caseloads that are too big, when we aren't taking care of ourselves, we tend to [think], “Okay, this client is at a six, they can live at a six for a while,” which is absolutely true. And if they can [live with this level of suicidality], and they have the good factors that allow them to live there – great. It's just how close are they to that 7, 8, 9?” – Curt Widhalm, LMFT Moderating motivational factors, which move clients from passive to more active suicidality (or the reverse) Looking at what is keeping someone from being at risk for suicide (protective factors) The importance of knowing our clients well before they move into the volitional phase Understanding the clinician factors and putting structure around assessment Assessment for Suicide“Assessment is intervention.” – Curt Widhalm, LMFT SAMHSA’s GATE protocol Gather information using a structured assessment tool (Columbia Scale, LRAMP) Looking at intention, means, plan as well as risk and protective factors Moving into a safety plan The importance of recognizing the human during the assessment (versus focusing only on the protocol or your liability) Seeking supervision or consultation – don’t do this alone The importance of using the least restrictive intervention for suicide“There is a rupture in the therapeutic relationship when you are sending your client or facilitating a hospitalization against their will. It can save their lives …but that may not always be the case.” – Katie Vernoy, LMFT The idea of “responsible” action The range of options for keeping a client safe Having a conversation with the client on how to avoid attempting suicide The potential impacts of hospitalization, including trauma The danger of hospitalizing someone who does not need this level of intervention Additional intervention between sessions The practicalities to set up your schedule and your practice to support your clients and your self Additional risk factors (transition phases between providers)  

Risk Factors for Suicide: What therapists should know when treating teens and adultsCurt and Katie chat about suicide risk factors. Suicide rates have been increasing across the nation and there is an increasing need for the mental health workforce to be prepared to assess and intervene with clients of all ages. We take an in-depth look at the risk and protective factors associated with suicidal ideology and behaviors in both teens and adults. We also lay the beginning foundations of a suicide model to help clinicians better understand and intervene with clients exhibiting suicidal thoughts. This is a continuing education podcourse.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we explore what makes someone more likely to attempt suicideWe’ve talked frequently about suicide, but thought it would be important, especially during Suicide Prevention Awareness Month, to go more deeply into the risk factors that make someone more likely to attempt and complete suicide. What are the highest risk factors for suicide?“Anxiety Sensitivity… the fear of the feelings of being anxious… is even more so correlated with suicidal ideation and suicide attempts than depression is.” – Curt Widhalm, LMFT Defining acute, active suicidality (versus passive or chronic suicidality or non-suicidal self-Injury) Going beyond the list of risk factors to how big of a risk each factor is for attempting or completing suicide Exploring how impactful a previous attempt is on whether someone is likely to attempt of complete suicide The importance of getting a complete history of suicidality and suicide attempts at intake The impact of family members who have attempted or died by suicide Alcohol and other substance use and abuse as an additive risk factor Cooccurring mental disorders (eating disorders, psychosis and serious mental illness, depression, anxiety and anxiety sensitivity, personality disorders) Child abuse history, especially folks with a history of sexual abuse history Life transitions, especially unplanned and sudden life transitions Owning a firearm makes you 50 times more likely to die by suicide Racial differences in who is more likely to attempt or complete suicide Living at a high elevation What are additional risk factors for suicide specific to teens? Early onset of mental illness Environmental factors Exposure to other suicides (social media, contagion) Not being able to identify other options Seeking control over their lives and lacking impulse control leading to suicide attempts The importance of communication and the potential for a lack of communication Bullying and lack of social support, without a way to escape due to social media and cell phones What are protective factors when assessing for suicidality?“Just because protective factors are present doesn't mean that they balance out risk factors [for suicide].”– Curt Widhalm, LMFT Reasons for living, responsibility to others Spirituality or attending a place of worship that teaches against suicide Where you live based on cultural or societal factors Having a children or child-rearing responsibilities, intact marriage Strong social support, employment Relationship with a therapist  Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley

How Therapists Can Manage a Sedentary Job: An interview with Celina Caovan, DPTCurt and Katie interview Celina Caovan about physical self-care for therapists. We talk about how to mitigate the impacts of a sedentary job as well as the benefits of physical therapy and consistent physical activity. We also look into what physical therapy is, how clients can advocate for it, and how therapists might collaborate to support the physical and mental health of their patients.Transcripts for this episode will be available at mtsgpodcast.com!An Interview with Celina Caovan, DPTCelina Caovan received both her undergraduate degree and Doctorate of Physical Therapy degree from the University of Southern California. She has been practicing in an outpatient orthopedic setting in the South Bay in California for the last two years and is a Certified Strength and Conditioning Specialist.In this podcast episode, we talk about how therapists can take care of their bodies while working in a sedentary jobMany therapist friends of ours have described low back pain and challenges in maintaining physical health when much of the work we do is while sitting.What should therapists know about physical activity and physical therapy?“Physical therapists are trained movement experts… we can diagnose, we can treat using hands on skills, patient education, and then we prescribe individual exercise for a bunch of different injuries, the ultimate goal being to improve the way someone moves and emphasize injury prevention. And the cool thing about physical therapy: it can be an alternative to pain medication, in a society where they prescribe a lot of a lot of pain medication, and then surgery as well.” – Celina Caovan, DPT There are a number of subspecialties in physical therapy to support all different elements of improving movement The importance of moving outside of a sedentary job US Department of Health guidelines on activity levels What can therapists do to take care of themselves during the work week? Getting out of the chair, some chair exercises Stretching and gentle movements during the breaks between sessions No drastic differences in activity from the work week to the weekend (i.e., avoid weekend warrior behavior, especially when extremely sedentary during the week_ Slowly increase activity and gradually increase cardio or resistance training Stretching (static and dynamic), warming up, and cooling down How can therapists think about physical therapy for their clients?“Someone's physical and mental health – that’s interconnected… that mind body connection. And I think this would be a really great opportunity for us to create this interdisciplinary relationship where we can approach it from a physical and mental standpoint.” – Celina Caovan, DPT Referrals and direct access to physical therapy Psychoeducation and support for advocacy to obtain physical therapy Chiropractors versus physical therapists How physical and mental health therapists can collaborate to support patients  Resources for Modern Therapists mentioned in this Podcast Episode:We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Physical Activity Guidelines for Americans from the US Department of Health and Human ServicesBeach Cities Orthopedics and Sports MedicineReach out to Celina Caovan, DPT: celinaDPT at gmail.comConsultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute HourConnect with the Modern Therapist Community:Our Facebook Group – The Modern Therapists GroupModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/

Therapists on the Hostage Negotiation Team and Supporting Police Work: An interview with Dr. Andy YoungCurt and Katie interview Andy Young about hostage (crisis) negotiation and his work with SWAT and crisis negotiation in Lubbock, TX. Content warning: discussion of violence, suicide, and homicide. We talk about what therapists can do within police departments, the interplay between mental health and law enforcement, what that work looks like – especially when involved in crisis negotiation, and skills therapists need when working in these settings. We also look at trauma response and how it is handled when things go south.Transcripts for this episode will be available at mtsgpodcast.com!An Interview with Dr. Andy YoungDr. Andy Young has been a Professor of Psychology and Counseling at Lubbock Christian University since 1996 and a negotiator and psychological consultant with the Lubbock Police Department’s SWAT team since 2000. He also heads LPD’s Victim Services Unit and is the director of the department’s Critical Incident Stress Management Team. He has been on the negotiating team at the Lubbock County Sheriff’s Office since 2008 and is on the team at the Texas Department of Public Safety (Texas Rangers, Special Operations, Region 5). He is the author of, “Fight or Flight: Negotiating Crisis on the Frontline” and “When Every Word Counts: An Insider’s View of Crisis Negotiations.” He was recently added as a third author for the 6th Edition of “Crisis Negotiations: Managing Critical Incidents and Hostage Situations in Law Enforcement and Corrections”.In this podcast episode, we talk about the role therapists can play in crisis negotiationThere have been many calls to defund the police and create roles for mental health professionals in law enforcement. Dr. Andy Young has already been doing this for 20 years. We talked with him about what that experience looks like.What can therapists do for law enforcement? Crisis counseling Hostage or Crisis Negotiation support (advising on the negotiation) Psychiatric consultation Predicting violence or suicide, assessing subjects’ mental health What is the interplay between mental health and law enforcement? Police officers get 40 hours of active listening and mental health Officers started out a bit stand-offish, reported increased mental load due to needing to protect mental health professionals at the scene Finding value in taking mental health out of scope of law enforcement There is a huge importance in developing relationship with the officers Specialized training needed that can support integrating mental health providers into law enforcement teams What does work look like for therapists in law enforcement and crisis negotiation? Coaching on communication Assessing the situation and the subject Strategizing interventions to de-escalate the situation Provide context and reassurance to law enforcement professionals Hostage Negotiation calls are typically once to twice a month (and not every month). There are successful outcomes 97% of the time How do these law enforcement and mental health providers handle things when they go south? Crisis support Critical Incident Stress Management Mental health providers who are accepted within the law enforcement culture The political, investigative and personal elements of a lethal force incident Processing and debriefing within the team What skills should therapists have to work with law enforcement and hostage negotiation? Pragmatic and understanding the situation you’re in Practical, knowing your own limits Ability to manage emotional situations calmly Navigating the extreme stakes out in the streets Understanding law enforcement The benefit of having a mental health provider on a hostage negotiation team Training the team on mental health concerns Improving “batting average” on successful outcomes The importance of a well-trained team Resources for Modern Therapists mentioned in this Podcast Episode:

Why Therapists Shouldn’t Be Taught Business in Grad SchoolCurt and Katie debate whether graduate school programs for therapists should include business education. We look at the pros and cons for including business education for students, specifically identifying a mismatched developmental level, bloated curriculums, and underutilized career resources. We also look at the responsibility graduate schools have to their students to be employable or to be able to create a sustainable business. Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about whether clinical grad programs should include business educationWe have seen marketing that highlights that business isn’t taught in grad school (and have done a lot of it ourselves). We discuss whether it actually should be included.What is already included in grad school for therapists? A large number of clinical courses required for graduation Career centers and other business resources may be available, but not used What career or business resources should therapists get through graduate school? Career centers with up-to-date relevant employment resources Potentially an optional class or workshop for how to run a business Why shouldn’t business education be added to clinical programs?“The timing of it just isn't right. Like, yeah, these are ideas that can be introduced, but the practicalities of it, in my experience, just aren't developmentally where a lot of grad students are… I don't think that [teaching someone to run a business] at a developmental time when people aren't capable for it or aren't ready for it – or legally not allowed to put those things in place – it just ends up being so far off that it's not a practical sort of training thing.” – Curt Widhalm Accreditation bodies don’t access for employability, so programs won’t focus their attention The increasing number of credits required to become a therapist Developmentally inappropriate timing for what therapists are able to do when they graduate What would business education look like if it were included in graduate programs?“I'm not ready to let the grad schools off the hook for their responsibility to students. I feel like they are responsible to students to adequately prepare them for the job.” – Katie Vernoy Potentially lackluster participation due to overwhelm The importance of introducing what clinicians will actually face Seminar versus a full course Orientation to job options and business basics Resources for Modern Therapists mentioned in this Podcast Episode:We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Saving Psychotherapy by Dr. Ben Caldwell

What Goes in Your Notes? Interstate therapy practice and documentation for clients considering abortion or gender affirming careCurt and Katie chat about documentation and practice questions related to abortion or gender affirming care when providing therapy to folks in states where these types of medical care are banned or will be banned soon. We look at medical documentation privacy concerns (related to HIPAA and the 21st Century Cures Act), how therapists avoid “aiding and abetting” a client to get an abortion, what to include in your notes, and special considerations related to duty to warn and child abuse reporting. This is a law and ethics continuing education podcourse.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we explore post-Roe documentation for therapistsWe’ve heard a lot of questions about what therapists should do now that Roe has been overturned. We decided to dig into practice and documentation guidelines to help modern therapists navigate the changing times.Medical documentation privacy concerns with interstate practice and the new abortion bans HIPAA and the 21st Century Cures Act The impact on clients who move from safe haven states to states with abortion bans The impact of the Counseling Compact (and similar mental health compacts) and how many participating states have trigger laws to ban or limit abortion Paying attention to jurisdictional differences and where the client lives Who qualifies as a HIPAA covered entity? Psychotherapy (Process) Notes versus Progress Notes Psychotherapy notes are not defined the same and/or protected in every state The impact of civil law suits on confidentiality of process notes The huge challenge of information blocking and who may pass along your treatment information Talk to an attorney or your professional organization when subpoenaed How do you avoid “aiding and abetting” a client to get an abortion during mental health treatment? Processing feelings and helping client to make their own decisions Aiding and abetting can include telling them where to go, encouraging them to get an abortion, or providing practical support (like money or a ride) How to provide resources without aiding and abetting Self-empowerment and clients making their own decisions Liability and risk in practice (check with your malpractice insurance) Whether/how you let your clients know where you stand on the overturn of Roe v Wade What do you include in your notes when talking about abortion and gender affirming care? What is relevant to your treatment goals? Documenting progress toward treatment goals Creating a policy related to medical decision-making Phrases that you can use to briefly describe what is happening in session How much to document and the recommendation to be less specific in progress notes when discussing medical decisions The special considerations related to duty to warn and child abuse reporting when talking about abortion and gender affirming care No case law to guide us here The difference between permissive versus required reporting Vast differences across the states with all of the different pieces HIPAA says that we should not report, but we will be impacted by state laws Recommendations to pay attention to what is happening in the states where you practice and to identify advocacy opportunities to protect information, safe haven laws