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

Working with Trans Clients: Trans Resilience and Gender EuphoriaAn interview with Beck Gee-Cohen, MA CADC-II, about how therapists can be better clinicians for trans people. Curt and Katie talk to Beck about gender identity (and why every therapist should do their own work around gender), historical perspectives on masculinity and femininity, the concepts of trans resilience and gender euphoria, the real problems with the DSM diagnosis of gender dysphoria and considerations for providing therapy to trans clients. Interview with Beck Gee-Cohen MA CADC-II Director of LGBTQ+ ProgrammingIn this podcast episode we talk about trans mental healthWe invited Beck Gee-Cohen, MA CADC-II to come talk with us about providing therapy for trans individuals.Modern therapists need to keep learning when working with trans clients Getting pronouns correct is a basic expectation at this point Finding the balance between focusing on a client’s trans identity and other elements of their identity and experience Understanding trans identity 101 is a basic level of knowledge that all therapists should have What you do need to learn from your trans clients Therapists need to do their own work around gender The work that therapists must do around gender The role that society plays in defining gender and the binary The privilege cis folks have in not being asked to assess/address their gender “Women’s” and “men’s” issues Societal expectations related to gender The history of gender expression and how what is acceptable has shifted Cultural and generational differences related to gender  The Concept of Trans Resilience The tendency to focus on the pain of being trans The bias and hate that trans folks face, and how they continue to show up The importance of celebrating who you are as a trans person “You’re so brave” doesn’t see the full picture How hard it is to show up – and what it means that trans folks continue to do so Moving away from just focusing on gender dysphoria versus looking at gender euphoria  Gender Dysphoria versus Gender Euphoria and the problems with the DSM How the DSM is used for the medical needs of trans folks The problem with assigning the diagnosis of Gender Dysphoria to an individual Internalized gender dysphoria (it is not my dysphoria, it is the dysphoria of the people around me about my gender) Playing around with gender shouldn’t be a diagnosis, it is so culturally bound Trans individuals have to know what to report so they can get hormones (i.e., they may have to lie about being dysphoric in order to “check the boxes”) The problem with gatekeeping and the hope that trans folks being in work groups to help shift these guidelines  Better Therapy for Trans Clients Therapeutic alliance is the most important How therapists can appropriately use vulnerability when a client comes out as trans The likelihood of someone coming out initially versus after trust is built and how to handle it Sharing the therapeutic process and how you will learn and educate yourself The problem of signaling that you are capable of working with LGBTQ+ people when you are not trained Awareness of how being trans impacts the client in front of you When the client is coming into therapy due to their gender identity Understanding the back story and how someone identified that “something is different” Looking at what they want to do next (which may be very little or a full plan on how they handle being trans).

Who’s in the Room? Siri, Alexa, and ConfidentialityCurt 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 assistantsWe 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? – 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? 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 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 WaddellHey Siri and Alexa: Let's Talk Privacy Practices by Elizabeth Weise, USA TodayPatient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: An Observational Study of Siri, Alexa, and Google Assistant, 2018Hey Siri: Did you Break Confidentiality, or did I? By Nicole M. Arcuri Sanders, Counseling TodayAlexa, Siri, Google Assistant Not HIPAA Compliant, Psychiatry AdvisorHey Alexa, are you HIPAA compliant? 2018Person-Centered Tech 

How to Understand and Treat Psychosis: An interview with Maggie Mullen, LCSWCurt and Katie interview Maggie Mullen, LCSW, a national trainer on culturally responsive, evidence-based care for psychotic spectrum disorders. We talk with Maggie about their 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, LCSWIn this podcast episode we talk about looking at psychosis differentlyMaggie Mullen’s anti-racist and disability justice framework of psychosis 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 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 

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 orientationWe 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 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 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 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 MindfulnessVery Bad Therapy PodcastPetko, 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. LazarusPoznanski and McClennan (2007): Measuring Counsellor Theoretical OrientationRelevant Episodes of MTSG Podcast: Unlearning Very Bad Therapy Interview with Dr. Diane Gehart: An Incomplete List of Everything Wrong with Therapist Education 

The January 2022 Surprise of Good Faith Estimates RequirementsCurt 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 RequirementWhen 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? 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? 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 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 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 ActFederal Register: Requirements Related to Surprise Billing; Part IICMS.gov: Requirements Related to Surprise Billing; Part II, Interim Final Rule with comment periodRelevant Episodes of MTSG Podcast: Should Private Practice Therapists Take Insurance? Make your Paperwork Meaningful

How Can Therapists Actually Retire? - An interview with David Frank, financial planner for therapistsCurt 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 PlanningIn 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

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 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

When Clients Have to Manage Their TherapistsCurt 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)

How to Be Accessible Beyond the Sliding ScaleAn 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 BalanceLindsay 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

Peer Support SpecialistsIt’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, LMFTKemisha 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.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.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