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

Serious Mental Illness and HomelessnessAn interview with California State Senator Henry Stern and Dr. Curley Bonds, Chief Medical Officer for Los Angeles County Department of Mental Health about legislation and programmatic changes needed to better serve highly vulnerable individuals. Curt and Katie talk with both Senator Stern and Dr. Bonds about the limitations of Laura’s Law and the Lanterman-Petris-Short Act as well as the hope for stronger, more collaborative mental health initiatives for individuals grappling with serious mental illness and homelessness. We talk about the practical funding and workforce concerns as well as how to fix them while also supporting mental health professionals. Curley L. Bonds, M.D., oversees all clinical practices for the Los Angeles Country Department of Mental Health (LACDMH) as well as the full range of programs that function to engage and stabilize clients by bringing them into the Department’s community-based system of care.In this episode we talk about: Continuing our special series on Fixing Mental Healthcare in America What the ideal mental health care can look like for individuals with serious mental illness, substance abuse treatment, and navigating homelessness The siloed nature of services at present The importance of consistent engagement and familiarity Recovery-oriented and person-centered care The importance of self-directed care Wraparound services The importance of engaging people with lived experience Culturally responsive services The current laws protect autonomy without the means to support people without capacity The bureaucracy that is keeping people from getting the services they need Changes to Laura’s Law and LPS Act that are needed to better serve individuals with grave disability or require conservatorship Engagement, rights, and how to better serve individuals Assisted Outpatient Treatment – how it can be best utilized and most effective The ability to shift things through budget and regulatory changes The understanding that current caseloads that are too high and the need to add resources Alternatives to long term conservatorship The willingness to invest in services and solutions Balancing the tension between self-advocacy/self-determination versus providing care Mental Health Advanced Directives as a tool to help with making these decisions Who can and should be at the table in making these decisions The desire to invest in people to provide services Whether to invest and how to assess efficacy The problem of the fragmented systems and communication about mental health advanced directives The importance of education for people needing and providing care on the options Looking at the benefits and “selling” the positive elements of assisted treatment Letting clinicians do clinical work – why that’s important and ideas of how to make it work Tracking outcomes effectively while diminishing bureaucracy Looking at the most effective goals and outcomes for clients Looking at unfunded mandates and how to support therapists and clients to get services without so much paper pushing and complicated outcomes Having service providers at the table to create the programs effectively Results-driven metrics and payment (the pros and cons) Addressing policy and stigma Looking at the problems with the current process for services and conservatorship Ideas for redirecting funding and working in collaboration with law enforcement How to take part in these efforts and weigh in on legislation, especially early in the process Our reflections on the interviews and the next steps

Fixing Mental Healthcare in AmericaAn interview with Dr. Nicole Eberhart and Dr. Ryan McBain from the RAND Corporation. Curt and Katie kick of their special series related to the problems and potential solutions in the mental healthcare system. We interview Drs. Eberhart and McBain about the study they authored related to the structural concerns in the mental health system as it is currently built and their recommendations for solutions and best practices going forward.Nicole Eberhart, PhD is a Senior Behavioral Scientist at the RAND Corporation and a licensed clinical psychologist whose research and evaluation focuses on mental health. She has expertise in health program evaluation, prevention and early intervention, health services and systems, and innovative care models including those that integrate primary and behavioral health care. Dr. Eberhart been evaluating mental health programs and policies in California and nationally for over a decade.Ryan K. McBain is a policy researcher at the RAND Corporation. He focuses on the design and evaluation of health policies and programs meant to reach vulnerable populations—including those coping with mental health conditions, HIV/AIDS, homelessness, and poverty. To achieve this, McBain has utilized a wide range of methodologies, including econometric approaches for quasi-experimental analysis, cost-effectiveness analysis, and decision analytic models, as well as key informant interviews and focus group discussions. Internationally, McBain has worked with the World Bank, World Health Organization, Harvard University and Partners In Health, where he has focused on evaluating mental health, HIV, and primary care service delivery systems, primarily in sub-Saharan Africa and Haiti. McBain holds a Ph.D. and M.P.H. in global health with concentrations in health economics and health policy analysis from Harvard University, as well as a B.A. in psychology from Gordon College and Oxford University in the United Kingdom.In this episode we talk about: Introducing our new series on Fixing Mental Healthcare in America RAND corporation report on the mental health system Structural issues in the current mental health system Work force issues, lack of professionals, poor distribution across communities Payment issues – Mental Health providers are not paid as well as other medical providers The problem of fee for service, government insurance programs, and private pay Culture problem – historical lack of value of mental health, stigma and de-prioritization of mental health Lack of educational programs for mental health, lack of consistent, effective crisis response The idea of increasing wages for entry level positions Peer Support Specialists as another way to expand mental health workforce The importance of lived experience and the professionalization of the peer support specialist profession (for example certification) The idea of paying for value rather than paying for services Focusing on prevention rather than costly emergency services The need for legislators to make changes The costs of not fixing the mental healthcare system An evidence-based continuum of care Taking a big picture approach (looking at the cost for services and the cost for society)

It’s NOT a Chemical ImbalanceAn interview with Dr. Kristen Syme on the situational and cultural impacts on depression. Curt and Katie talk with Dr. Syme about the role anthropology can play in helping to challenge long held assumptions in psychology. We look at conceptualizations for depression and suicidality and how the over focus (in the Western world) on the individual as the agent for mental health and wellness. We talk about how the chemical imbalance model doesn’t hold up as well as better explanations for depression and suicidality.  In this episode we talk about: Syme’s research and how she is working to challenging assumptions The lack of attention on networks and systems and an over-focus on “the self” as an agent for mental health and wellness How psychological pain is signaling us that there are things in our environment that are unhealthy for us Depression and psychological pain are not just within us, but also around us What is wrong with the idea of “chemical imbalance” model Adversity causes depression The problem of saying “there’s a pill for that” The work case for depression research Ethical issues related to medicating away depression or psychological pain How non-western cultures address psychological pain There is “not a direct translation for depression in any other language” – Kristen Syme The internal idea of the imbalance of black bile that leads directly through the ages to the concept of imbalance of serotonin How other cultures talk about depression and situations, with more refined, specific language How our language creates our reality around depression and how broadly we define it How common depression (as broadly defined) is in the modern world The lack of evidence for a “chemical imbalance” How big pharma has impacted the conceptualization of depression The inadequacy of treatment based on this conceptualization The causes of suicidality: sexual assault, forced marriages, abuse The problem of trivializing “seeking attention” The tendency of coming up with “the theory” Looking at how people might be better served by the mental health system The importance of creativity and novelty in identifying better treatment 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!Article: Mental health is biological health: Why tackling “diseases of the mind” is an imperative for biological anthropology in the 21st centuryDr. Kristen Syme on Twitter Dr. Kristen Syme on Google Scholar Relevant Episodes: Burnout or Depression Is Therapy an Opiate of the Masses? Connect with us!Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined Conferences Our consultation services:The Fifty-Minute HourCredits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Partners of TherapistsCurt and Katie chat about how our job and training can impact our partners. We look at the benefits like emotional intelligence, resilience, and perspective. We also look at the challenges therapists and their partners face when trying to navigate being in relationship while one partner is navigating this career. Suggestions about how to navigate conversations and confidentiality as well as possibilities for improving relationships are discussed.    It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.In this episode we talk about: The impact of being a therapist on long-term relationships/partnerships The insight into people and relationships that can be a benefit of partnering with a therapist Expecting that the therapist will be the expert or do the emotional lifting The concern that therapists overanalyze their relationships (don’t therapize me!) Therapists breaking down characters in movies and books and ruining things for our partners Positive communication and being able to navigate challenging conversations The desire to talk about the relationship more frequently than our partners The potential of differences when you start a relationship as a therapist or whether you start prior to becoming a therapist Using our training to do what “successful couples” do What might be different if one were to approach dating or starting relationships later The challenge of not being able to talk about work at the end of the day (confidentiality) Specific parameters around how to talk about one’s day (process versus content) When partners aren’t part of our field, they don’t understand how our field works or what our job entails The difficulty of processing trauma, countertransference, empathy fatigue Gaps in the relationships with our partners related to partners not being able to process and handle challenging material The challenge of leaving work at work, being able to relate to other people at the end of the day The impact of the pandemic on childcare and balance of parenting and coparenting Therapist dissociation and self-care When our profession is overtaxed and we are overtaxed, our partners and kids can get pushed to the side What therapists’ partners might need to be successful in these relationships The lack of resources and resilience during the pandemic The difficulty those who are in relationships with therapists understanding that they are human and that we are not always able to cope. How our knowledge and resourcefulness can help with us taking care of ourselves and meeting the needs of our partners The gratitude and love that we can share with our partners when we see how things go wrong Our capacity to have challenging conversations to improve relationships Emotional intelligence and perspective, self-awareness Resources mentioned:We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!Our Facebook GroupRelevant Episodes: Dating as a Therapist Therapy with an Audience Off Duty Therapist Connect with us!Our Facebook Group – The Modern Therapists Group Get Notified About Therapy Reimagined 2021 Our consultation services:The Fifty-Minute HourCredits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano http://www.crystalmangano.com/ 

Bilingual SupervisionAn interview with Adriana Rodriguez, LMFT, about how to support bilingual, bicultural therapists. Curt and Katie talk with Adriana about her experiences as a clinician as well as her perception of the systemic concerns that bilingual/bicultural therapists face. We also dig into common work challenges for these clinicians, the ethical and competency concerns monolingual supervisors face, and specific action steps for individuals and organizations to increase the quality of supervision and training for these clinicians.  It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.Interview with Adriana Rodriguez, LMFT (She/Her/Ella)Adriana Rodriguez (She/Her/Ella) is a California Licensed Marriage and Family Therapist, she obtained a BA in Sociology from Sacramento State and a MA in Counseling Psychology from the University of San Francisco. Adriana is a bilingual, queer, Salvadorian immigrant woman who is passionate about destigmatizing mental health. Adriana’s lens is intersectional, she is passionate about understanding how intergenerational trauma compounded with personal trauma impacts the mental health of first-generation adult children of immigrants and QTBIPOC. Adriana works with individuals and dyads in private practice in Sacramento, CA.In this episode we talk about: Adriana’s story as a bilingual, bicultural therapist who immigrated from El Salvador Experiences of immigration, learning English, and trauma Criticism, bias, and navigating a different culture The impacts of uninformed supervision on bilingual or monolingual clients The requirement to build one’s own tools (i.e., translating documents) What is getting lost in translation – linguistic, cultural, etc. The importance of understanding context The power differential within the clinical supervision How do I level the playing field and share the power? Sharing knowledge (rather than seeing the supervisor as the only person who has knowledge in the relationship) Acknowledging and talking about differences Ethical concerns and supervisor responsibility The systemic challenges that bilingual clinicians can face in getting hired or promoted The need for greater diversity in leadership roles The idea of “first generation everything” The make up of the job for bilingual clinicians Survivor guilt – immigrating, learning English, education, and making it professionally The identification and desire to empower clients that remind you of yourself, your family members The exploitation of that desire by agencies who do not have sufficient bilingual clinicians How frequently bilingual clinicians have large caseloads and not sufficient compensation or matching or curating of caseloads The risk for burnout for these clinicians The complexity of translation The need for more research around the impacts of monolingual supervisors providing supervision on bilingual clinicians (as well as the impacts on monolingual or bilingual clients) The constant need for self-awareness and re-examining your bias Making sure to understand the differences between personality and culture Adjusting case conceptualization, looking at the triad of supervisor-clinician-client

Therapy with an AudienceAn interview with Doug Friedman, LCSW, the host of Your Mental Breakdown, on why he chose to record therapy sessions for his podcast. Curt and Katie talk with Doug about the logistics and benefits of publicly providing therapy. We also look at how podcasting can decrease stigma and open up flexibility to learn as a therapist (rather than rigidly holding to a modality or to an expert status that doesn’t allow for mistakes).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 Doug Friedman, LCSWDoug Friedman is a Licensed Clinical Social Worker in private practice in Los Angeles. He has spent nearly 20 years working with adults, adolescents and families with issues ranging from depression and anxiety to substance abuse, bipolar disorder and PTSD. He has supervised programs in community mental health settings and he continues to provide clinical supervision to therapists in his private group practice, Clear Mind Full Heart. Doug is the creator and co-host of the mental health/entertainment podcast, Your Mental Breakdown.Doug received a Masters in Social Work from The Catholic University of America and a BA in Study of Religion from UCLA. Before becoming a psychotherapist, Doug worked for a music management company that oversaw bands like Nirvana, Foo Fighters, Beastie Boys, and Bonnie Raitt. Doug is also the artist and songwriter behind all the music heard on the podcast, Your Mental Breakdown.In this episode we talk about: Doug’s mission of normalizing therapy and decreasing mental health stigma The importance of learning as a therapist and exploring mistakes or alternatives The experience of being a therapist on a public-facing podcast Why Doug doesn’t hold a modality sacred How therapy serves the client as a focus for treatment The logistics of setting up the podcast (laws, ethics, etc.) Navigating the relationship with the client on the podcast (dual relationships, confidentiality) The benefit of recording sessions and reviewing them later Exploration of opportunities and different choices that we can make in the room Cohost rapport and trust, inquiry, love, disagreement, calling out The comfort level in being recorded for a podcast: shifting from one on one to a public audience Creating a system to keep the work of making the podcast sustainable Being vulnerable and authentic as a value Being an expert does not mean having the right answer in the room, but knowing how to find the answer and seek additional advice How other clients respond to Doug’s podcast The possibility of the public persona and “fame”

Episode 200: Mail Bag!Curt and Katie reflect on 200 episodes, answer questions and respond to feedback from listeners. We explore the tension between making a good living and providing affordable mental health care to consumers. We dig into paying prelicensed individuals, antitrust concerns, training centers, ethics codes, app therapy, setting fees, and therapist career trajectories.        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: Celebrating 200 episodes! Question about how to make money and help to provide affordable access to clients Systemic challenges and the phases of change to the system Individual responsibility and the problems of this individual responsibility to therapists The way in which we can take action to make our careers more sustainable, while also advocating for change The debate about unpaid internships, training centers, and free labor (which is against the law) Online App Therapy – whether it is hurting the field and gaslighting therapists Sliding scale, setting fees, and why therapists’ rates vary so widely Why people don’t stay therapists, feel the need to become a thought leader Reflections on 200 episodes  Resources mentioned:We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! CAMFT’s statement on Paying Prelicensees as a Best PracticeDepartment of Labor Statement on Internship Programs Robert Casares Jr. (2020): Embracing the Podcast Era: Trends, Opportunities, & Implications for Counselors, Journal of Creativity in Mental Health, DOI: 10.1080/15401383.2020.1816865

Why Therapists Quit Part 2Curt and Katie chat about the response from listeners to our episode on why therapists quit. We look at the differences in responses (those who felt angry and those who felt validated) as well as our reasons for doubling down. We also dig into the differences between pessimism and realism, pairing our realistic take on the current problems with a call to action that aspires to change the systemic problems we’ve started to outline.    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: Responding to listener feedback on Why Therapists Quit The critical feedback we received related to the “negative tone” we put forward The positive feedback from listeners who felt seen The different stages of individuals’ careers and how they responded Assessing whether we are doing the profession a disservice by speaking the truth of our experiences and the problems we see in the profession How the knowledge of the information that this job is hard can impact the relationships with our clients, consultees, supervisees, etc. “Saving Psychotherapy” by Dr. Ben Caldwell The individual responsibility that clinicians are taking for systemic issues The problem when we don’t understand the system before we’re deep into the career The expectation that therapists must be good all of the time – which is unrealistic How we’re looking for ways to improve the therapy system, the mental health profession, etc. The responsibility we feel to help change How critical it is to frame the problem before you can solve Why it is important to opt in to a job, warts and all The problem of idealizing the profession Our plan for a new series that talks about the state of mental health care Differentiating between realism and pessimism The values systems for therapists that can be challenged by the system The response from therapists who may be more pessimistic than Curt and Katie are at this time A call to action to reach critical mass in order to make a change The people who don’t make it into the profession for many different reasons The shifts in the smaller systems (improving work environments) Whether our clients listen and what they might think about what we’re talking about Our responsibility in our role in this podcast, to make the profession better How we’ll be moving forward in an upcoming series, looking for solutions

Infertility and Pregnancy LossAn interview with Tracy Gilmour-Nimoy, LMFT, on understanding infertility as well as pregnancy and infant loss. Curt and Katie interview Tracy, a certified perinatal mental health professional, on what the medical and mental health professions often miss related to reproductive health and pregnancy. We dig into the basics and common mistakes as well as the harm caused when therapists are uninformed. We explore trauma, grief, and the invisibility of these common struggles faced by some who want to have children. 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 Tracy Gilmour-Nimoy, LMFT and Certified Perinatal Mental Health ProfessionalTracy is a Licensed Marriage and Family Therapist and Certified Perinatal Mental Health Professional. She has a group practice in San Diego, CA, where she specializes in working with individuals who have experiences of trauma, depression, anxiety, reproductive mental health, perinatal mental health, maternal mental health, paternal mental health, grief, loss, life transitions, and relational challenges, to name a few. In addition to her love of mental health, Tracy is an avid reader and writer. Her articles have appeared on her mental health blog and other public forums, such as Scary Mommy. She writes about varying mental health topics, as well as her personal experiences of infant loss, grief, and trauma. To learn more about Tracy, connect with her on Instagram @TGNtherapyIn this episode we talk about: What we missed in our episode about navigating pregnancy How hidden infertility and pregnancy loss is in society, how the conversation is taboo The lack of trauma-informed care within the medical field The problems of assumptions around fertility and whether people want children The way that common questions can be triggering and traumatizing How dismissive of the grief people are when it deals with infant and pregnancy loss The rose-tinted lenses that hurt women during the whole process of getting pregnant and having a baby How hidden it is and how little discussed are all the stages of women’s development The gaps in therapist training related to infertility and pregnancy/infant loss The focus on the baby versus the parent Ideas for advocacy within the educational and medical systems The discomfort with sitting with these types of experiences and losses The tendency of people wanting to fix it and move forward without accounting for loss and recognizing when it cannot be fixed The shadow losses and losses of an absence Holding space for grief and loss, for how horrible it is What therapists need to know about infertility The importance of understanding the medical terminology, the financial burden, the emotional implications of the fertility process The internal focus on how the body works and what to do for your body The identity aspects related to motherhood or not becoming a mother What therapists need to know about pregnancy and infancy loss The perception of the death of their child Traditions to honor the child who didn’t come home The importance of remembering dates for individuals who have infant and pregnancy loss Acknowledging loss, using language or names that are relevant Honoring how they view their parental status after a loss

Why Therapists QuitCurt and Katie chat about the systemic reasons that therapists leave the profession. We look at the work environment, the infrastructure of community mental health, as well as the frequent ways that therapists set up their own private practices. We also identify changes on a systems level as well as calls to actions for individuals who would like to continue as a therapist.  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: Challenges in the mental health system leading to therapists quitting the profession Why therapists don’t stay therapists when they wanted to stay therapists Obstacles and lack of opportunities The lack of quality of supervision or inadequate training for other elements of the job The lack of research on therapist workforce issues Not a lot of empathy for therapists as we “chose” to do this Caseload sizes, the weight of carrying the challenges of many people Niche fatigue and hearing the same story over and over The challenge of holding the hope for clients and communities The heaviness and the boredom of hearing so many similar conversations The full workload including paperwork and other consultations, case management and advocacy Who is drawn to the work, the desire for deep and meaningful work, and the problems of the bureaucratic system in providing meaningful work The training doesn’t match the actual job The status quo and inertia in the work, while at the same time that all the changes that happen in the other pieces of the profession Productivity standards and billing, differences in philosophy Systemic problems with under and unpaid services and requirements What we’re asking from the professional organizations and the challenges that professional organizations may have in advocating for these types of systemic changes What could actually move forward in legislation The issues related to antitrust People are more concerned about our patients than about therapists Why clinicians in all settings (including community mental health, private practice, etc.) The sameness of the workload when you’re in private practice The isolation as a therapist Increased demands with higher demand, less delineated work/life balance The appeal of a job where you can just show up The weight we carry as business owners, including decision-making and responsibility to generate income The benefit of diversifying your caseload Calls to action: advocating for quality workplaces, finding peer support, setting boundaries for yourself throughout your professional journey, what we can do if enough of us make these changes The time is now to address mental health systemic problems – shining a light on how we are well-situated, making sure we are paid, and sharing messages to support the community