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

REPLAY - Therapists Are Not Robots: How We Can Show Humanity in the RoomWe’re on vacation, but wanted to share one of our favorite episodes with all of you. We start with a quick reflection on the episode and what we’ve learned since it originally aired. Today’s replay is of Episode 255: Therapists Are Not Robots: How we can show humanity in the room. We talk vulnerably about how we have managed some pretty challenging life crises while also being therapists. You can see the original show notes and transcripts for episode 255 here: Therapists are Not Robots.

What Do Therapists Need To Do About Medicare? Opting in or out for 2024: An interview with Joy Alafia, CAECurt and Katie interview Joy Alafia, Executive Director of California Association of Marriage and Family Therapists, on the journey for MFTs and Counselors to become eligible to be Medicare providers. We look at the high-level tasks that every therapist needs to take. We also talk about the decision-making process for whether you should opt in or opt out, providing some basic guidance and resources on the steps you need to take now.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode, we talk about MFTs and Counselors becoming Medicare ProvidersCurt and Katie have spent hours in advocacy efforts for MFTs and Counselors to become Medicare providers through their past involvement in the California Association of Marriage and Family Therapists (CAMFT). And it’s finally gone through! We asked Joy Alafia to come join us to discuss this journey as well as what therapists need to do now that we’re eligible to be Medicare providers. We answer the following questions and have a step by step guide in our show notes at mtsgpodcast.com:What was the process for MFTs and Counselors to be included in Medicare?Now that Marriage and Family Therapists and Counselors are eligible to bill Medicare, what do we need to do?What do therapists need to do if they would like to Opt In to provide Medicare services?What do therapists need to do if they would like to Opt Out of billing Medicare?What should therapists consider when deciding whether to take Medicare?·      Clinical specialty – if you work with folks 65 and older or with disabled folks, you will want to strongly consider taking Medicare as these clients are typically eligible and would like to use their insurance·      Access – if you have the ability (i.e., space in your caseload) to see Medicare patients, there is a huge need for providers who accept this insurance·      Credibility – there is increased credibility as a provider when you are able to take Medicare·      Rates – check out what the rates are for the areas where you see clients. To do so, look for your locality on the Physician Fee Schedule and multiply the rates by 75% if you are a masters level provider. If the rates are sufficient, you will consistently get clients and will consistently get paid. If the rates are not sufficient for your business, you will want to consider opting out and remaining private pay for these clients.·      Documentation requirements – the documentation requirements are similar for most insurance plans, especially Medicaid. If you’re able to keep clean, efficient documentation, this should not be a deterrent for taking Medicare·      Billing complexity – you will want to make sure to take trainings available (see below) to understand how you will need to bill this insurance plan and/or hire a biller who does·      Consistency and recession-proofing your practice – Medicare is known to pay consistently and provide a lot of clients for your practice. As the population ages, this will be a larger and larger portion of the folks seeking mental health services. You may want to consider taking Medicare.Resources for Modern Therapists mentioned in this Podcast Episode:We’ve pulled together LOTS of resources mentioned in this episode and put together some handy-dandy links.California Association of Marriage and Family Therapists (CAMFT)California Association of Marriage and Family Therapists (CAMFT)CAMFT’s Medicare Corner (for CAMFT members)CAMFT’s Medicare WebinarsA TON of other Resources can be found on our website at mtsgpodcast.com.Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:Our Linktree: https://linktr.ee/therapyreimaginedModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/

How Can Therapists Take a Real Vacation?Curt and Katie chat about how therapists can take extended time away from their therapy practices. We talk about how to budget time and money for vacation as well as what therapists need to have covered when they’re gone. We also look at how to mitigate foreseeable risk and manage continuity of care.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about how therapists can get time away from workWe’ve heard too many people talking about the challenges of taking time off when you’re working as a therapist.How can therapists budget for time off?·      Determining fees based on time you’re actually working (i.e., charging more or determining number of weekly sessions based on when you can be away)·      Scheduling based on diminishing the number of actual missed sessions (i.e., scheduling vacations when your clients are on vacation and/or taking long weekends and moving clients within the week to take partial weeks off)What do therapists need to cover when they go on vacation?·      Clinical coverage within your practice or with colleagues·      Identify when you’re on-call and how you navigate that within your vacation·      Supervision coverage planning·      Understanding when you can respond to clients or supervisees (i.e., being in wise mind)·      Safety planning with clients, including coverage plan and/or when you’re availableHow can therapists mitigate the clinical risks for taking longer vacations?·      Determining when you should stop taking new clients before a longer vacation·      Teaching your clients to be okay without you·      Flexibility on when you take time away and how to take time away from the office·      Planning for foreseeable risks·      Homework or other resourcesWhat does a hybrid work vacation look like?·      Virtual work as needed·      Creating times/spaces for clinical sessions and follow up·      Make sure you have sufficient wifi or cell reception and privacy·      It’s important to make sure you get downtime and aren’t constantly workingWhy is it important to take time off when you’re a therapist?·      Getting rejuvenated and living life·      Working to prevent burnout·      Renewed sense of energy within the profession·      Our job is to talk about pain and suffering and there is so much pain and suffering in the world, so it is important to get restorative breaksStay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:Our Linktree: https://linktr.ee/therapyreimaginedModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/ 

The podcast explores religious trauma and high-control religions with expert Anna Clark Miller. Topics include the impact of religious trauma, common therapist mistakes, and healing after leaving high-control religions. The discussion covers therapy approaches, rebuilding lives post-religion, rigid thinking, LGBTQ+ trauma, and therapist training for religious trauma.

How Much Autonomy Do Therapy Clients Deserve? Balancing client autonomy with therapist skillCurt and Katie chat about client autonomy. We look at what patient autonomy is and what therapists need to understand about this very complex topic. We explore how therapists can overstep or abdicate their role in supporting their clients in making decisions. We also look at what true informed consent is and the dimensions of client autonomy. This is an ethics continuing education podcourse.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about client autonomyTherapists are faced with balancing their professional knowledge with the needs and desires of clients. At the core of this issue is the principle ethic of client autonomy. How much autonomy do therapists need to give clients? What do therapists do when clients don’t have the capacity for autonomy in the first place? This workshop explores the considerations that therapists must face when balancing the needs of clients with professional mental health services.henWhat is patient or client autonomy in mental health?·      Clients making decisions about their treatment based on solid information and an understanding of that information·      There is a debate related to whether we defer to clients’ decisions no matter what versus standing in the role of professional therapistWhat do therapists need to understand about client autonomy?·      There is a lot of complexity and nuance related to therapist responsibility as professionals versus when therapists can become too paternalistic·      There is a not a lot of discussion within the ethics codes related to client autonomy, they are usually in the preamble, so it is more important while also be less discussed·      Freedom (or liberty) to make choices versus agency (or capacity) to understand the choices·      Therapists need to clarify for clients the options and make sure they can make informed decisionsHow is informed consent related to client autonomy?·      If clients don’t know what their therapists are doing, do they have client autonomy?·      Evaluation of whether someone has the capacity to make treatment decisions can be impacted by bias, but is the role of the therapist within the mental health treatment·      We don’t want to equate autonomy with autonomous decision-makingDimensions of client autonomy and the therapist’s responsibility·      Decisional dimension – being able to plan and make decisions about their mental health treatment·      Executive dimension - being able to follow through on the plans made·      Therapists need to be able to step forward and provide additional support to clients to bring them back to autonomy or hold a line in treatment that will and will not be offered·      Informed dimension - understanding the difference between informed consent and informed assent and being able to give instructions ahead of time if have a mental health crises·      Looking at a “Mental Health Advanced Directive” – one example is the Wellness Recovery Action Plan (see the resources section in the show notes).Paternalism and client autonomy·      Not all “paternalism” is wrong – when clients are unable to care for self, they may need some paternalism to be able to be safe or get the treatment that they need·      Asymmetrical versus libertarian paternalism is discussed·      The importance of understanding your own bias and how the way you frame options can be manipulativeReceive Continuing Education for this Episode of the Modern Therapist’s Survival GuideContinuing Education Information including grievance and refund policies.Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:PatreonBuy Me A CoffeeModern 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’s Confidential and What’s a Secret? Navigating “No Secrets” PoliciesCurt and Katie chat about no secret policies. We look at what they are, what needs to be in these policies, how to navigate secrets in therapy, the importance of these policies in relational therapy, and the complexity of “no secrets” when working with kids and teens.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about no secrets policies in therapyIn our continuing efforts to touch on all the topics that therapists need to know about, we decided to dig deeply on no secrets policies.What is a no secrets policy?·      Typically, these types of policies are created for relational therapy·      “No secrets” means that the therapist will not keep a secret that is clinically relevant from a member of the treatment unit, even when someone contacts the therapist outside of session·      This policy needs to be understood by all the members of the treatment unitHow can therapists navigate secrets in therapy?·      If there is communication outside of therapy, it is important to hold the boundaries within your no secrets policy·      Flexibility related to when and how secrets are shared (versus rigidity and immediacy)·      Explicit discussion around exceptions of the “no secrets” policy related to intimate partner violence·      It is important to have a clinical evaluation of when and how the secret is shared into the treatment unit and whether the secret is clinically relevant to the treatment unit·      Clarify the treatment unit and clinical orientation to sort through what needs to be in your secrets policy·      Determining how not to be triangulated by members of the couple or familyWhat needs to be in a therapist’s secrets policy?·      Clear guidance on who is included in the treatment unit·      What secrets will be kept or not kept (e.g., intimate partner violence)·      How secrets will be handled as they come up·      Assessment of the capacity of each member of the treatment unit to participate in these conversations about confidentiality and secretsWhat about no secrets when you’re working with kids and teens?·      Clarity on the treatment unit (individual kid or family, etc.)·      Identifying how confidentiality is held for kids and teens·      Working with the kids and teens to plan for disclosure to caregivers·      For parents of young/school-aged children, there may be work to help caregivers to disclose information appropriately over time (thus the therapist holds the secret for a period of time)Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:Our Linktree: https://linktr.ee/therapyreimaginedModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/

Is This My Stuff? How therapists can sort through countertransference: An Interview with Dr. Amy Meyers, LCSWCurt and Katie interview Dr. Amy Meyers on countertransference. We talk about what countertransference is, how therapists typically struggle when working in the transference and countertransference, how the profession’s relationship to countertransference has changed, and what therapists can do to better understand themselves. We also talk a bit about the blank slate.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode, we look at countertransferenceWe’re talking about a topic we haven’t touched on yet: countertransference. We are joined by an expert in countertransference, Dr. Amy Meyers, LCSWWhat is countertransference?·      Beyond self-awareness and understanding oneself·      We have experiences and make them our own and expect people to respond to me in the same way as others have in the pastWhat do therapists struggle with when addressing transference and countertransference?·      When therapists don’t know themselves well enough, they will not be able to identify when countertransference is coming up·      Therapists will often avoid conflict or put too much of themselves in the room without full assessment·      Therapists misunderstand the utility of countertransference and try to avoid it·      Simplification of the blank slate. Dr. Meyers’ understanding is that it is avoiding unintentionally putting your emotions in the session, which gets in the way of clients’ projecting emotions on the therapist (transference)How should therapists be taught to use countertransference?·      Looking at how you feel about the interactions with your clients and your feelings about your clients as individuals·      Treating therapists as human beings with emotions and explore how their humanity interacts with their work with their clientsHow has the field changed its relationship with countertransference?·      People have moved into quicker therapy and more manualized treatments·      There is less focus on longer term, relationship based treatment rather than tools and strategies·      Supervisors and trainers are less focused on training therapists in this element of the workWhat can therapists do when they become aware of their countertransference reactions·      Considering other options rather than what is familiar·      Using the relationship in therapy as a corrective emotional experience·      We discuss a couple of case examples to explore how to work with countertransference with real clients·      Sorting out what is self-disclosure versus use of self in session and how are each can be helpful·      Go to therapy·      Go to supervision·      Learn and read more about countertransferenceStay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:Our Linktree: https://linktr.ee/therapyreimaginedModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/

Decolonizing Therapy: A Movement - An Interview with Dr. Jennifer MullanCurt and Katie interview Dr. Jennifer Mullan about decolonizing therapy. We discuss what it means to decolonize therapy and the importance of doing so, as well as the challenges therapists face when they are looking to decolonize their practices and incorporate cultural and community healing. We also explore rage, the tendency to pathologize big emotions, and the impact of historical trauma.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode, we look at what it means to decolonize therapyOver time we’ve talked with innovators who are pushing back against the status quo and the medical model. We were so excited to dig more deeply into Decolonizing Therapy with Dr. Jennifer Mullan.What does “decolonizing therapy” mean?·      Looking at accessibility to therapy and how lack of access impacts individuals·      Decolonizing therapy doesn’t work for everyone, especially folks in the global majority and/or who have the most need·      The way that therapy is practiced is not sufficiently addressing the mental health crisis·      Shifting therapy to include cultural healing practices, community healing and support·      Moving the “blame” for poor mental health away from the individual to the individual’s contextWhat can therapists do if they would like to decolonize their own therapy practice?·      Make sure you are doing your own work and have support while working in the role of healer·      Identifying and accepting that all individuals have social, political and other frames that come in with them to the therapy room·      Unlearning and embracing new knowledge, being okay with not knowing·      Looking at historical trauma and colonization as core attachment wounds·      Understanding how historical events impact your clients (and yourself)·      Looking at how historical trauma is transmitted directly and indirectly·      Learn in community·      Rethink diagnosisWhat can therapists get wrong when they are working to decolonize their therapy practice?·      Struggling to see where compliance can conflict with the needs of clients at times·      The impact of diagnosis on clients (especially behavioral diagnoses frequently given to Black and brown boys that often lead a child into the school to prison pipeline)·      Not understanding larger concepts around what is political and big questions like why are people poor?·      Deflecting questions from clients as being clinical material rather than understanding that clients are seeking a human connection·      Holding to firmly to rigid “rules” around attendance and coming on time, for exampleHow can therapists work with rage and other big emotions?·      It’s important to recognize that we are not receiving sufficient education around rage·      It is important to understand what rage and what it is not·      Grief, shame, and trauma lead to rageStay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:Our Linktree: https://linktr.ee/therapyreimaginedModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/

Should Therapists Admit to Making Mistakes in Therapy?Curt and Katie chat about what therapists can do to effectively navigate their own mistakes in the therapy room. We look at what constitutes a mistake in therapy, the types of mistakes that therapists make, and considerations on how to address mistakes. This is an ethics continuing education podcourse.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about how modern therapists can navigate making mistakesWhen therapists make mistakes, clients can prematurely terminate treatment or fail to meet their goals. Most research on effective therapy looks at factors that minimize the therapist’s tendency to make mistakes, rather than what to do when they happen. However, focusing on the effectiveness of handling mistakes is one of the factors that clinicians can actually control. This workshop focuses on how effectively handling mistakes made by therapists and the mental health system can lead to better outcomes for clients.What should therapists do when they make a mistake?·       Looking at the humanity of the therapist·       It is important to define what is actually a mistake·       Looking at where mistakes can happen within treatment·       Mistakes can be defined based on the definition of successWhat types of mistakes do therapists make in therapy?·       Incorrect or mismatched treatment without adjustment·       Treatment failures happen for many different reasons – what is a mistake versus a work in progress?·       Mistakes can be based on the individual client or therapist factors and the focus of the therapist in the therapeutic work and relationshipWhen should therapists admit mistakes?·       Consideration of whether admitting the mistake will harm the client·       Going beyond “non-malfeasance”·       Exploring how clients like to handle a mistake·       Paying attention to therapist’s own preferences or bias·       Understanding when and how to take responsibility for what you’ve done as a therapist·       Avoiding the impact on the client that they believe that they have made the mistake·       Making sure therapists are resourced when they engage in this processWhat are the systemic errors in mental health treatment?·       Taking a global view to therapy can allow for seeing the other elements and systems·       Recognizing the limits of what therapists can do to solve clients’ concerns, including due to agency policies·       Harm caused by the profession and professional associations (statements made, research completed, etc.)Receive Continuing Education for this Episode of the Modern Therapist’s Survival GuideContinuing Education Information including grievance and refund policies.Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:PatreonBuy Me A CoffeeModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/ 

Is BPD a Genuine Diagnosis or a Dismissive Label?Curt and Katie chat about whether (or not) Borderline Personality Disorder is a useful diagnosis. We look at the difficulty in differential diagnosis, the huge overlaps with other diagnoses, and the harm caused by misdiagnosis and dismissal of these clients. We also explore whether BPD is just complex PTSD in disguise. We don’t come to total agreement, but we get a little bit closer on how we can move past the harmful elements of the BPD label. Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we explore the diagnosis of Borderline Personality DisorderAfter reading an article that suggests that there is no clinical utility to the BPD diagnosis, we decided to dig into whether or not BPD is a diagnosis worth using. We struggled to get this episode recorded as we started from a place of deep disagreement. We were able to get to a helpful conversation, we think.Why is Borderline Personality Disorder controversial?·       It is heterogeneous·       There are a lot of rule outs and overlap with other diagnoses·       There may not be clinical utility in using this diagnosis·       There is bias and judgment related to having this diagnosis·       There is a lot of harm from misdiagnosisWhat are the problems and challenges in diagnosing “BPD?”·       Overlap with autism, psychosis, complex or chronic trauma and others·       Must look at the causes rather than solely the symptoms·       The ongoing complexity of how trauma interacts with other elements of a person’s experience and personality make it hard to tease out what is really going onHow is Borderline Personality Disorder distinct from Chronic PTSD?·       First you must understand the relationship between PTSD and Chronic or Complex PTSD·       A theory is that Chronic PTSD has more relational avoidance than BPD·       Another theory is that BPD has an absence of sense of self, which CPTSD does not·       There is literature that shows that not all patients with BPD have trauma historyShould BPD remain as a recognized diagnosis in clinical practice?·       We’re still not sure and don’t completely agree·       At the very least, it needs to be renamedStay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:Our Linktree: https://linktr.ee/therapyreimaginedModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/