The Modern Therapist&#8217;s Survival Guide with Curt Widhalm and Katie Vernoy

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How Much Autonomy Do Therapy Clients Deserve? Balancing client autonomy with therapist skill Nov 27, 2023

Show notes

How Much Autonomy Do Therapy Clients Deserve? Balancing client autonomy with therapist skill

Curt 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 autonomy

Therapists 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.hen

What 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 therapist

What 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 decisions

How 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-making

Dimensions 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 manipulative

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Continuing Education Information including grievance and refund policies.

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What’s Confidential and What’s a Secret? Navigating “No Secrets” Policies Nov 20, 2023

Show notes

What’s Confidential and What’s a Secret? Navigating “No Secrets” Policies

Curt 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 therapy

In 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 unit

How 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 family

What 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 secrets

What 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)

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Is This My Stuff? How therapists can sort through countertransference: An Interview with Dr. Amy Meyers, LCSW Nov 13, 2023

Show notes

Is This My Stuff? How therapists can sort through countertransference: An Interview with Dr. Amy Meyers, LCSW

Curt 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 countertransference

We’re talking about a topic we haven’t touched on yet: countertransference. We are joined by an expert in countertransference, Dr. Amy Meyers, LCSW

What 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 past

What 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 clients

How 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 work

What 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 countertransference

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Decolonizing Therapy: A Movement - An Interview with Dr. Jennifer Mullan Nov 06, 2023

Show notes

Decolonizing Therapy: A Movement - An Interview with Dr. Jennifer Mullan

Curt 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 therapy

Over 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 context

What 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 diagnosis

What 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 example

How 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 rage

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Should Therapists Admit to Making Mistakes in Therapy? Oct 30, 2023

Show notes

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 mistakes

When 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 success

What 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 relationship

When 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 process

What 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 Guide

Continuing Education Information including grievance and refund policies.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Is BPD a Genuine Diagnosis or a Dismissive Label? Oct 23, 2023

Show notes

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 Disorder

After 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 misdiagnosis

What 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 on

How 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 history

Should 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 renamed

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Dealing with “Therapy Doesn’t Work” Oct 16, 2023

Show notes

Dealing with “Therapy Doesn’t Work”

Curt and Katie chat how to engage with people who doubt the efficacy of therapy. We look at how to address general skeptics, mandated clients, hesitant prospective clients, and uncertain longer-standing clients. Spoiler alert: validation, understanding, and coming back to the relationship go far.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we explore how to talk with folks who don’t believe in therapy

In response to a Reddit thread asking how therapists can respond when someone says they don’t believe in therapy or that therapy doesn’t work.

How can therapists respond when someone says, “therapy doesn’t work?”

· Therapy is not for everyone

· Validating concerns

· Work to understand their previous experiences in therapy

· Acknowledge problematic elements in therapy

How do you approach clients who are mandated or forced into treatment?

· Working with resistance

· Going back to the relationship and shared goals

· Meeting client where they are

What can therapists do when parents don’t believe in therapy for their kid?

· Understanding fear or concerns

· Joining and building rapport

· Exploring their goals for their child

· Seeking engagement and involvement

· Don’t throw evidence-base at them

· Explaining how therapy works for kids

· Avoiding defensiveness on the part of the therapist

How can you explain therapy to a hesitant client considering therapy for the first time?

· Validation of fears and concerns

· Acknowledging challenges in coming into therapy

· Identifying what would be most helpful to address in therapy

· Trying to break through preconceived worries about it not working

· Exploring how to find a good match

· Describing what therapy can look like

· Explain that therapy might not be the only answer (e.g., coaching, social work, meds, etc.)

The importance of being able to describe what therapy is like with you

· Curt’s suggestion of having a casual conversation with a colleague to describe what your therapy look like

· Know how to describe your approach to people who don’t know what therapy is

· Not every client is best for you

· Focusing on the relationship you will provide to the client

What are the options for talking with long term clients who are doubting therapy?

· Use the concerns clinically

· Validating concerns

· Coming together related to expectations and goals

· Acknowledging when therapy isn’t working

· Reframing incremental progress

· Therapists seeking consultation and supervision, so these conversations don’t feel painful

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Is Your Therapist Website ADA Compliant? An Interview with Anita Avedian, LMFT Oct 09, 2023

Show notes

Is Your Therapist Website ADA Compliant? An Interview with Anita Avedian, LMFT

Curt and Katie interview Anita Avedian, LMFT about her recent experiences related to an ADA complaint on her website. Anita shares with us how she has navigated this lawsuit and what she’s learned about ADA Compliance for websites. We also talk about the predatory lawsuits on small businesses in California and the benefits of becoming ADA compliant for therapists.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we look at what therapists should know about ADA compliant websites

Our friend, Anita Avedian, LMFT, just went through a legal complaint related to her website. It was found to not be ADA compliant, meaning that she had to pay some fines and update her website. She wanted to share what she learned, so we thought – let’s bring this conversation to the podcast!

What is needed for a website to be ADA compliant?

· Images have to have alt text

· Videos have to have closed captioned at 95% accurate

· Videos need both closed captions and transcripts

· Contrast colors need to be far enough apart for visibility

· Appropriate font sizes

· Buttons and navigation system have to be ADA compliant

· You cannot have PDFs on your website, you must have documents

· When you are cited, you have to make corrections and keep it up

What goes into an ADA compliance lawsuit against a website (including therapist websites)?

· There are predatory lawyers who are seeking out noncompliance to open lawsuits with small businesses

· There are thousands of lawsuits

· Your liability insurance doesn’t cover these claims because it is considered discriminatory

· Oftentimes you don’t know that you’re being sued

· There is not an opportunity to make corrections, you are fined and must make corrections immediately

· There is usually oversight and monitoring for 5 years

How can therapists make their websites more accessible?

· Accurate transcripts and closed captioning for videos

· Making sure that you are at least 95% compliant by doing a free scan

· Using some of the resources listed in the show notes on our website at mtsgpodcast.com (in the resources section)

· Having a deep scan to identify how close you are to compliance

· Making sure that your web developers know how to make your website ADA compliant

· There are attorneys to help with this process and can provide training on how to make a website ADA compliant

· Side benefits of improved SEO and Google standing

· There isn’t currently a widget to make your website ADA compliant and website themes and templates do not have these requirements built in structurally

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Voice Over by DW McCann https://www.facebook.com/McCannDW/

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We Answer the Question: Is EMDR a Pyramid Scheme? Oct 02, 2023

Show notes

We Answer the Question: Is EMDR a Pyramid Scheme?

Curt and Katie chat about an episode of Very Bad Therapy that asks the question, Is EMDR a Cultish Pyramid Scheme. This is our response to that question. We talk about what EMDR is, common misconceptions of the model, the concerns with people doing EMDR poorly, and the benefits of this model. We also talk about clinician factors that impact whether someone can do EMDR well.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we explore EMDR

We decided to respond to an episode of Very Bad Therapy. Curt is an EMDR clinician and consultant in training, so he wanted to respond to the criticisms of EMDR that were brought forward in that episode as well as a related article in The Therapist magazine.

What is EMDR?

· Eye Movement Desensitization and Reprocessing

· The mechanism of action is hard to study due to not being able to cut open the brain

· EMDR is a well-defined 8-stage protocol

· The “greatest hits” of other theories put together

What are the misconceptions related to EMDR?

· “It’s expensive,” but the training (which is intensive and comprehensive) breaks down to $35 per CE – a usual and customary rate for continuing education

· There is an argument that the only things that are different from other theories are the eye movements or bilateral stimulation, but it is more of an integrative model

· “EMDR” is manualized and only taught in one way – which is not true. There are a number of stages in the protocol that are taught very differently and there is more nuance

· The criticisms about EMDR may be related to clinician factors, not necessarily model factors

What are the concerns with people doing EMDR poorly?

· Only getting the EMDR certification to be marketable

· Not doing EMDR soon enough and forgetting the model

· Lack of confidence that leads them to revert back to theories they are comfortable with

· Not fully learning the theory and trying to use it outside of the model

· Clinicians with less training or less experience may struggle to adapt the model to complex trauma or relational trauma

What are the benefits of EMDR?

· Intensive training with deliberate practice being built into the certification

· Consultation and support in learning the model

· Strong research base for single incident trauma

· For stronger or more experienced clinicians, there are uses of EMDR for complex trauma and/or transdiagnostic purposes

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: