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

Modern 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 Can Therapists Do When Clients Don’t Getting Better? Jul 10, 2023

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What Can Therapists Do When Clients Don’t Getting Better?

Curt and Katie chat about what modern therapists can do when their clients don’t (or can’t) get better. We explore what “getting better" looks like in therapy, what can get in the way of clients improving, how we can support clients who are unable to reach traditional treatment goals, and how clinicians can take care of ourselves while doing this longer-term work.

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

In this podcast episode we talk about how therapists can happen when clients aren’t improving

At a recent talk, we got the question – what if my clients aren’t getting better? We decided it was time to look at how goals are set, what “getting better” actually looks like, and how therapists can cope with clients whose treatment goals are "not getting worse."

What does “getting better” look like in therapy?

· Treatment goals are often set based on functionality, independence, and productivity

· Outcome measures can be used to track improvement on mood, anxiety, etc.

· Goals of “not getting worse” or prevention of future concerns are often hard to quantify or are unsatisfying for therapists (and potentially for their clients)

What can get in the way of clients improving in therapy?

· Situational concerns that are not changed

· Longer-standing diagnoses that don’t go away, but can be stabilized

· When improvement is defined as reaching goals, rather than avoiding relapse

How can therapists support clients who are unable to reach traditional treatment goals?

· Collaborative treatment goal setting

· Identifying appropriate expectations

· Quality of Life goals

· Showing ongoing medical necessity and documenting appropriate need for ongoing care

· Higher acuity and relevant diagnoses documented

How can clinicians take care of ourselves when we have longer term clients who don’t show dramatic improvement?

· Getting clear on client’s capacity for growth

· Be clear on your own skills and capacity as a therapist

· On-going conversations with the client to determine whether other help is needed

· Exploring quality of life goals

· Identifying incremental gains and reframing to build hope

· Deepening the therapeutic relationship, focusing on the attachment

· Redefining success and understanding the pieces that are still uncomfortable

· Making sure that therapists do not define their own success based on client outcomes

· Destigmatizing long-term weekly therapy as a coping strategy

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

Podcast Homepage

Modern Therapist’s Survival Guide Creative Credits:

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

Music by Crystal Grooms Mangano https://groomsymusic.com/

Are You Actually Neurodivergent Affirming? An Interview with Sonny Jane Wise Jul 03, 2023

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Are You Actually Neurodivergent Affirming? An Interview with Sonny Jane Wise

Curt and Katie interview Sonny Jane Wise, the Lived Experience Educator. We chat about therapists getting stuck in neuro-normative expectations and norms or refusing to accept medication or accommodations as neurodivergent affirming. We look at how you can get more creative and individualized to support neurodivergent individuals more effectively. We also look specifically at neurodivergent friendly DBT and whether skills-deficit models are inherently ableist.

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

In this podcast episode, we talk about creating neurodivergent affirmative therapy practices

Too often, therapists create goals and engage in practices that are neuro-normative. When working with neurodivergent clients and their families, these practices can be harmful. We asked Sonny Jane Wise, the Lived Experience Educator, to talk with us about how to best incorporate neurodivergent affirming practices for therapy.

What do therapists get wrong when moving toward neurodiversity affirming practice?

· Removing medication or accommodations as an acceptable option

· Failing to allow for individual differences and preferences

· Neuro-normativity shows up in goals, especially looking at independence and productivity

· Setting expectations inappropriately

How can therapists become more neurodivergent affirming?

· Understanding the impacts of intersectionality on how someone chooses how they navigate their neurodivergence

· Moving away from independence as the goal of therapy

· Understanding that a neurodivergent person’s needs are more important than neuro-normative norms

· Getting creative with problem-solving and communication

· Recognizing differences, learning to work with them and not try to change them or work against them

Are skills-deficit based models (like Dialectical Behavioral Therapy) inherently ableist?

· When the model states that the problem lies with the individual, then it is ableist

· Adjusting the environment and the external factors is more appropriate

· DBT skills can be helpful to learn emotions regulation that wasn’t learned when growing up

· It is important to recognize differences and giving opportunities to work with differences

· Letting go of the one size fits all and moving toward options

What is an ideal for neurodiversity affirming spaces?

· Viewing differences as differences and not something to be fixed or changed

· Needs based system (not diagnosis-based system)

· Understanding that everyone needs different things and accommodations, not just those with

· Removing neuro-normative standards and expectations

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

Podcast Homepage

Modern Therapist’s Survival Guide Creative Credits:

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

Music by Crystal Grooms Mangano https://groomsymusic.com/

Liability Hot Potato: Defensive Therapy practices that give clients inadequate care Jun 26, 2023

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Liability Hot Potato: Defensive Therapy practices that give clients inadequate care

Curt and Katie chat about defensive therapy practices. We talk about how therapists avoid liability by practicing defensively, which can harm our clients. We look at common defensive therapy practices, like refusing to see clients with certain types of risk or too quickly hospitalizing someone. We explore the risks to our clients when we practice this way and how we can navigate risk to avoid practicing defensively. This is a continuing education podcourse.

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

In this podcast episode we talk about therapists minimizing their own liability without benefitting their clients

Therapists facing difficult decisions in therapeutic treatment are presented with the competing tasks of providing quality care to clients while also trying to minimize their legal risks. This can lead to therapists who may choose courses of action that do not benefit clients while doing things to protect the therapist. This podcourse explores the types of defensive practices that therapists take, how to recognize them, what steps can be done to protect therapists, and how to maximize client outcomes.

What are defensive therapy practices?

· Actions taken by a therapist that don’t benefit the client, but are done to protect the legal liability of the therapist

· Avoidant versus Assurant defensive therapy practices

· Responding to very scary law and ethics classes

· Avoiding lawyers and subpoenas

What are examples of Defensive Therapy practices?

· Avoidant: Avoiding talking about anything that is even related to things outside of our scope of practice (e.g., medical or legal advice); refusing to see clients with specific types of risk

· Assurant: Sending clients to the hospital quickly based on risk rather than on treatment efficacy, over-reporting abuse and engaging clients with systems

· Therapists are employing defensive therapy practices when making sure to shift liability elsewhere

How do I navigate the risk that often leads to defensive therapy practices?

· Make clear the limitations on your knowledge, but respond to questions and needs in the best way you can, referring to experts as appropriate

· Prescriptive Assurant practices (taking action based on laws, rules, and/or ethical decision-making)

· Documentation of ethical decision-making process and the decision and actions made

· Documentation of the conversations with the client related to the action or inaction

· Also, documentation of the ongoing evaluation procedure for the action taken

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

You can find this full course (including handouts and resources) here: https://learn.moderntherapistcommunity.com/pages/podcourse

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information including grievance and refund policies.

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

www.therapyreimagined.com

Modern Therapist’s Survival Guide Creative Credits:

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

Music by Crystal Grooms Mangano https://groomsymusic.com/

Special Episode: Modern Therapist’s Consumer Guide on Thrizer Jun 22, 2023

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Special Episode: Modern Therapist’s Consumer Guide on Thrizer

Curt and Katie talk with Raunak Sharma, owner of Thrizer, a modern payment processing app for private pay therapists. Thrizer is a modern payments solution built for therapists. You can charge clients securely, receive payments seamlessly, and enable insurance reimbursements automatically. We chat with Raunak about Thrizer as well as his perspective on the finances of therapy, specifically out of network billing. We explore the challenges (and ineffectiveness) of super bills as well as a new solution (ThrizerPlus) that will help clients only pay what they owe.

This is the Modern Therapist Consumer Guide, a series of special episodes to help modern therapists navigate products and services specifically designed for therapists and their clients. We dig deeply into the companies, the people, and the products and services so you can make smart decisions in building your practice and serving your clients.

Transcripts will be available on mtsgpodcast.com.

Interview with Raunak Sharma, Founder and CEO of Thrizer

Raunak is the Founder and CEO of Thrizer, a payments app for private pay therapists. A therapy-goer himself, he got tired of the struggle to leverage his out-of-network benefits and get reimbursed for his sessions, and wanted to build a solution to help both therapists and their clients. Thousands of therapists now use Thrizer daily to securely charge for appointments and upgrade their client experience.

In this podcast episode we talk about out of network billing and payment processing with Thrizer

Interview with Raunak Sharma, Thrizer

2:04 How did you decide to create Thrizer? How did you put together the business?

3:08 What are the values that guide your business and business decisions?

4:51 When therapists are putting together their private pay practice, what should they consider when designing their financial systems? (i.e., Private pay, Insurance-based, Out of network billing)

8:14 What does out of network billing involve?

10:34 What does out of network billing look like when using Thrizer?

12:59 What kind of out of network rates are people getting?

15:33 How often are clients wanting and able to use their out of network benefits?

18:49 How does Thrizer work?

21:22 How do you actually have enough information to create a claim?

24:22 How can you make a profit if you are only charging the 3% processing fee?

26:40 What is ThrizerPlus?

31:21 What makes Thrizer different than other payment processors and/or other out of network billers?

32:40 What’s still a work in progress at Thrizer?

34:04 Special offer from Thrizer for our Modern Therapist audience

Curt and Katie Chat – Our review of Thrizer

36:19 What do you see as the deciding factors when deciding whether to use Thrizer for payment processing and out of network billing (or not)?

A Special Offer for the listeners of Modern Therapist’s Survival Guide podcast from Thrizer

Go to bit.ly/moderntherapists and use the code MODERNTHERAPISTS for free payment processing on your first $2,500 of payments.

Relevant Links:

Thrizer Website

Email: Raunak at thrizer.com

Social Media:

Thrizer on Instagram

Thrizer on Facebook

Thrizer on LinkedIn

Stay in Touch:

www.mtsgpodcast.com

Our Facebook Group – The Modern Therapist’s Group

https://www.facebook.com/therapyreimagined/

https://twitter.com/therapymovement

https://www.instagram.com/therapyreimagined/

Credits:

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

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

How to Provide Culturally Appropriate Care for African American Families: An interview with Mercedes Samudio, LCSW Jun 19, 2023

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How to Provide Culturally Appropriate Care for African American Families, An Interview with Mercedes Samudio, LCSW

Curt and Katie interview Mercedes Samudio, LCSW, about working with African American Families. We talk about what therapists typically get wrong when working with these families, what therapists need to know about working with African American families, how to work cross culturally, and how both conscious and unconscious bias impact therapy.

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

In this podcast episode, we talk about how therapists can work with African American families more effectively

Our friend, Mercedes Samudio, LCSW, is researching how therapists can best support African American families. She is looking at how these clients are treated and how they traverse the mental health system to get healing.

What do therapists get wrong when working with African American Families?

· Therapists will apply therapy universally to diverse groups that require nuance and different interventions

· Therapists don't understand enough about African American families to understand the differences

What do therapists need to know about African American families?

· There are differences between “Black” and “African American”

· The impacts of the transatlantic slave trade

· Cultural differences based on which country one is living in as well as how one travels as a human in their country of residence

How can therapists work cross-culturally with African American families?

· Specialized training like Mercedes’ training: Engaging African American Families

· Work with people who have expertise

· Google alerts for

· Understanding how you show up in the world, create an identity statement for all of the identities you have that are relevant to you, your social location

· Talking about conscious and unconscious bias and identities throughout the therapy process

· Understanding generational differences

How do conscious and unconscious bias impact therapy?

· What we know we don’t like about people (conscious)

· What may influence us from before we understand labels and differences

· Prejudices that influence how we show up in the therapy room can cause conflict

· Explore the conflict, explore the potential biases

· Use tentative language (I wonder if this is showing up here or impacting our relationship)

· Understanding how your identity often shows up socially can provide the therapist with fodder for exploring what bias may be present in the room

What are best practices for working with African American families?

· Genograms are helpful to explore how everything impacts the family members and who they say are included in their families

· Understanding how these families fit within their communities and who is involved with each of these families

Resources for Modern Therapists mentioned in this Podcast Episode:

https://shameproofparenting.com/

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

Modern 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 Future is Now! Chatbots are Replacing Mental Health Workers Jun 12, 2023

Show notes

The Future Is Now: Chatbots are Replacing Mental Health Workers

Curt and Katie chat about what happened with the National Eating Disorder Association and their chatbot, Tessa, as well as new prompts to make ChatGPT act like a CBT therapist. We also look at the risks related to chatbots taking over mental health and crisis services. We also discuss what therapists can do to safeguard their practices in the wake of the robot revolution.

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

In this podcast episode we talk about Tessa, the chatbot replacing NEDA hotline workers

After their hotline workers unionized, National Eating Disorder Association (NEDA) fired all of their hotline workers and replaced that service with Tessa, an AI chatbot. This chatbot quickly started telling folks seeking eating disorder assistance that dieting could be a good idea. There are already prompts folks are using to have ChatGPT act as your therapist. We decided we needed to talk about how the chatbots are coming for our jobs.

What happened with National Eating Disorder Association (NEDA) and Tessa?

· The hotline workers unionized and were fired by the association and replaced with Tessa

· Tessa is a prevention chatbot that was created to provide support to folk waiting for resources

· Tessa was launched and when tried, provided harmful advice, and then was taken down

· Now there is no crisis hotline or back up chat support offered by NEDA

What is the Tessa Chatbot?

· An evidence-based practice was redesigned as conversations

· Writing prompts and infographics to break up the text

· Studies were done to see how it works and to fix some of the errors

What are the risks related to chatbots taking over mental health services?

· There are now instructions for prompts to have ChatGPT act as a CBT therapist

· As people interact with chatbots, they will add to the dataset, theoretically improving it

· The concerns about the iterations, if unchecked, will become more and more harmful as it adopts human disordered thinking and language

· Evidence-based practices are prime to be put into chatbots

· The utility of the resources that chatbots can provide (including coping strategies and writing prompts)

What can therapists do to address the concerns of the robot revolution?

· Understand the technology and pay attention to the innovation process

· Look at where AI may not be able to replace immediately, focus your attention there in developing your skills

· Intuitive leaps that humans make that AI may find too risky

· Higher level risk assessment and more challenging diagnoses may be reserved for humans

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

Purposeful and Profitable Summit in July

Modern 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 Sky is Falling: How Therapists Can Protect Our Industry, Patient-Centered Care, and Our Businesses, An Interview with Dr. Ajita Robinson Jun 05, 2023

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The Sky is Falling: How Therapists Can Protect Our Industry, Patient-Centered Care, and Our Businesses, An Interview with Dr. Ajita Robinson

Curt and Katie interview Dr. Ajita Robinson about innovation within the mental health industry that could threaten therapists in private practice. We chat about Value Based Care in insurance, insurance credentialing companies, and big tech disruptors. We also talk with Dr. Ajita (an income strategist) about ways that therapists can diversify their income leveraging both their license AND their knowledge, to try to mitigate these risks to our businesses.

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

In this podcast episode, we talk about how therapists can protect our profession

With the changes to our industry, we thought it would be important to talk with Dr. Ajita Robinson, an income strategist and insurance expert, about how therapists can weather the storm.

What are the threats to the mental health industry?

· Big tech companies innovating in our space, with a focus on efficiency

· Value-based insurance billing

· Credentialing and billing services (like Alma and Headway) moving us out of direct communication with insurance companies

How can therapists leverage their skills for alternative revenue streams?

· Understanding what other types of services can therapists provide

· Clarifying when we’re leveraging our knowledge versus leveraging our license

· Identifying problems that we’re best situated to solve

· Entering the self-help industry

How can therapists get started when they are ready to leverage alternative revenue?

· Identifying the problem you solve rather than the transformation you want to provide

· Understanding what your target client has already tried

· Knowing what the barriers are for them to solve their problem

· Clarifying who is the customer and who is the consumer

· Contracting with schools, cities, etc. is possible for therapists to increase income

· Accessing resources and experts to help you do what you need to do

· Distinguishing when to start a separate business

Resources for Modern Therapists mentioned in this Podcast Episode:

Dr. Ajita’s website

Dr. Ajita Robinson’s book: The Gift Of Grief: A Practical Guide On Grief And Loss

Facebook: facebook.com/drajita

Instagram: instagram.com/dr.ajitarobinson

LinkedIn: linkedin.com/ajitarobinson

Facebook group: Purposeful & Profitable Therapist Community

Relevant Episodes of MTSG Podcast:

Private Practice Planning for the Future of Mental Healthcare: An interview with Maureen Werrbach

Post-Pandemic Practice

Is AI Smart for Your Therapy Practice?

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

William Perry’s Scheme of Intellectual and Mental Development

Modern 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 Do Therapists Develop? May 29, 2023

Show notes

How Do Therapists Develop?

Curt and Katie chat about how therapists can be rigid in their thinking at times and then seem to be performing mental gymnastics at other times. We look at the developmental stages of therapists (drawing from William Perry’s work) and identify where therapists get stuck, where they often regress, rebel, or sink into compliance.

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

In this podcast episode we talk about what typical development looks like for therapists

Therapists go through developmental stages just like everyone else. We thought it would be good to look at how therapists can get stuck in rigidity (or do mental gymnastics) at early stages of development.

How can therapists be both rigid AND do mental gymnastics?

· Therapists employ mental gymnastics when they are trying to put together conflicting ideas and solve all of the problems in the field, individually

· Rigidity can happen when people have “figured out” their own choices and believe that everyone should do what they do

· Under-resourced and under-motivated folks can often get very rigid

How do William Perry’s developmental stages apply to therapist development?

· First stage is dualism (i.e., right or wrong), everything is fixable or solvable (grad school students wanting to know what to do)

· Second stage is about finding the right authority to listen to (i.e., sticking very tightly to a specific modality)

· Third stage, early multiplicity, which is getting to the stage where therapists start to know what they don’t know

· Fourth stage, late multiplicity, most problems have solutions we don’t know, people can have their own opinions, and some problems can’t be solved. This is a very uncomfortable stage.

· There are additional stages mentioned in the episode, we focus on Stage 4

· When people get stuck at stage 4, they are likely to regress to early stages (and become more rigid) or they are likely to rebel, or play the game

What are the concerns with therapists at earlier stages not moving through to later stages?

· Therapist Facebook groups may support stage 4 and earlier therapists providing dualistic or simplistic questions and answers leading to shortsighted

· Difficulty looking at any opposing voices due to rigidity or rebellion or compliance

How can therapists avoid rigidity in their thinking (or rebellion, or compliance)?

· Providing space to understand the options

· Employing critical thinking

· Deeper thought about what you’re doing and why you’re doing it

· Explore context and have conversations with folks further along in their development

Resources for Modern Therapists mentioned in this Podcast Episode:

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

Continuing Education Information

Modern Therapist’s Survival Guide Creative Credits:

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

Music by Crystal Grooms Mangano https://groomsymusic.com/

Teaching Wisdom: Best practices for decision-making to support your clients May 22, 2023

Show notes

Teaching Wisdom: Best practices for decision-making to support your clients

Curt and Katie chat about decision-making best practices. We look at how we make decisions, what the decision-making process looks like, what can get in the way of effective decision-making, and how therapists can support their clients in making the best possible decisions.

This is a continuing education podcourse.

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

In this podcast episode we talk about how therapists can support clients in decision-making

When therapists are asked “what do I do?!?” by their clients, we can often redirect our clients back and encourage them to make their own decisions. But what if we could provide them with best practices to support their decision-making process? This workshop is designed to help therapists learn more about how people typically make decisions, the cultural differences that can show up in the decision-making process, and best practices to support clients in making informed decisions.

How do we make decisions?

· We don’t often choose what is in our best interest

· Emotions, mood, bias impact how we make decisions

· The DBT concept of Wise Mind, is a strong space to make decision

· Individual differences, including age, generation, family structures

· Cultural differences, including individualistic versus collectivist, tight or loose cultures (how many norms and how strictly they are enforced), cognitive style (wholistic versus analytic)

· Intersectionality also plays a part in how these factors can impact decision-making

What does the decision-making process look like?

· Does a decision need to be made?

· Who/what makes this decision?

· How is the decision?

· How much time and energy are invested in the decision-making?

· What are the alternatives?

· What could happen if the decision is implemented?

· What would happen if I make this decision?

· What values are relevant?

· What are the tradeoffs?

· How acceptable is this decision to the people around me?

· Implementation

What can get in the way of effective decision-making?

· How someone has been parented

· Mental health concerns like anxiety

· Cognitive biases like confirmation bias, anchoring, and availability bias

· Misalignment with values

· Errors from Decisive by Dan and Chip Heath: narrow framing, confirmation bias, short-term emotions, overconfidence

· Defensive decision-making when there is a lack of resources or safety

· Low sleep impacts both at overall cognitive and metacognitive levels

What are best practices for decision-making?

· Looking at opportunities for moral development when there are misalignments or conflicts between core values when making a decision

· From Decisive: WRAP techniques to improve decision-making

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

You can find this full course (including handouts and resources) here: https://learn.moderntherapistcommunity.com/pages/podcourse

Continuing Education Approvals:

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