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

Latest Episodes:

Do Therapists Curse in Session? Mar 14, 2022

Show notes

Do Therapists Curse in Session?

Curt and Katie discuss a recent citation from the California Board of Behavioral Sciences (BBS) to a therapist for cursing while in session. We explore: Can therapists swear in session? Should they? Are there times when cursing is appropriate in session? Are therapists allowed to make errors without the fear of citation from their board? We explore these and more in this episode.

In this podcast episode we talk about the ethics and responsibilities of cursing in session.

After hearing about the citation for a clinician who had cursed in session, we wanted to explore what is acceptable related to using curse words in session. We know as therapists that what we say matters, and now more than ever our choice of language matters. Who is allowed to curse in the therapy room? We tackle this question in depth:

Is swearing or cursing ever appropriate in session?

Both Curt and Katie swear in session when appropriate
Swearing in session can create a more authentic therapeutic rapport with some clients
Sometimes clients will ask for permission to swear in session
Follow the client’s lead when it comes to their language in session, including cursing
It is mostly important to reflect the client’s language without judgement
Clients might be looking for more humanity in their therapists
Therapists are people; curses can slip out when therapists feel depleted and without resource
Cursing based on your own humanity can cause therapeutic rupture and clinicians should be mindful of the therapeutic alliance and make repair attempts

What does the research show us about swearing?

Some research suggests that cursing out loud decreases pain
“Professional language” is often rooted in whiteness with a goal of excluding people of color
When not accurately reflecting a client’s language, you run the risk of editing them
Swearing speech is primarily meant to convey connotative or emotional meaning with emphasis

What do professional organizations say now about cursing in session?

The BBS recently cited a therapist for swearing in session as unprofessional language
Only one professional organization, The National Association of Social Workers, officially bars cursing in session – specifically derogatory language
Swearing speech is primarily meant to convey connotative or emotional meaning with emphasis
Therapists have a responsibility to make sure they are emotionally equipped to deal with clients

Is there an ideal language for therapists to use? … I caution against blanket rules. – Curt Widhalm

Slurs are never acceptable to use during session, especially when there are cultural differences between client and therapist
Considerations related to expressing your humanity, using curse words, and the clients you see
Ethically, we have guidelines of client beneficence and avoiding maleficence, meaning don’t harm the client
Technically cursing is allowed, but only with reason and while remembering that some folks are litigious

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Thriving Over Surviving: Growing a Practice without Burn Out Mar 07, 2022

Show notes

Thriving Over Surviving: Growing a Practice without Burn Out

Curt and Katie interview Megan Gunnell, LMSW, coach, and Founder and Director of Thriving Well Institute. We explore: What changes are therapists facing as they grow their practice in the telehealth age? How do therapists scale their businesses and what should they be aware of? Can a therapist and their practice thrive, or does something have to give? All of this and more in the episode.

Interview with Megan Gunnell, LMSW and Founder & Director of Thriving Well Institute

Megan Gunnell LMSW, is Founder and Director of Thriving Well Institute which aids therapist in building the private practices of their dreams. Megan offers a series of courses and individual coaching to aid therapists in expanding their private practices through building group therapy programs, building online courses, creating in person retreats, and even how to build a group practice. Megan teaches therapists how to build not only their practices but themselves up. Megan has been a practicing clinician for over 20 years working as an individual therapist in addition to her coaching and advisory work. Megan started her work as a music therapist, a passion which she still carries to this day.

In this podcast episode we talk about how therapists can build their practices without burning out.

With the increase in telehealth therapy options, therapists are confronted with a unique problem. How does a therapist build their practice with so many therapeutic options out there, while simultaneously avoiding burn out? Curt and Katie connect with Megan Gunnell to discuss how therapists can make sure they, and their practices, thrive.

How can therapists’ network as telehealth therapists?

Your potential client base has now become the whole state.
Focus on designing your online real estate and increase your SEO.
Joining local Facebook groups of therapists can help expand your referral base.
Speak to specific client issues on your website that you specialize in.
Avoid template and more generalized language in websites and marketing material.
Make your website unique but clear in what you work with.

What is scaling and how does it avoid burn out?

For many therapists, caseloads have increased dramatically over the past couple years
Scaling is more about pivoting than it is creating passive income.
Looking to expand your practice into a group practice can help alleviate referral loads.
Some therapists can avoid burn out by diversifying their workload and reintegrating natural talents such as creativity.
Getting into community, especially with other therapists, is a great way to avoid burn out.
There is still a need for single-focus private practices.

What can therapists do to scale their businesses?

Be in tune with out motivated you are to scale your business; ask how committed am I?
Consistency is key.
Have a willingness to make mistakes and take risks.
Don’t be afraid of failing; use moments of failure to motivate you.
Be open to learning new things like tech, marketing, or automation.
Be realistic of your capacity to take on learning sometimes complicated or frustrating systems that might help your business.
Don’t be afraid of showing who you are as a person as you build out your practice.
It can be scary to expand your practice, and many therapists want assurance, but there is no one way to expand – it’s individual to your unique practice.
It can take support to expand your practice; reach out to your community for help.

What’s New in the DSM-5-TR? An interview with Dr. Michael B. First Feb 28, 2022

Show notes

What’s New in the DSM-5-TR?

Curt and Katie interview Dr. Michael B. First, MD, editor and co-chair of the American Psychiatric Associations’ DSM-5 Text revision, coming out March 2022. We explore: What are the differences between a full update and a text revision? What changes have been made (and how were these changes decided)? What new diagnoses can we expect? Can clinicians continue to use the older DSM-5? How can clinicians advocate for changes in future versions of the DSM? All of this and more in the episode.

Interview with Dr. Michael B. First, MD

What changes have been made in the new DSM-5-TR?

Text revisions occur to avoid letting the text become stale while supporting ongoing updates.
New disorders, specifically Prolonged Grief Disorder, have been added.
New codes, modeled off symptom codes, created for documenting suicidality and non-suicidal self-injury with another diagnosis.
New categories of Unspecified Mood Disorder.
New Criteria set for Autism Spectrum Disorder which is more conservative.

How are cultural differences addressed in the DSM-5-TR?

Starting with DSM-IV, there has been a special committee created for culture and culture related issues
Hypothetically, the criteria sets should apply to everyone, but in the text, there is a section on Culture Related Features which is more specific.
The impact of the George Floyd protests inspired the creation of a new committee to look for systemic racism, lack of nuances, and prevalence issues within the DSM.
There are conflicting opinions if “transness” should be included in the DSM and if it’s even a mental disorder.
As the DSM is a diagnostic tool to code for insurance, the DSM takes the stance that the Gender Dysphoria diagnosis stay included so individuals can have access to medical intervention and treatment.
The Steering Committee for new diagnosis is small, but there is diversity.
Before a diagnosis is approved, it is posted for 45 days on the DSM website for all, including people with lived experience, to comment and advocate for diversity

What is the Process for Accepting New Diagnose?

The steering committee accepts proposals through the DSM portal for new diagnosis
Some diagnoses are qualified based on the United States’ continued use of ICD-10, whereas the ICD-11 is more progressive.
With Complex Post Traumatic Stress Disorder, some of the criteria from the ICD have been incorporated into the DSM diagnosis of PTSD
Proposals are floated around often, but they often don’t have enough empirical research yet.
Proposals need to show a pool of patients who don’t fit other diagnoses, a gap in treatment, and a difference from other possible similar diagnoses.
New diagnoses will be approved on a continuum, making the electronic DSM-V-TR the most up to date resource.

How Therapists Promote Diet Culture: An interview with Rachel Coleman Feb 21, 2022

Show notes

How Therapists Promote Diet Culture: An interview with Rachel Coleman Curt and Katie speak with Rachel Coleman, LMFT, CEDS about what therapists should consider in working with clients who have eating disorders, the impact of society on body image, and how clinicians can increase their competency in an area many feel they are lacking. Why do so many clinicians feel under trained in treating eating disorders? How do societal views impact our client’s body image and what is the impact of diet culture? Does a lack of graduate education in eating disorders ethically impact our ability to treat eat disorders in a non-specialized practice? What’s missing from our understanding of eating disorders? All of this and more in the episode. Interview with Rachel Coleman, LMFT, CEDS

What do clinicians do when therapeutic interventions might trigger eating disorder behavior?

Many interventions call for physical activity that might trigger eating disorder behavior or feelings in clients.
If a client wants to participate in a physical activity intervention, consider their motivation.
Ensure that a client has multiple tools in their anxiety toolbox.
Be mindful if the modalities and treatment recommendations are based in fat phobia or weight stigma.

How can clinicians assess their clients for an eating disorder?

Eating disorders can present meeting full DSM-V criteria or, in many cases, seem at the “subclinical” or mildly clinical level.
Evaluate how your client feels about societal messaging and the impact it might have on them.
In assessing clients, look to determine the impact of behaviors and patterns on daily functioning. If client’s are sacrificing other values to focus on weight or body, it should be discussed.

How can clinicians increase their education in treating eating disorders?

Clinicians need to do their own work surrounding their bodies and internalized messaging.
Therapists should focus on learning about the complexities of eating disorders and the social justice movements that surround weight stigma and fat phobia.
Familiarize yourself with the ideas of body trust, body neutrality, and health at every size.
Many treatment centers offer free webinars to educate clinicians in eating disorder treatment.

What are the ethical and legal considerations in treating eating disorders in a non-specialized private practice?

Always get consultation.
Some clients might present with “subclinical” or mildly clinical levels of an eating disorder.
There is a difference between asking questions and treating the answers.
Clinicians should encourage clients to see a medical doctor when necessary.
Working with dieticians and medical doctors to create a holistic team, best serves the client.
Clinicians should be aware when to refer to a higher level of care.
Therapists should limit self-disclosures

How does Diet Culture impact our clients?

Diet culture is a mindset and system of theories we all exist in, that credits a person’s shape and size as the primary indicators of health and moral superiority.
When bodies don’t meet these “standards” of beauty as societally defined, they are often oppressed.
Messaging about dieting and our bodies is inescapable in our society, so it’s easy for subconscious beliefs about food and bodies to infiltrate sessions.
Therapists’ self-disclosures should be limited and focus on affirming client’s experience.

What to Know When Providing Therapy for Elite Athletes Feb 14, 2022

Show notes

What to Know When Providing Therapy for Elite Athletes

Curt and Katie chat about the specific competence required to work with elite athletes. We explore how elite athletes present (including diagnosis) as well as what treatment looks like for elite athletes. We also talk about the training cycles and periodization, developmental stages, and identity formation for competitive athletes. We also look at what healthy training environments include and how athletes can take care of their own well-being.

In this podcast episode we look at what therapists need to know about working with elite athletes

For our second continuing education worthy podcast, we wanted to support therapists in understanding what they need to know (or know that they don’t know) about working with elite athletes.

The differences between being a fan and being competent to work with elite athletes

The types of competence needed to support athletes who are at an elite level
Sports psychology and other areas of specialty to support athletes
The stringent criteria to be called a sports psychologist

What diagnoses do athletes present with when they enter therapy?

Not necessarily anxiety, but it can be anxiety related or unrelated to sport
Diagnoses can be related to the sport due to body, substance, or changes in circumstances
Diagnoses can also be related to other elements of their life and transitions

What does treatment look like for elite athletes?

High school and college athletes are most likely the clients we’ll see
The integral nature of their team and who is best to be included in the treatment team
Logistics and scheduling due to games and practices, obtaining required consents
Training schedules, food information is relevant to therapeutic work
The different goals for elite athletes than for other folks who enjoy sports
Looking at in the moment frustrations versus a desire to leave the sport
Sports assessments to identify athletic coping skills
Helping athletes to make decisions for themselves and identify when it’s burnout and when it’s a mismatch

Understanding training cycles and the impact on athlete clients

Specific language that athletes may use
Periodization, micro, meso, and macro cycles in training
The importance of planned growth and rest as well as peaking at the right time
The focus of timing for everything
How injuries or changes in schedule (like with covid) can impact this timing and what that means for athletes

Developmental factors for young athletes

The focus of training for younger children as well as the investment phase for youth
Developing one’s identity as an athlete
What can positively impact and negatively impact the future commitment to sport
Other developmental factors related to being a teen interacting with these developmental elements

What a balanced life looks like for elite athletes

Who athletes spend time with, share their life with
The hobbies that complement the sport
Understanding how maintenance impacts the rest of the schedule

The factors that improve an athlete’s well-being

Myths related to the tangential benefits of being an elite athlete (i.e., I’ll get college paid for)
The importance of having a therapist who isn’t just a “fan”
The differences between team and individual sports
The competency needed related to understanding the sport to understand all of the dynamics
What good social systems around athletes have in common
The understanding of how each person in the athlete’s circle interacts with the goals
The culture created within the team and with the people around the athlete
Simone Biles and Naomi Osaka – a look at how they have been taking care of themselves

The transition out of being an elite athlete

Injury and unplanned retirement
Planning for an intentional retirement
Moving out of the athlete identity into something new

Antiracist Practices in the Room: An Interview with Dr. Allen Lipscomb Feb 07, 2022

Show notes

Antiracist Practices in the Room: An Interview with Dr. Allen Lipscomb

Curt and Katie speak with Dr. Allen Lipscomb, PsyD, LCSW about what therapists should consider in working with Black clients, common mistakes, and implementing anti-racist procedures into practice. What can therapists do better? Where is graduate education lacking? How do we respect and explore our Black client’s narratives? Who can work with Black clients? How can therapists help clients heal from race-based trauma?

How can we do better with our Black male clients?

Black male grief shows up in different ways than other client’s grief might show up.
When assessing Black males for psychosis or conspiracy theories, ensure that you look at the context of their lived experience before determining psychosis
The traumatic experiences of racialization, trauma, and mistreatment that many Black people can sound like lead to thoughts that might sound psychotic to an uneducated clinician.
Listen to the client’s narratives. Question what the themes and patterns are and if the thought is maladaptive to their functioning and well-being.
Utilize FIDO: frequency, intensity, duration and onset in questioning clients
If a clinician is unsure if a thought is a conspiracy or legitimate threat, assess for how the client’s community is responding to the client’s narrative
Ask clients how the session was for them. How was it for you to meet with me? Acknowledge your cultural limitations and create an invitation for the client to let you know when you can do better.
Be mindful, Black male clients might be minimizing their experiences to be “less threatening.” This is the cultural congruency dichotomy that clients often have to take to avoid further potential trauma.

What does it mean to be antiracist?

Clients might be resistant to bringing up a clinician’s whiteness in the space.
Black clients might not think that a white clinician has the capability or desire to talk about race. It is the responsibility of the clinician to actively establish the openness of the space to discuss race and the client’s lived experience.
This should be a continuous conversation that is led by therapists, to make the topic open until it feels naturally open.
It’s affirming to have someone who is white in a position of power to say to me – hey I recognize we’re racially different and we could have a different experience how that shows up in this space.
You can catch moments where anti-racist action could’ve been taken or acknowledged in the next session, if missed during a session.
The need to revamp our graduate programs to be anti-oppressive and anti-racist
How to show up as an ally in the room, without centering your own experience

What is Dr. Allen Lipscomb’s BRuH Method?

The BRuH Method, or BAT, stands for BRuH Approach to Therapy.
BRuH stands for Bonding through Recognition to promote Understanding in Healing when providing therapeutic services to Black men specifically.
The approach is modeled off of other therapeutic approaches like CBT and DBT
Phases include: Bonding Phase, Recognition Phase, Understanding Phase, Healing Phase
The clinician is always doing aspects of the various phases throughout the course of treatment
This is not an evidence-based practice but an honoring based practice
The evidence of efficacy in this practice comes when you see your clients continuously returning to receive more sessions, from the feedback they give you, and the improvements in day-to-day life.

Who can work with Black male clients?

There can be an urge for white therapists to refer clients of color, especially Black men, to Black clinicians
These referrals are unnecessary. A therapist of any background, if holding the space correctly and connecting with the client’s felt experience, can work with a client of color, specifically Black men.
It’s important to be mindful that questions asked to clients are not investigative or for the purpose of educating the therapist.

What Can Therapists Say About Celebrities? The ethics of public statements Jan 31, 2022

Show notes

What Can Therapists Say About Celebrities? The ethics of public statements

Curt and Katie chat about whether therapists should make public statements and diagnose public figures. This is our first continuing education eligible podcast, discussing the ethics of speaking out about the mental health of people in the public eye. We explore the origins of the Goldwater rule, a group of psychiatrists who purposefully broke it, and how masters level organizations address this concern. We also provide you with some ideas about how you can make this decision for yourself.

In this podcast episode we look at the ethics of modern therapists diagnosing public figures

For our first continuing education worthy podcast, we wanted to address something that is becoming more and more prevalent in our field: therapists speaking out about the mental health of public figures.

What is the Goldwater Rule?

The history of the Goldwater Rule
The impact of DSM II (and the update to DSM III)
The original intention of the rule versus the current interpretation of the Goldwater Rule
Fears from the American Psychiatric Association that seems to have driven the development of (and on-going commitment to) this rule

How the Goldwater Rule (and Similar Ethical Principles) Have Shifted Over Time

Perspective from one of the original framers of the Goldwater Rule
Moving from teleological to deontological interpretations
How the internet and social media has changed the landscape
The American Psychiatric Association expanding their commitment to the Goldwater Rule, stating reasons psychiatrists should not assess
The Goldwater “Caveat” or “Principle” versus Goldwater “Rule” or even Goldwater “Doctrine”
Beyond diagnosis to restricting any comment on the behavior or mental health of a public figure
The stance on this ethic from American Psychological Association and the large Masters Level Organizations (AAMFT, ACA, NASW, and CAMFT, for example)

The Dangerous Case of Donald Trump – the Public Diagnosis of an American President

The group of psychiatrists who pushed back on the Goldwater Rule
The Duty to Warn – does it apply here?
What are the challenges of accurately diagnosing Trump?
Where expertise is helpful (and how the public can water down diagnosis)

Current Guidelines for Modern Therapists

Whether diagnosis is required for a duty to warn
The tactic of putting forward information without drawing conclusions (and why we don’t like this strategy)
Specific guidance from the professional organizations on what therapists can and cannot do
Taking special care in how one decides what they say about an individual in public settings
Using one’s professional judgement and special care

Cautions When Using Your Professional Judgment

The potential harm of discussing diagnosis on social media
Bias, cultural factors, and other information that could make an inaccurate or harmful diagnosis
Mental health stigma and other concerns related to diagnostic language (ICD-10, DSM-V)
Speaking outside of your professional expertise
Questions to ask yourself before making a public statement

Working with Trans Clients: Trans Resilience and Gender Euphoria Jan 24, 2022

Show notes

Working with Trans Clients: Trans Resilience and Gender Euphoria

An interview with Beck Gee-Cohen, MA CADC-II, about how therapists can be better clinicians for trans people. Curt and Katie talk to Beck about gender identity (and why every therapist should do their own work around gender), historical perspectives on masculinity and femininity, the concepts of trans resilience and gender euphoria, the real problems with the DSM diagnosis of gender dysphoria and considerations for providing therapy to trans clients.

Interview with Beck Gee-Cohen MA CADC-II Director of LGBTQ+ Programming

In this podcast episode we talk about trans mental health

We invited Beck Gee-Cohen, MA CADC-II to come talk with us about providing therapy for trans individuals.

Modern therapists need to keep learning when working with trans clients

Getting pronouns correct is a basic expectation at this point
Finding the balance between focusing on a client’s trans identity and other elements of their identity and experience
Understanding trans identity 101 is a basic level of knowledge that all therapists should have
What you do need to learn from your trans clients
Therapists need to do their own work around gender

The work that therapists must do around gender

The role that society plays in defining gender and the binary
The privilege cis folks have in not being asked to assess/address their gender
“Women’s” and “men’s” issues
Societal expectations related to gender
The history of gender expression and how what is acceptable has shifted
Cultural and generational differences related to gender

The Concept of Trans Resilience

The tendency to focus on the pain of being trans
The bias and hate that trans folks face, and how they continue to show up
The importance of celebrating who you are as a trans person
“You’re so brave” doesn’t see the full picture
How hard it is to show up – and what it means that trans folks continue to do so
Moving away from just focusing on gender dysphoria versus looking at gender euphoria

Gender Dysphoria versus Gender Euphoria and the problems with the DSM

How the DSM is used for the medical needs of trans folks
The problem with assigning the diagnosis of Gender Dysphoria to an individual
Internalized gender dysphoria (it is not my dysphoria, it is the dysphoria of the people around me about my gender)
Playing around with gender shouldn’t be a diagnosis, it is so culturally bound
Trans individuals have to know what to report so they can get hormones (i.e., they may have to lie about being dysphoric in order to “check the boxes”)
The problem with gatekeeping and the hope that trans folks being in work groups to help shift these guidelines

Better Therapy for Trans Clients

Therapeutic alliance is the most important
How therapists can appropriately use vulnerability when a client comes out as trans
The likelihood of someone coming out initially versus after trust is built and how to handle it
Sharing the therapeutic process and how you will learn and educate yourself
The problem of signaling that you are capable of working with LGBTQ+ people when you are not trained
Awareness of how being trans impacts the client in front of you
When the client is coming into therapy due to their gender identity
Understanding the back story and how someone identified that “something is different”
Looking at what they want to do next (which may be very little or a full plan on how they handle being trans).

Who’s in the Room? Siri, Alexa, and Confidentiality Jan 17, 2022

Show notes

Who’s in the Room? Siri, Alexa, and Confidentiality

Curt and Katie chat about how therapists can maintain confidentiality in a world of AI assistants and smart devices. What duty do clinicians have to inform clients? How can we balance confidentiality with the reality of how commonly these devices are involved in therapy? Can telehealth therapy be completely confidential and data secure? We discuss our shift in clinical responsibility, best practices, and how we can minimize exposure of clinical data to ensure the confidentiality our clients expect and deserve.

In this podcast episode we talk about something therapists might not consider: smart devices and AI assistants

We received a couple of requests to talk about the impact of smart devices on confidentiality and their compliance with HIPAA within a therapeutic environment. We tackle this question in depth:

What are best practices for protecting client confidentiality with smart devices?

Turning off the phone, or placing the phone on “airplane mode”
Warning clients about their own smart devices and confidentiality risks
The ethical responsibilities to inform about limits of confidentiality and take precautions
It’s all about giving clients choice and information

What should therapists consider when smart devices and AI assistants are in the room?

– Curt Widhalm

Whistle-blower reports on how often these devices are actually listening
Turning off your phone is a lot cheaper than identity theft
Consider your contacts, geolocation, and Wi-Fi connection
Some of this, as we progress into a more technological world, might be unavoidable

How do Alexa and Siri impact HIPAA compliance for therapists?

The importance of end-to-end encryption for all HIPAA activities (and your smart device may not be compliant)
The cost of HIPAA violations if identity theft can be traced back
Understand the risks you are taking, do what you can, and remember no one is perfect

What can modern therapists do with their smart devices?

GPS location services can be left on for a safety reason, emergency services use GPS location
Adjusting settings for voice activation, data sharing, when apps are running, locations, etc.
Turning off and airplane mode are also options
Always let the client know the limits of confidentiality

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Psychotherapy in Ontario: How Confidential is my Therapy? By Beth Mares, Registered Psychotherapist The Privacy Problem with Digital Assistants by Kaveh Waddell

Hey Siri and Alexa: Let's Talk Privacy Practices by Elizabeth Weise, USA Today

Patient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: An Observational Study of Siri, Alexa, and Google Assistant, 2018

Hey Siri: Did you Break Confidentiality, or did I? By Nicole M. Arcuri Sanders, Counseling Today

Alexa, Siri, Google Assistant Not HIPAA Compliant, Psychiatry Advisor

Hey Alexa, are you HIPAA compliant? 2018

Person-Centered Tech

How to Understand and Treat Psychosis Jan 10, 2022

Show notes

How to Understand and Treat Psychosis: An interview with Maggie Mullen, LCSW

Curt and Katie interview Maggie Mullen, LCSW, a national trainer on culturally responsive, evidence-based care for psychotic spectrum disorders. We talk with Maggie about their anti-racist and disability justice framework of psychosis, understanding psychosis on a spectrum, what to do when psychosis enters the treatment picture, assessment of psychosis, and treatment using Dialectical Behavior Therapy (DBT). We also talk about how society defines “normal” and pathology, exploring cultural differences in these definitions.

Interview with Maggie Mullen, LCSW

In this podcast episode we talk about looking at psychosis differently

Maggie Mullen’s anti-racist and disability justice framework of psychosis

Maggie came from a community organizing background
Inequity and lack of resources for people who experience chronic psychosis
The focus on medication rather than other forms of treatment for psychosis
BIPOC individuals being shot by police when psychosis shows up in a public space

“Psychotic spectrum” versus the segregation of psychosis as “other”

“We are often the least prepared to deal with our most acute clients”

The continued segregation of psychotic disorders
Cultural considerations when determining what is psychosis or other types of experiences
The lack of inclusion of psychosis in the research
Psychosis is not “other” but is actually a spectrum of behaviors and are very common
The symptoms of psychosis are not constant, they fluctuate for every individual
The importance of following the model and voices of the disability justice movement
Including education on the treatment for psychosis, rather than allowing therapists to opt out
Folks with psychosis are often not included in the research, which needs to change

What to do when psychosis comes into the treatment picture for our clients

We need more training on psychosis to feel confident
Normalizing the experience of psychosis
Helping to make peace with psychotic symptoms (i.e., making friends with the voices) to decrease distress
Looking at treatments beyond medication
How to identify psychosis and assess for impact and impairment
The myth that all elements of psychosis are distressing and bad

Why Maggie Mullen is using Dialectical Behavior Therapy (DBT) to treat psychosis

“People with psychosis deal with emotion dysregulation, actually more so than the average person…that's where we know DBT is really effective”

We frequently underestimate the ability to help folks with psychosis
Using DBT skills for emotion regulation concerns that frequently come up in psychosis
Psychosis and PTSD oftentimes occur together and aren’t always diagnosed
Trauma can influence the onset of psychosis AND psychosis can be traumatic
Maggie’s pilot program with DBT for psychosis
The concrete and straight forward nature of DBT skills make them very accessible

Understanding psychosis differently, including the cultural differences of what is “normal”

How to identify what is “real” and what is psychosis
How do you define what is normal for someone?
What do we decide what we pathologize?
Breaking up the binary of normal or not normal – reframing as “experience”
The importance of understanding what is negatively impacting the client and how to keep clients safe
Take the lead of your client and trust that they know themselves best
The tension between taking the lead of the client and mandates and requirements as a therapist

The Dialectical Behavior Therapy Skills Workbook for Psychosis by Maggie Mullen, LCSW