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

What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive interventionCurt and Katie chat about suicide assessment, safety planning, and how to keep clients out of the hospital. We reviewed the Integrated Motivational Volitional Model for Suicide, we talked about what therapists should be assessing for in every session, what strong assessment looks like (and suggested suicide assessment protocols), and why the least restrictive environment is so important when you are designing interventions and safety planning. This is a continuing education podcourse.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about suicide assessment, safety planning, and interventionWe continue our conversation on suicide, progressing from risk factors (from last week’s episode) to how to assess and safety plan with the least intrusive interventions at the earliest stages. Review of the Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley Continued to review the IMV model (graphic in the show notes at mtsgpodcast.com)What should therapists assess for in every session, related to suicide?“When clinicians are burnt out, when we have caseloads that are too big, when we aren't taking care of ourselves, we tend to [think], “Okay, this client is at a six, they can live at a six for a while,” which is absolutely true. And if they can [live with this level of suicidality], and they have the good factors that allow them to live there – great. It's just how close are they to that 7, 8, 9?” – Curt Widhalm, LMFT Moderating motivational factors, which move clients from passive to more active suicidality (or the reverse) Looking at what is keeping someone from being at risk for suicide (protective factors) The importance of knowing our clients well before they move into the volitional phase Understanding the clinician factors and putting structure around assessment Assessment for Suicide“Assessment is intervention.” – Curt Widhalm, LMFT SAMHSA’s GATE protocol Gather information using a structured assessment tool (Columbia Scale, LRAMP) Looking at intention, means, plan as well as risk and protective factors Moving into a safety plan The importance of recognizing the human during the assessment (versus focusing only on the protocol or your liability) Seeking supervision or consultation – don’t do this alone The importance of using the least restrictive intervention for suicide“There is a rupture in the therapeutic relationship when you are sending your client or facilitating a hospitalization against their will. It can save their lives …but that may not always be the case.” – Katie Vernoy, LMFT The idea of “responsible” action The range of options for keeping a client safe Having a conversation with the client on how to avoid attempting suicide The potential impacts of hospitalization, including trauma The danger of hospitalizing someone who does not need this level of intervention Additional intervention between sessions The practicalities to set up your schedule and your practice to support your clients and your self Additional risk factors (transition phases between providers)  

Risk Factors for Suicide: What therapists should know when treating teens and adultsCurt and Katie chat about suicide risk factors. Suicide rates have been increasing across the nation and there is an increasing need for the mental health workforce to be prepared to assess and intervene with clients of all ages. We take an in-depth look at the risk and protective factors associated with suicidal ideology and behaviors in both teens and adults. We also lay the beginning foundations of a suicide model to help clinicians better understand and intervene with clients exhibiting suicidal thoughts. This is a continuing education podcourse.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we explore what makes someone more likely to attempt suicideWe’ve talked frequently about suicide, but thought it would be important, especially during Suicide Prevention Awareness Month, to go more deeply into the risk factors that make someone more likely to attempt and complete suicide. What are the highest risk factors for suicide?“Anxiety Sensitivity… the fear of the feelings of being anxious… is even more so correlated with suicidal ideation and suicide attempts than depression is.” – Curt Widhalm, LMFT Defining acute, active suicidality (versus passive or chronic suicidality or non-suicidal self-Injury) Going beyond the list of risk factors to how big of a risk each factor is for attempting or completing suicide Exploring how impactful a previous attempt is on whether someone is likely to attempt of complete suicide The importance of getting a complete history of suicidality and suicide attempts at intake The impact of family members who have attempted or died by suicide Alcohol and other substance use and abuse as an additive risk factor Cooccurring mental disorders (eating disorders, psychosis and serious mental illness, depression, anxiety and anxiety sensitivity, personality disorders) Child abuse history, especially folks with a history of sexual abuse history Life transitions, especially unplanned and sudden life transitions Owning a firearm makes you 50 times more likely to die by suicide Racial differences in who is more likely to attempt or complete suicide Living at a high elevation What are additional risk factors for suicide specific to teens? Early onset of mental illness Environmental factors Exposure to other suicides (social media, contagion) Not being able to identify other options Seeking control over their lives and lacking impulse control leading to suicide attempts The importance of communication and the potential for a lack of communication Bullying and lack of social support, without a way to escape due to social media and cell phones What are protective factors when assessing for suicidality?“Just because protective factors are present doesn't mean that they balance out risk factors [for suicide].”– Curt Widhalm, LMFT Reasons for living, responsibility to others Spirituality or attending a place of worship that teaches against suicide Where you live based on cultural or societal factors Having a children or child-rearing responsibilities, intact marriage Strong social support, employment Relationship with a therapist  Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley

How Therapists Can Manage a Sedentary Job: An interview with Celina Caovan, DPTCurt and Katie interview Celina Caovan about physical self-care for therapists. We talk about how to mitigate the impacts of a sedentary job as well as the benefits of physical therapy and consistent physical activity. We also look into what physical therapy is, how clients can advocate for it, and how therapists might collaborate to support the physical and mental health of their patients.Transcripts for this episode will be available at mtsgpodcast.com!An Interview with Celina Caovan, DPTCelina Caovan received both her undergraduate degree and Doctorate of Physical Therapy degree from the University of Southern California. She has been practicing in an outpatient orthopedic setting in the South Bay in California for the last two years and is a Certified Strength and Conditioning Specialist.In this podcast episode, we talk about how therapists can take care of their bodies while working in a sedentary jobMany therapist friends of ours have described low back pain and challenges in maintaining physical health when much of the work we do is while sitting.What should therapists know about physical activity and physical therapy?“Physical therapists are trained movement experts… we can diagnose, we can treat using hands on skills, patient education, and then we prescribe individual exercise for a bunch of different injuries, the ultimate goal being to improve the way someone moves and emphasize injury prevention. And the cool thing about physical therapy: it can be an alternative to pain medication, in a society where they prescribe a lot of a lot of pain medication, and then surgery as well.” – Celina Caovan, DPT There are a number of subspecialties in physical therapy to support all different elements of improving movement The importance of moving outside of a sedentary job US Department of Health guidelines on activity levels What can therapists do to take care of themselves during the work week? Getting out of the chair, some chair exercises Stretching and gentle movements during the breaks between sessions No drastic differences in activity from the work week to the weekend (i.e., avoid weekend warrior behavior, especially when extremely sedentary during the week_ Slowly increase activity and gradually increase cardio or resistance training Stretching (static and dynamic), warming up, and cooling down How can therapists think about physical therapy for their clients?“Someone's physical and mental health – that’s interconnected… that mind body connection. And I think this would be a really great opportunity for us to create this interdisciplinary relationship where we can approach it from a physical and mental standpoint.” – Celina Caovan, DPT Referrals and direct access to physical therapy Psychoeducation and support for advocacy to obtain physical therapy Chiropractors versus physical therapists How physical and mental health therapists can collaborate to support patients  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! Physical Activity Guidelines for Americans from the US Department of Health and Human ServicesBeach Cities Orthopedics and Sports MedicineReach out to Celina Caovan, DPT: celinaDPT at gmail.comConsultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute HourConnect with the Modern Therapist Community:Our Facebook Group – The Modern Therapists GroupModern Therapist’s Survival Guide Creative Credits:Voice Over by DW McCann https://www.facebook.com/McCannDW/Music by Crystal Grooms Mangano https://groomsymusic.com/

Therapists on the Hostage Negotiation Team and Supporting Police Work: An interview with Dr. Andy YoungCurt and Katie interview Andy Young about hostage (crisis) negotiation and his work with SWAT and crisis negotiation in Lubbock, TX. Content warning: discussion of violence, suicide, and homicide. We talk about what therapists can do within police departments, the interplay between mental health and law enforcement, what that work looks like – especially when involved in crisis negotiation, and skills therapists need when working in these settings. We also look at trauma response and how it is handled when things go south.Transcripts for this episode will be available at mtsgpodcast.com!An Interview with Dr. Andy YoungDr. Andy Young has been a Professor of Psychology and Counseling at Lubbock Christian University since 1996 and a negotiator and psychological consultant with the Lubbock Police Department’s SWAT team since 2000. He also heads LPD’s Victim Services Unit and is the director of the department’s Critical Incident Stress Management Team. He has been on the negotiating team at the Lubbock County Sheriff’s Office since 2008 and is on the team at the Texas Department of Public Safety (Texas Rangers, Special Operations, Region 5). He is the author of, “Fight or Flight: Negotiating Crisis on the Frontline” and “When Every Word Counts: An Insider’s View of Crisis Negotiations.” He was recently added as a third author for the 6th Edition of “Crisis Negotiations: Managing Critical Incidents and Hostage Situations in Law Enforcement and Corrections”.In this podcast episode, we talk about the role therapists can play in crisis negotiationThere have been many calls to defund the police and create roles for mental health professionals in law enforcement. Dr. Andy Young has already been doing this for 20 years. We talked with him about what that experience looks like.What can therapists do for law enforcement? Crisis counseling Hostage or Crisis Negotiation support (advising on the negotiation) Psychiatric consultation Predicting violence or suicide, assessing subjects’ mental health What is the interplay between mental health and law enforcement? Police officers get 40 hours of active listening and mental health Officers started out a bit stand-offish, reported increased mental load due to needing to protect mental health professionals at the scene Finding value in taking mental health out of scope of law enforcement There is a huge importance in developing relationship with the officers Specialized training needed that can support integrating mental health providers into law enforcement teams What does work look like for therapists in law enforcement and crisis negotiation? Coaching on communication Assessing the situation and the subject Strategizing interventions to de-escalate the situation Provide context and reassurance to law enforcement professionals Hostage Negotiation calls are typically once to twice a month (and not every month). There are successful outcomes 97% of the time How do these law enforcement and mental health providers handle things when they go south? Crisis support Critical Incident Stress Management Mental health providers who are accepted within the law enforcement culture The political, investigative and personal elements of a lethal force incident Processing and debriefing within the team What skills should therapists have to work with law enforcement and hostage negotiation? Pragmatic and understanding the situation you’re in Practical, knowing your own limits Ability to manage emotional situations calmly Navigating the extreme stakes out in the streets Understanding law enforcement The benefit of having a mental health provider on a hostage negotiation team Training the team on mental health concerns Improving “batting average” on successful outcomes The importance of a well-trained team Resources for Modern Therapists mentioned in this Podcast Episode:

Why Therapists Shouldn’t Be Taught Business in Grad SchoolCurt and Katie debate whether graduate school programs for therapists should include business education. We look at the pros and cons for including business education for students, specifically identifying a mismatched developmental level, bloated curriculums, and underutilized career resources. We also look at the responsibility graduate schools have to their students to be employable or to be able to create a sustainable business. Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about whether clinical grad programs should include business educationWe have seen marketing that highlights that business isn’t taught in grad school (and have done a lot of it ourselves). We discuss whether it actually should be included.What is already included in grad school for therapists? A large number of clinical courses required for graduation Career centers and other business resources may be available, but not used What career or business resources should therapists get through graduate school? Career centers with up-to-date relevant employment resources Potentially an optional class or workshop for how to run a business Why shouldn’t business education be added to clinical programs?“The timing of it just isn't right. Like, yeah, these are ideas that can be introduced, but the practicalities of it, in my experience, just aren't developmentally where a lot of grad students are… I don't think that [teaching someone to run a business] at a developmental time when people aren't capable for it or aren't ready for it – or legally not allowed to put those things in place – it just ends up being so far off that it's not a practical sort of training thing.” – Curt Widhalm Accreditation bodies don’t access for employability, so programs won’t focus their attention The increasing number of credits required to become a therapist Developmentally inappropriate timing for what therapists are able to do when they graduate What would business education look like if it were included in graduate programs?“I'm not ready to let the grad schools off the hook for their responsibility to students. I feel like they are responsible to students to adequately prepare them for the job.” – Katie Vernoy Potentially lackluster participation due to overwhelm The importance of introducing what clinicians will actually face Seminar versus a full course Orientation to job options and business basics 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! Saving Psychotherapy by Dr. Ben Caldwell

What Goes in Your Notes? Interstate therapy practice and documentation for clients considering abortion or gender affirming careCurt and Katie chat about documentation and practice questions related to abortion or gender affirming care when providing therapy to folks in states where these types of medical care are banned or will be banned soon. We look at medical documentation privacy concerns (related to HIPAA and the 21st Century Cures Act), how therapists avoid “aiding and abetting” a client to get an abortion, what to include in your notes, and special considerations related to duty to warn and child abuse reporting. This is a law and ethics continuing education podcourse.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we explore post-Roe documentation for therapistsWe’ve heard a lot of questions about what therapists should do now that Roe has been overturned. We decided to dig into practice and documentation guidelines to help modern therapists navigate the changing times.Medical documentation privacy concerns with interstate practice and the new abortion bans HIPAA and the 21st Century Cures Act The impact on clients who move from safe haven states to states with abortion bans The impact of the Counseling Compact (and similar mental health compacts) and how many participating states have trigger laws to ban or limit abortion Paying attention to jurisdictional differences and where the client lives Who qualifies as a HIPAA covered entity? Psychotherapy (Process) Notes versus Progress Notes Psychotherapy notes are not defined the same and/or protected in every state The impact of civil law suits on confidentiality of process notes The huge challenge of information blocking and who may pass along your treatment information Talk to an attorney or your professional organization when subpoenaed How do you avoid “aiding and abetting” a client to get an abortion during mental health treatment? Processing feelings and helping client to make their own decisions Aiding and abetting can include telling them where to go, encouraging them to get an abortion, or providing practical support (like money or a ride) How to provide resources without aiding and abetting Self-empowerment and clients making their own decisions Liability and risk in practice (check with your malpractice insurance) Whether/how you let your clients know where you stand on the overturn of Roe v Wade What do you include in your notes when talking about abortion and gender affirming care? What is relevant to your treatment goals? Documenting progress toward treatment goals Creating a policy related to medical decision-making Phrases that you can use to briefly describe what is happening in session How much to document and the recommendation to be less specific in progress notes when discussing medical decisions The special considerations related to duty to warn and child abuse reporting when talking about abortion and gender affirming care No case law to guide us here The difference between permissive versus required reporting Vast differences across the states with all of the different pieces HIPAA says that we should not report, but we will be impacted by state laws Recommendations to pay attention to what is happening in the states where you practice and to identify advocacy opportunities to protect information, safe haven laws

An Interview with Metta World PeaceMetta World Peace played professional basketball for 19 years. He won the NBA World Championship with the LA Lakers in June 2010 and received the J. Walter Kennedy Citizenship Award – the NBA’s highest citizenship and community service honor – in April 2011. He was selected to the 2005-06 NBA’s All-Defensive Team, was voted by the media as 2003-04 NBA’s Defensive Player of the Year and was the only man with 271 steals in his first two seasons in the NBA, breaking Michael Jordan’s record. His autobiography, “No Malice: My Life in Basketball” was released in May 2018 with Triumph Publishing and a documentary on his life in basketball, “Ron Artest: The Quiet Storm” was released on Showtime in May 2019. World Peace is currently pursuing entrepreneurial projects including the XvsX Sports project he cofounded in 2017 and an NFT project, Meta Panda Club, to bring decentralized basketball community to the masses.World Peace is also known as a prominent mental health advocate, pop culture personality, philanthropist, and media favorite. He raffled off his 2010 NBA World Championship Ring with the proceeds going to his nonprofit, Xcel University (now known as Artest University). The online ring raffle raised more than $650,000. Funds were donated to nonprofits in 5 cities that provide mental health therapists and mental health services to their communities, and to provide scholarships to underprivileged youth in the New York City area.World Peace was part of the 13th season of ABC’s Dancing With The Stars, a contestant on CBS’s first edition of Celebrity Big Brother, as well as the CBS competition show, Beyond The Edge. He is active in entrepreneurial endeavors, serves as an advisor to several tech start ups, and seeks to help other basketball players who have aspirations for a pro career with his app and league, XvsX Sports. For more information, please visit https://www.xvsxsports.com/, https://metapandaclub.com/, and https://artestuniversity.org/.Why did Metta World Peace start speaking about his mental health? Metta shared his story growing up The Crack Epidemic and the impact on his neighborhood The challenges of incarceration, lack of education, and access to resources Building a shell to protect yourself on the streets What you learn and practice in the neighborhood he grew up in The role of history and the impact of slavery on mental health of generations of Black people The number of friends who are incarcerated The role of “chemical imbalance” in the mental health landscape and the family members who have dealt with more serious mental illness Metta’s desire to give back to the mental health community How Metta World Peace is working to solve the problems that lead to poor mental health The meaning of his name and why he changed it Coming together with all types of people Pushing back on separation and division or divisive statements No guns or drugs allowed in my neighborhood Challenging what has been defined as “life” in his neighborhood The lack of connecting resources (like parks) in all neighborhoods The importance of play and letting kids be kids The challenges that Metta World Peace faces in putting forward his message Describing self as emotional and colorful Needing to boost his confidence Mental health stigma before his first disclosure (thanking his therapist in 2010) How people perceive Metta versus how he sees himself interacting in the world Metta World Peace’s vision for the future Everyone has access to mental healthcare Everyone has a chance to have a good life We try to understand each other and what motivates them, what they are going through People coming together to improve society Parenting and partnership training in schools Putting parks in every neighborhood so kids can play, connect, and be kids

Infant and Early Childhood Mental Health: An Interview with Dr. Barbara StroudAn Interview with Dr. Barbara StroudBarbara Stroud, PhD, is a licensed psychologist with over three decades worth of culturally informed clinical practice in early childhood development and mental health. She is a founding organizer and the inaugural president (2017-2019) of the California Association for Infant Mental Health, a ZERO TO THREE Fellow, and holds prestigious endorsements as an Infant and Family Mental Health Specialist/Reflective Practice Facilitator Mentor. In 2018 Dr. Stroud was honored with the Bruce D. Perry Spirit of the Child Award. Embedded in all of her trainings and consultations are the activities of reflective practice, demonstrating cultural attunement, and holding a social justice lens in the work. Dr. Stroud’s book “How to Measure a Relationship” [published 2012] is improving infant mental health practices around the globe and is now available in Spanish. Her second book, an Amazon best seller, “Intentional Living: finding the inner peace to create successful relationships” walks the reader through a deeper understanding of how their brain influences relationships. Both volumes are currently available on Amazon. Additionally, Dr. Stroud is a contributing author to the text “Infant and early childhood mental health: Core concepts and clinical practice” edited by Kristie Brandt, Bruce Perry, Steve Seligman, & Ed Tronick.Dr. Stroud received her Ph.D. in Applied Developmental Psychology from Nova Southeastern University, and she has worked largely with children in urban communities with severe emotional disturbance.  Dr. Stroud’s professional career path has allowed her to work across service delivery silos supporting professionals in mental health, early intervention (part c), child welfare, early care and education, family court staff, primary care, and other arenas. She is highly regarded and has been a key player in the inception and implementation of cutting-edge service delivery to children Prenatal to five and their families; her innovative approaches have won national awards. More specifically, Dr. Stroud is a former preschool director, a non-public school administrator, director of infant mental health services and agency training coordinator. She has held an adjunct faculty position at California State Long Beach and maintained a faculty position in the Infant-Parent Mental Health Fellowship for 12 years. Currently, Dr. Stroud’s primary focus is professional training and private consultation from an anti-racist lens, with a focus on social justice, in the field of infant mental health. Dr. Stroud remains steadfast in her mission to ‘changing the world – one relationship at a time’.What is infant and early childhood mental health? Looking at big feelings and social and emotional development The current brain science that is impacting infant and early childhood mental health How adults impact infant developing brains What are the basics that therapists should know when working with children under 5 years old? The importance of dyadic therapy Parent training Social emotional developmental stages The damage of punishment on the development of an authentic self What infants need to love themselves, have healthy development Infants want to be safe, seen, heard, and helped Co-regulation and holding the big feeling with the child The impacts of this work on adults Transgenerational work – we treat the parent in the way that we would like the parent to treat the child How to support parents in healing their own wounds Therapy Interventions for infants and children under five years old Play therapy is complex and advanced and requires training and supervision Before children can think symbolically or have words, play is not effective Attunement and attachment work

What Maslow Missed in his Hierarchy of Needs - The Native Self Actualization Model: An Interview with Dr. Sidney Stone BrownAn Interview with Dr. Sidney Stone Brown, LPCSidney Stone Brown was born in Kalispell Montana, and is an enrolled member of the Blackfeet Indian Nation of Browning Montana. She was raised on / near her reservation until 1955, living in her great grandmother’s log house with her parents, great uncle, brother and older sisters. They had no running water or indoor toilets; the house was heated with oil and light by kerosene lanterns until 1950. Dr. Brown’s family relocated to Coos Bay Oregon when their reservation faced termination in 1955. Thereafter Dr. Brown attended west coast schools. She attended 30 different schools between first grade and graduation at Oregon State University in 1974.Dr. Brown worked her way through college and was employed by her tribe as an employment counselor, where she met a resident psychologist working at the tribal Hospital and became interested in Psychology. Near completion of her master’s program she contracted with 1) the University of Minnesota developing community action teams for the Red Cliff Reservation, 2) a Lakota CAP agency in Rapid City South Dakota acting alcohol program director and 3) the University of Utah (Montana Wyoming) Alcohol Counselor Trainer and 4) became permanent employment as director of NARA 1974. The program was originally funded at $81,000 and in ten years was 1.2 million. NARA (1981) won a national recognition award for program excellence and it was noted at the presentation in New Orleans that the model (Native Self Actualization) she developed was the most innovative cross-cultural model ever submitted to the National Council on Alcoholism since the awards began in 1946.She has served on many other non-profit boards, appointed a member of the (ADAMHA) Alcohol and Drug Abuse Mental Health Administration Minority Advisory Committee (1974-1976). She lobbied for Indian and minority services at the Oregon State Legislature subcommittees, and before the US Senate. she helped form the board and helped develop the certification criteria for NW Indian Alcohol Drug Counselor Certification Board.In this podcast episode, we talk about The Native Self-Actualization ModelHow has native teaching impacted psychology? Erickson and Jung studied with different tribes Maslow studied with the Blackfoot people before creating his Hierarchy of Needs Maslow did not publish or acknowledge the work of the Blackfoot tribe Maslow’s work was for corporations What did Maslow find when studying Native people? Most people were secure (versus the high percentage of folks in poverty on the East Coast) He moved from behaviorist to humanist Learned the way of life with the Blackfoot Tribe What is the Native Self-Actualization Model? Inverted Lodge or Teepee (turning Maslow’s hierarchy of needs upside down) The inherent purpose or promise babies come into the world with The philosophy of Indigenous People The importance of culture and altruism What has impacted Native mental health? Clement Bear Chief’s concept of the holes torn through Native communities The sexualization and objectification of Native women The need for protection people, earth, animals The story of the Blackfoot relationship with the buffalo The commonality of the indigenous experience Everything that was taken from Native people creating holes How to incorporate indigenous practices and teachings to support mental health treatment Important Takeaways The importance of intergenerational knowledge It is essential that indigenous wisdom and way of life survive The power of altruism and reciprocity We all are human beings and need to take care of each other

What Therapists Need to Know about Abortion and Termination for Medical Reasons: An Interview with Jane ArmstrongCurt and Katie interview Jane Armstrong, LCSW, a clinical social worker in Texas, about terminating a wanted pregnancy for medical reasons. We look at the impacts of the overturn of Roe v Wade on reproductive care. We also dig into what termination for medical reasons (TFMR) is, how society stigmatizes these parents, and what therapists can do to effectively support clients facing this decision and the outcome of TFMR.Transcripts for this episode will be available at mtsgpodcast.com!An Interview with Jane Armstrong, LCSW-S, PMH-CJane is a termination for medical reasons (TFMR) mom, native Texan, & clinical social worker certified in perinatal mental health. Following the birth & death of her first child, Frankie, through TFMR, Jane opened Both/And Therapy, PLLC to provide individual therapy & support groups to other TFMR parents. These services aim to support clients through the unique barriers & grief of ending a wanted pregnancy, particularly in the state of Texas where such care is no longer accessible. She’s passionate about building community, eliminating shame, & honoring grief for TFMR families. In this podcast episode, we talk about Termination for Medical Reasons (TFMR)In the wake of Roe v. Wade being overturned, we reached out to Jane Armstrong, LCSW-S, PMH-C who specializes in TFMR and is based out of Texas, a state with some of the biggest barriers to this type of medical, reproductive care.What are the clinical impacts on individuals who are considering or who have had an abortion? Trauma related to pregnancy as well as abortion The differences between ending wanted and unwanted pregnancies The shame – societal and internalized What therapists can get wrong when interacting with the topic of abortion Unexamined bias related to abortion TFMR – is baby loss and TFMR parents are entitled to grief Disenfranchised grief and traumatic loss The impact of anti-abortion legislation on patients considering abortion and TFMR Lack of access to all types of medical care Logistics related to getting access to medical care The emotional impact of continuing to carry a pregnancy when it is known that the baby will die How late parents can find out about medical concerns that mean that TFMR is indicated The lack of time to make a decision What is Termination For Medical Reasons (TFMR)? Terminating a pregnancy due to health issues with the pregnant person or with the baby For the pregnant person: fatal Hyperemesis Gravidarum, requirement for treatment, mental health conditions For the baby: 12 week genetic screenings or subsequent testing, scans, etc. can point out chromosomal abnormalities, neural tube deficits How can therapists work with TFMR clients? The conflict between the laws and a clinician’s own ethics Make sure your clients know you will be a support resource to them The importance of the client being able to tell their story Recognizing that TFMR is typically not talked about and opening space for these clients Trauma, grief, loss – sitting with the client with their hard stuff Helping clients to make this impossible decision Affirming parenthood and the challenge of the decision Decision versus “choice” and the ways in which bias can enter the conversation about decision-making