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

Should Therapists Correct Clients?Curt and Katie chat about whether therapists should correct clients who use offensive language. We look at what we should consider when addressing what clients say (including treatment goals and the relationship), how therapists can take care of themselves to be able to treat clients who hold a different worldview, and how (and when) therapists can address problematic language appropriately.Transcripts for this episode will be available at mtsgpodcast.com!In this podcast episode we talk about whether therapists should call out their clients on words they find inappropriateWe decided to address the language that clients use in session and what to do when we find the language offensive or harmful.Should therapists correct clients when they use language we find offensive or harmful? Blank slate or “join your clients” approaches Whether the language should be addressed when it doesn’t align with a client’s stated treatment goals Showing up as a human and addressing the therapeutic relationship Judgment or shaming that can happen with clients What should therapists consider when addressing what clients say? The relationship between the therapist and client Relevance to clinical goals The impact on trust in the therapeutic alliance The importance of using the client’s language to affirm their experience The power differential between therapist and client How can therapists show up with clients who see the world differently than they do? Addressing objectification of therapist’s identities Assessing when therapists are centering their own experience versus responding to what is in the room Using the relationship to process client’s perspective What can therapists do to appropriately address problematic language with their clients? Process what is being said before correcting specific words Address within the relationship and within the treatment goals Using our own coping skills to be able to navigate what our clients bring to session Where social justice plays a role (and maybe shouldn’t) Education and supporting the client’s whole development Assessing the impact of these interventions (both positive and negative) Assessing the harm in not pointing out bias or harmful language   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!Therapist–Client Language Matching: Initial Promise as a Measure of Therapist–Client Relationship Quality Feedback Informed Treatment Relevant Episodes of MTSG Podcast: Do Therapists Curse in Session? How to Fire Your Clients (Ethically) How to Fire Your Clients (Ethically) part 1.5 When is it Discrimination? Conspiracy Theories in Your Office

Is the Counseling Compact Good for Therapists?Curt and Katie chat about the brand-new Counseling Compact and what therapists may not know or understand about these interstate agreements. We explore the proposed benefits as well as the potential risks and complications like regulatory discrepancies and a lack of consumer protections. We also look at how big tech can benefit while individual clinicians may be left unable to compete in a larger market.In this podcast episode we talk about the new Counseling Compact and PsypactThe counselors got their 10th state and officially have Counseling Compact to practice in other states. We thought it would be a good idea to talk about what that means (and what we might want to pay attention to).What is the Counseling Compact? Opportunities for practicing privileges (not licensure) in other states The complexity of putting together these interstate compacts Implementation and regulation hurdles Scope of practice discrepancies and concerns Law and Ethics practices across states Benefits of Interstate Compacts for Mental Health Providers Continuity of care Ease of meeting with clients who are moving around the country Bringing clinicians to areas where there is a workforce shortage Potential Problems with the Counseling Compact Not bringing more clinicians, if only states with workforce shortages join Doesn’t solve the infrastructure problems (i.e., stable Wi-Fi) for rural areas that typically don’t have local therapists The people who most benefit: the big tech companies like Better Help The FBI is opposing this legislation due to lack of federal background checks Lack of consumer protection or consistency in what consumers can expect from their therapist Costs for the therapists to get practicing privileges Large gigantic group practices and tech solutions will contract with insurance and leave smaller practices unable to compete and required to be private pay Solving the Problems with the Counseling Compact Overarching regulation and expectations at a national level Federal bodies to oversee background checks and consumer protections Expensive, time-intensive We don’t have universal healthcare, so insurance parity will need to be addressed (and not just by big tech) 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!Counseling CompactPsypactVery Bad Therapy PodcastRelevant Episodes of MTSG Podcast: Special Series: Fixing Mental Healthcare in America Fixing Mental Health in America: An interview with Dr. Nicole Eberhart, Senior Behavioral Scientist, and Dr. Ryan McBain, Policy Researcher, The RAND Corporation Online Therapy Apps Why You Shouldn’t Sell Out to Better Help 

Clinical Considerations When Working with Asian Immigrants, Refugees, and Dreamers: An Interview with Soo Jin LeeCurt and Katie interview Soo Jin Lee, LMFT on the clinical implications of working with Asian American immigrants, refugees, and dreamers. We explore how best to assess these clients, specific clinical considerations related to the immigration experience (and legal status in the country), and ideas for working with these clients clinically. We also talk about the impact of societal views, media portrayals, and representation on AAPI clients.An Interview with Soo Jin Lee, LMFTSoo Jin Lee is a co-director of Yellow Chair Collective and co-founder of Entwine Community. She is a licensed marriage and family therapist in CA and has a special focus on training and consulting on Asian mental health related issues. She is passionate about assisting individuals find a sense of belonging and identity through reckoning of intersectional identity work and those that are navigating through difficult life changes. In this podcast episode, we talk about what therapists should know about Asian American immigrants, refugees, and dreamersIn preparation for Asian American Pacific Islander Heritage month, we wanted to dig more deeply into specific issues relevant to the AAPI community that are often not discussed in grad school or therapist training programs.What assessment questions should be included for AAPI immigrant clients? How to assess and ask about the immigration story (including about whether someone is documented or undocumented) The assumption of citizenship status during the assessment Exploration of cultural values and family dynamics The definitions for refugee, asylum seekers, immigrant, undocumented immigrant, dreamer Looking at reasons behind coming to the United States as well as legal status in the country  What is the impact of societal views and media portrayals of Asians on AAPI clients? The common stereotypes and the gap in the representation in the Asian diaspora The typical portrayal of undocumented immigrants from Latin America, Mexico, etc. Lack of representation in the media of the broad experience of being an undocumented immigrant or refugee The misrepresentation of families being all documented or undocumented (it’s actually a mix of statuses) Language, cultural and values differences between the generations  What are the unique clinical issues for refugees and undocumented immigrants? The uncertainty of staying in the country The hidden traumas and the fear of being kicked out The lack of planning for the future Education and financial barriers to pursuing the future Trauma and PTSD are key elements, but sharing the story means that their survival is at risk  How do therapists more effectively work with refugees and undocumented immigrants in therapy? The fear and risk involved in disclosure and the challenge of talking about identity Exploring their story creatively, without nitpicking or having to interrogate or make them verbalize their story The importance of building trust and building a safe space within therapy Bringing the mainstream media into the session Addressing fear and decision-making Soo Jin Lee’s healing journey to become a therapist and advice for other dreamers 

Reflections on Content Creation and the Therapy ProfessionCurt and Katie chat about our principles and philosophies as they relate to the work we do, including podcast creation. We also reflect on the feedback we’ve received on episodes with large listenership as well as other typical responses we get to the work we do. Considering content creation as part of your business? This isn’t a how-to, but it certainly can give you things to consider before you dive in.In this podcast episode we talk about how we put together the podcastWe’ve received a lot of feedback recently about our episodes and we wanted to talk about how we make decisions on what we talk about, who we interview, whether we call folks out on the podcast, and how we edit the episodes.Our Philosophy and Principles for creating content for the Modern Therapist’s Survival Guide How to navigate the career as is (tools and strategies to survive in this field) The importance of advocacy in moving forward with our field How to strategically time advocacy for best effect How we take in feedback and respond Responding to Feedback from our Audience on our “What’s New in the DSM-5-TR?” Episode The concern about the Autism diagnosis changes Whether we should have called out Dr. Michael B. First and the impressions of what was said Grappling with the tension between protecting our audience and getting our guests on record and/or advocating for change in the larger systems How people can impact what becomes DSM 6 (and the efforts we are advocating for) The feedback we received and how we sort through it and improve The limits of our capacity Our plans for additional interviews to address the changes A Broader View of the Feedback We Receive on the Modern Therapist’s Survival Guide Podcast The depth of the conversation and our ability to deepen conversations with additional episodes Audience members anchoring on the title or episode artwork and not looking at the whole episode when pieces of the content resonate in a different way Our Plan Going Forward with the Podcast Advocacy, information, and focus on the profession Not as much of a focus on business building, money mindset, and side hustles Real conversations about the realities of working in this profession Working to leave the profession better than we find it  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!The Therapy Reimagined MissionOur PatreonBuy Me A CoffeeRelevant Episodes of MTSG Podcast: What’s New in the DSM-5-TR? A Living Wage for Prelicensees Mission Driven Work Therapists are Not Robots Why You Shouldn’t Sell Out to Better Help Advocacy in the Wake of Looming Healthcare Shortages

What is Eco Anxiety? An Interview with Dr. Thomas DohertyCurt and Katie interview Dr. Thomas Doherty about Eco Anxiety. We look at the history of eco anxiety, what therapists should know about the environment, the concept of environmental identity, and how we can support clients with Eco Anxiety in therapy. We look at ways to bring these topics up with our clients as well as empower them to take action.An Interview with Dr. Thomas J. DohertyThomas is a clinical and environmental psychologist based in Portland, Oregon, USA. His multiple publications on nature and mental health include the groundbreaking paper “The Psychological Impacts of Global Climate Change,” co-authored by Susan Clayton, cited over 700 times. Thomas is a fellow of the American Psychological Association (APA), Past President of the Society for Environmental, Population and Conservation Psychology, and Founding Editor of the academic journal Ecopsychology. Thomas was a member of the APA’s first Task Force on Global Climate Change and founded one of the first environmentally-focused certificate programs for mental health counselors in the US at Lewis & Clark Graduate School. Thomas is originally from Buffalo, New York.In this podcast episode we talk about what therapists should know about Eco AnxietyIn preparation for Earth Day, we wanted to understand more about Eco Anxiety and what therapists can do to support our clients and the planet.What is Eco Anxiety? The history of Eco Anxiety, including worry about the use of chemicals, climate change The importance of words, personal experiences, how the client sees the world The diagnoses that align with this area, the types of impacts on clients What Should Therapists Know About the Environment? Resources related to climate change How to explore Environmental Identity Understand our own Environmental Identity The 3 basic psychological impacts from the environment (disaster, chronic, or ambient) The benefits of nature and how people in all environments can access them What is your Environmental Identity? Relationship to the natural world Significant experiences in the outdoors The nuance of bringing these ideas up in Urban areas What “nature” means to each of us How Can We Support Clients with Eco Anxiety in Therapy? Understanding the basics on the environment and climate change Building capacity to be with these issues Reeling in the anxiety, imagination Understanding the waves of emotions and completing the anxiety cycle Giving clients permission to talk about the environment and how to open up the conversations Coping strategies specific to Eco Anxiety Suggestions for activism and what clients can do to improve the environment Helping clients to identify if they are doing enough Where to find resources on environmental efforts How therapists can employ climate awareness in their practices 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! Dr. Thomas Doherty's Practice Sustainable SelfClimate Change and Happiness PodcastDr. Thomas Doherty’s Consultation and Training Program on the Environment The Psychological Impacts of Global Climate Change by Thomas J. Doherty and Susan Clayton NY Times: Climate Change Enters the Therapy RoomClimate Psychology AllianceProject Draw DownRelevant Episodes of MTSG Podcast: What’s New in the DSM-5-TR with Dr. Michael B. First What You Should Know About Walk and Talk Therapy part 1 What You Should Know About Walk and Talk Therapy part 2 (Law and Ethics) Shared Traumatic Experiences

Therapists Are Not Robots: How We Can Show Humanity in the RoomCurt and Katie discuss how big life events (a big diagnosis, a huge personal loss, injuries and medical conditions) can show up in the room. We explore how much humanity is okay to share with our clients. How do we decide what we tell our clients (and how do we manage their reactions)? We also look at how we take care of ourselves while also taking care of our clients. Therapists aren't robots, but we certainly need to be aware of our clients when life happens. In this podcast episode we talk about appropriate self-disclosure practices for modern therapists going through life eventsAs therapists it’s important that we hold a professional exterior during therapy. But can it be helpful to share with clients the big moments in our lives? How can we be human in the room?What are some considerations for therapists when deciding to self-disclose? Showing your humanity can help bond a client with the therapist. Self-disclosure may be different for planned or unplanned life events and whether they come into the room or private/hidden and in the background of your life Deciding when and whether to tell clients Clients often will use the therapist as an example on how to handle big life events. Not all settings are appropriate for therapist disclosure. Clients do not have the same confidentiality requirements as therapists; if you self-disclose to a client, it could be known by others or other treatment team members. In self-disclosing, the therapist will need to process the disclosure with the client. Processing difficult personal material with multiple clients could be difficult for the therapist. How much you disclose will depend on the client, but you might share more with a long-term client than a newer client. Are there ethical considerations for therapists sharing about our lives? There are no BBS outlined ethical considerations for sharing personal disclosures in therapy. The therapeutic environment should encourage a client to question the therapist. The therapeutic environment should encourage clients to participate in self-advocacy. Remember that certain self-disclosures might be triggering for clients; be mindful of what you share with who. Document all ruptures in relationships in your note and what you did to help heal the rupture. Be mindful - clients could be retraumatized or try to care take after a therapist’s disclosure. Not all clients need to know everything; know your population. What should new counselors and therapists know? Therapists are human! Life will continue to affect you even while working. It is important for therapists to take time off when they need it. Ruptures in the therapeutic relationship will happen; it’s all about how you handle it. New counselors often want hard rules for how to act, but it gets easier with experience. The most damage happens from not acknowledging or apologizing for ruptures. When ruptures occur, be honest and accountable to your clients. Sharing our human moments with clients can create a deeper and richer relationship. Don’t forget you don’t have to do this alone – always consult if unsure on disclosures! 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! Struggles of the Novice Counselor and Therapist by Thomas M. Skovholt and Michael H. RønnestadAbstract: Shared Trauma: The Therapist’s Increased Vulnerability by Dr. Karen W. Saakvitne

What You Should Know About Walk and Talk Therapy and Other Non-Traditional Counseling Settings – Part 2Curt and Katie chat about non-traditional therapy settings like outdoor walk and talk therapy as well as home-based counseling. In the second of a two-part, continuing education podcourse series, we look at law and ethics, accessibility, informed consent, navigating confidentiality, dual relationships, and what therapist might want to consider before getting started.In this continuing education podcast episode, we look at the laws and ethics related to non-traditional therapy settingsFor our fourth CE-worthy podcourse, we’re looking at the laws and ethics of bringing therapy into non-traditional settings, including walk and talk therapy and home visits. We cover a lot of topics in this episode:Debunking the hesitations of using non-traditional therapy settings Minimizing liability and concerns related to these environments Is it unethical to not consider these environments? Access and payment, including insurance/managed health care concerns and fee setting Unpredictability in the environment Scheduling and permission for services Business practices and systems that support this type of dynamic practice Accessibility of walk & talk and home-based therapies Financial, physical or other types of accessibility (and navigating those) Ways to make sure you clients can access the service and are prepared for the environment Extending boundaries and the consequences of these situations Documentation of any concerns that arise Clinician comfort and preference, do no harm, and do good Informed Consent for non-traditional therapies Client choice and appropriateness, including informed opt-in (and opt out) Health conditions, screening or attestation related to risk and liability Clinician safety and how to talk with your client about these concerns Cancellation policies and back up plans Ability to terminate (both passively and actively) Collaboration and communication Confidentiality when you’re meeting outside of the therapy office Managing the risks of the limits of confidentiality in these other settings Collateral consent forms for additional members of the treatment Release forms for others in the home Co-creating the plan to manage these situations Ideas for how to explain the relationship, if needed Active and passive loss of confidentiality (and how to talk about these risks) Boundaries versus confidentiality (for example where in someone’s home to meet) Documentation and consultation Dual Relationships that can happen during walk and talk or home-based therapies Professional therapy never includes sex Casual nature of the relationship in these settings and the threat of friendship vibes Not all dual relationships are problematic Host/guest dynamics as something to pay attention to, but not necessarily harmful Navigating the potential medical needs of home-bound clients (helping and/or advocating for more help) What therapists should assess before getting started Liability and malpractice Logistics and planning Assessing client vs clinician benefit Assessing competency for these types of services Training, consultation, supervision, documentation

What You Should Know About Walk and Talk Therapy and Other Non-Traditional Counseling SettingsCurt and Katie chat about non-traditional therapy settings like outdoor walk and talk therapy as well as home-based counseling. In the first of a two-part, continuing education podcourse series, we look at the basics, including why therapists should consider these settings (and may not), clinical and cultural considerations, and best practices.In this continuing education podcast episode, we look at non-traditional therapy settingsFor our third CE-worthy podcourse, we’re looking at the basics of bringing therapy into non-traditional settings, including walk and talk therapy and home visits. We cover a lot of topics in this episode:What are non-traditional therapy settings? The focus of this episode is walk and talk and home-based therapy Client’s locations like home, school, or work; community-based settings Anything beyond the typical therapy office or telehealth settings are worthy of consideration Creativity and collaboration in creating the space How different the therapy can be when opening up more settings as possibilities Why should therapists consider these non-traditional therapy settings? Logistical considerations that can lead to these settings being the ideal choice (or only choice) Clinical indications that walk and talk or home-based therapy is a better choice The impact on changing settings on the therapeutic relationship and the therapeutic work Specific modalities that are best served by client-centered spaces Assessment, treatment teaming How access, attendance, and attrition are impacted The therapeutic impact of the settings and movement What are the hesitations therapists have in considering alternative settings for therapy? The challenges in creating systems and managing the logistics Lack of alignment with the medical model Lack of training and guidance Legal and Ethical considerations (that will be talked about in next week’s episode) What are the clinical and cultural considerations when doing therapy outside or in someone’s home? Navigating the shifting relationship and boundaries Cultural differences between therapist and client, and assumptions made about the relationship The importance of leading the conversation about these relationships Hospitality and others who may be present at a client’s home The unusual space, the level of confidentiality, and emotional containment and depth of conversation Treatment planning based on where you meet and how the client interacts with the space The importance of the clinician holding the therapeutic space and attention Creating the space and the contract for how therapy will happen Cultural norms for the activities and for the client and family – more complexity to discuss Clinical How-To for Non-traditional Settings Assessment considerations Client and clinician characteristics Alignment with treatment goals and presenting concerns Presenting issues can vary and assessment can be important Initial assessment appointments and making the decision early in treatment Treatment Formulation related to active versus passive interaction with the space The importance of true informed consent and the dynamic nature of process contracting Introducing predictability Risk assessment Knowing your scope and what types of professionals you might consider consulting

Now Modern Therapists Need to Document Every F*cking Thing in Our Progress Notes?!?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: How do we document ruptures during the therapy session? Is the BBS over-reaching by controlling what therapists document? What are the best practices for note taking? All of this and more in the episode.In this podcast episode we talk about appropriate documentation practices for modern therapistsAs therapists it’s important that we take accurate notes. But what is important to include in the notes, and how much should we really be documenting?Wait – Is it alright to use curse words in session? Therapists should be first and foremost aware of the client and their potential reaction. Note the therapeutic relationship with the client, their history, and how the client empowers themself when making language selections. If considering using casual language, consider the client’s vernacular. Follow the client’s lead when it comes to their language in session, including cursing. The BBS has no specific statute related to cursing or swearing. What should modern therapists document in clinical notes? It is important to document any bold interventions or ruptures in the therapeutic relationship and repair attempts for ruptures. In note taking, it is important to follow the clinical loop: assessment, diagnosis, treatment plan, intervention, use of intervention, and the client’s reaction and progress. Your notes will be a balance of covering your liability and creating notes that help you remember the session. Therapists should consider documenting the use of any language that could be deemed not clinically appropriate, even positive statements like “I’m proud of you,” or “Yes, my dear.” Does the California Board of Behavioral Sciences (BBS) outline what we should say in our notes? In the 300-page PDF outlining the statutes for LPCCs, LMFTs, LCSWs, and Educational Psychologists, notes are only mentioned 10 times. There is no mention in the statutes of what can be said and what can’t be said in notes. Some agencies and institutions will stress writing very little to ensure protection from liability, but as this citation showcases, this might not be best practice. The BBS wants to ensure the protection of clients and you might need to justify your words, just as you would justify the use of an intervention. This is a reminder that the BBS can and do look at therapist’s notes. Support The Modern Therapist’s Survival Guide on Patreon!If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings, and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more. If you don't think you can make a monthly contribution – no worries – we also have a buy me a coffee profile for one-time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.

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 Support The Modern Therapist’s Survival Guide on Patreon!If you love our content and would like to bring the conversations deeper, please support us on our Patreon. For as little as $2 per month we're able to bring you more content, exclusive offerings, and more opportunities to engage in our growing modern therapist community. These contributions help us to expand our offerings for continuing education events and a whole lot more. If you don't think you can make a monthly contribution – no worries – we also have a buy me a coffee profile for one time donations support us at whatever level you can today it really helps us out. You can find us at patreon.com/mtsgpodcast or buymeacoffee.com/moderntherapist. Thanks everyone.