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

Which Theoretical Orientation Should You Choose?Curt and Katie chat about how therapists typically select their clinical theoretical orientation for treatment. We look at the different elements of theoretical orientation (including case conceptualization, treatment interventions, and common factors), what impacts our choices, the importance of having a variety of clinical models to draw from, the types of practices that focus on only one clinical theory, and suggestions about how to approach choosing your theories for treatment, including some helpful assessments.In this podcast episode we talk about how therapists pick their theoretical orientationWe received a couple of requests to talk about clinical theoretical orientation and how Curt and Katie chose their own. We tackle this question in depth:Choosing a clinical theoretical orientation The problem with the term “eclectic” when describing a clinical orientation How Curt and Katie each define their clinical orientations “Multi-modal” therapy The different elements of clinical orientations Case conceptualization Treatment interventions Common Factors and what actually makes therapy work What impacts which theoretical orientation we choose as therapists Clinical supervision Training Personal values and alignment with a theoretical orientation Common sense (what makes sense to you logically) Choosing interventions that you like The importance of having a variety of clinical theories that you can draw from Comprehensive understanding is required to be able to apply and know when not to apply a clinical orientation Avoid fitting a client’s presentation into your one clinical orientation Deliberate, intentional use of different orientations Why some therapy practices operate with a single clinical model Comprehensive Dialectical Behavioral Therapy (DBT) therapists run their practices and their lives with DBT principals Going deeply into a very specific theory (like DBT, EMDR, EFT, etc.) while you learn it Researchers are more likely to be singularly focused on one theory Suggestions on How to Approach Choosing Your Clinical Theoretical Orientation Obtain a comprehensive understanding of the theoretical orientation Understand the theory behind the interventions Recognizing when to use a very specific theory or when you can be more “eclectic” in your approach Deciding how fluid you’d like to be with your theoretical orientation Find what gels with you and do more of that The ability to pretty dramatically shift your theoretical orientation later in your career Instruments for Choosing a Theoretical Orientation Theoretical Orientation Scale (Smith, 2010) Counselor Theoretical Position Scale 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!Institute for Creative MindfulnessVery Bad Therapy PodcastPetko, Kendrick and Young (2016): Selecting a Theory of Counseling: What influences a counseling student to choose?What is the Best Type of Therapy Elimination Game The Practice of Multimodal Therapy by Arnold A. LazarusPoznanski and McClennan (2007): Measuring Counsellor Theoretical OrientationRelevant Episodes of MTSG Podcast: Unlearning Very Bad Therapy Interview with Dr. Diane Gehart: An Incomplete List of Everything Wrong with Therapist Education 

The January 2022 Surprise of Good Faith Estimates RequirementsCurt and Katie chat about the No Surprises Act, specifically how to navigate the requirement for clinicians to provide Good Faith Estimates to clients. We talk about the impact of Good Faith Estimates on the intake process, potential complications when providing these estimates to your patients, and suggestions for how to simplify and systemize this requirement.    In this episode of the Modern Therapist’s Survival Guide we talk about the No Surprises Act and the Good Faith Estimate RequirementWhen we heard about the planned implementation of these new requirements, we decided to dive into the legislation and articles from professional associations to understand what we actually need to do starting January 1, 2022.What is the No Surprises Act and the Good Faith Estimate (GFE) Requirement? The goal of the No Surprises legislation is to avoid surprising patients with large medical bills There are benefits and challenges with the requirement to provide good faith estimates to our clients The Good Faith Estimate requirement is to provide the estimated cost of services (fee times number of sessions) at the beginning of treatment (if asked) and at least annually, if needed How will the Good Faith Estimate Requirement impact the Intake Process for Therapy? We are required to determine whether someone is hoping to get insurance reimbursement We must communicate the ability to obtain a written good faith estimate from providers We are required to estimate the number of sessions and total cost of treatment We talk about when you may need to provide a new good faith estimate (and explain changes) We provided a suggestion to start with a GFE for the intake session and then provide a second GFE after that initial session Potential Complications Curt and Katie see for Therapists Providing Good Faith Estimates The requirement for diagnosis very early in treatment The requirement for a diagnosis written on paper – both for folks who don’t know or have not asked before, as well as for folks who do not want a written diagnosis Concerns related to putting forward the total cost of therapy for the year The elements of bureaucracy that could negatively impact the therapeutic relationship The No Surprises Act legislation isn’t finalized and may have additional components or changes Our Suggestions to Systematize the Good Faith Estimate (GFE) Requirement for Therapists Consider coordinating the timeline for updating GFEs, treatment plans, frequency of sessions, progress in treatment, and a reassessment of the sliding scale Think through how you talk about diagnosis and treatment planning ahead of time The idea to create some sort of mechanism for folks to either decline a GFE or to request an oral versus paper GFE Use recommended language to create your notice for your office as well as on your website Create your own template to simplify the process, including a boiler plate GFE for your intake Create a template for GFEs for on-going treatment 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!APA Article: New Billing Disclosure Requirements Take Effect in 2022 Suggested Notification Language for Good Faith Estimates Template for a Good Faith Estimate Good Faith Estimate Legislation Language from the No Surprises ActFederal Register: Requirements Related to Surprise Billing; Part IICMS.gov: Requirements Related to Surprise Billing; Part II, Interim Final Rule with comment periodRelevant Episodes of MTSG Podcast: Should Private Practice Therapists Take Insurance? Make your Paperwork Meaningful

How Can Therapists Actually Retire? - An interview with David Frank, financial planner for therapistsCurt and Katie talk with David about managing finances, including student loan debt and retirement. We look at when to start saving, what to do when you’re starting to save for retirement later in life, and how much is too much to save. David also shares his concept of a Money Date and how you should start looking at your financial picture. He also talks about financial planning and when to seek a professional for support.Interview with David Frank, Turning Point Financial Life PlanningIn this podcast episode we talk about: Managing Personal and Professional Finances How perfectionism can get in the way of saving The importance of “just getting started” in saving for retirement Saving money is a practice, not something you figure out once Why it is important to save money as soon as you can Navigating Student Loan Debt Student loan debt and how overwhelming it is to look at these debts The desire to pay off this debt as quickly as possible David’s advice to save at least one time your annual income before aggressively paying off your student loan debt The comparison of interest rates on your debt versus returns on investing money Retirement and Investing in your Future “Starting to save and invest young is such great advice… and… it’s advice for time travelers” For younger folks, the advice is to save as soon as possible What to do if you are closer to retirement age and you haven’t started saving for retirement How to determine when you can retire “No one does this money thing perfectly, even if we start out of the gate pretty strong.” What to do when life happens and you have to start over David’s own story of having to start over Societal fear due to 2008 and the Great Recession David Frank’s Concept of “Money Dates” Reserve time each week to look at your money Start understanding how much you need to save Idea: go to the Social Security Administration Website to see what you’re entitled to in social security How Much Money to Save The money mindset concerns that can get in the way of saving (or even looking at) your money How much money is too much money to save? Emergency funds and the feeling of safety and security The risks of saving too much money Quality of life questions when you are underspending Online tools to identify what you need in retirement, so you know when you’ve saved enough Actual numbers of what to save for retirement and what you can spend now Financial Planning – When and why to seek help with your money The complexity of the decisions related to paying debt versus investing The number of options available to each person when making decisions on our money Get feedback on how well you are doing on your practice financials and saving for retirement Risk planning, financial planning, estate and incapacity planning The importance of understanding your values when you look at how to spend your money Financial planning when you don’t have a lot of money Choosing what you sacrifice when you decide to invest in shiny objects The problem of “shoulds” and getting financial advice from other therapists

Should Private Practice Therapists Take Insurance?Curt and Katie chat about the latest data from SimplePractice on private practice clinicians billing insurance. We explore the most common set up for clinicians (a hybrid insurance/private pay practice) as well as how therapists bill insurance, the disparity between private pay fees and insurance rates (and how different these disparities are across the United States), how strategies for growing private practices are affected by who is paying, and how to set yourself up for a successful hybrid insurance practice.It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.In this episode we talk about: Demystifying the most Common CPT Codes E-Book from SimplePractice Looking at the most common make up of therapists’ private practices (hybrid: insurance and private pay) The theories about whether to take insurance of not The process of starting a practice (credentialing timeline, marketing, etc.) The benefits of being on an insurance panel (e.g., nearly 100% close rate) The income differences for clinicians at different stages of practice development The average number of appointments per week by type of practice (insurance, hybrid, or private pay) and what that means for your income How well insurance reimburses in different states (and comparing these rates to typical private pay fees) Financial considerations when looking at the insurance rates you will get in your area How to set up your practice if you choose to take insurance The most frequently billed CPT code (as well as others to consider) The controversy around 90837 and how to make sure you get paid Different strategies to build a sustainable business with an insurance or hybrid private practice Resources mentioned: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! Demystifying the Most Commonly Used CPT® Codes for Mental Health Relevant Episodes: Busting Insurance Myths Make Your Paperwork Meaningful Noteworthy Documentation Negotiating Sliding Scale Special Interview: Open Path Psychotherapy Collective Connect with us!Our Facebook Group – The Modern Therapists Group Our consultation services:The Fifty-Minute Hour

When Clients Have to Manage Their TherapistsCurt and Katie chat about the work (or mental load) therapists often give to clients that is really ours. We talk about requiring our clients to do things that are not helpful to treatment like: manage our time, do excessive paperwork, negotiate through our money stuff, be guinea pigs, or teach us about their culture or other differences. We also look at the impact of these abdications of responsibility on the therapeutic relationship and the clinical work.   It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.In this episode we talk about: When we give more work to clients (that isn’t really good therapy) The mental load or emotional labor that therapists can unwittingly add for clients Time management and the impact of poor practices on clients Being late, managing the shape of the session, scheduling The difference between being authentic and being irresponsible The care you show when managing rescheduling and the impact on the relationship What can come up, especially related to attachment wounds The problem when you consistently forget to get back to your clients Paperwork as a burden on clients, especially when clinicians don’t read the paperwork The message you give when you don’t follow up on a client’s homework When outcome measures feel like paperwork that is solely for the benefit of the therapist, rather than something that feels relevant to the client Feedback Informed Treatment (FIT) poorly implemented Delayed billing, not providing superbills timely Allowing a balance to accrue The power dynamic and power imbalance when clients owe therapists a sizable amount The labor we’re giving to our clients when don’t have structure on payment (sliding scale fees and payment plans) How our own money stuff might come into these conversations Adding new theories or trying new interventions on clients without a strong clinical rationale The danger to the client’s trust in the process if we throw new interventions in each week The mental load of asking our clients to teach about their own experience or navigating therapist bias Identifying a lack of fit or when treatment is over (rather than forcing our clients to do so) Own our humanness and set ourselves up for success Why this work sometimes gets handed to clients (rigidity, therapy culture)

How to Be Accessible Beyond the Sliding ScaleAn interview with Lindsay Bryan-Podvin, LMSW, about how therapy can be accessible (and not just financially). Curt and Katie chat with Lindsay about capitalism versus money exchange, the social enterprise model, and how therapists can make a good living without feeling like greedy capitalists. We also explore the many different types of accessibility and the importance of setting your fees based on your needs and values rather than as a mechanism to single-handedly fix the broken system or to meet an artificial money goal.   It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.Interview with Lindsay Bryan-Podvin, LMSW, Mind Money BalanceLindsay Bryan-Podvin (she/her) is a biracial financial therapist, speaker, and author of the book "The Financial Anxiety Solution." In her therapy practice, Mind Money Balance, she uses shame-free financial therapy to help people get their minds and money in balance. She's expanded her services to help private practice therapists with their money mindset, sustainable pricing, and authentic marketing so they can include financial self-care in their work. She lives with her partner and their dog on the traditional land of the Fox, Peoria, Potawatomi, and Anishinabewaki peoples also known as Michigan.In this episode we talk about: How therapy can be more accessible (and not just monetarily) The money “shit” that gets in the way of us thinking about other options for accessibility Decreasing stigma and the notion that therapy is by and for white folks Are we making our practices accessible for all sorts of folks? ADA compliance, supporting neurodivergent and disabled folks Cultural competence, the ability to apply that in sessions with clients who are different than us Being embedded in our communities Taking therapy out of the shadows The challenges in getting out and having a larger voice How accessibility is intertwined with therapist visibility How to become part of your community in effective and impactful ways Financial ways to make your practice more accessible beyond sliding scale Social Enterprise Model: intersection of what you do well, what values you stand for, and what can you get paid well to do Feeling like a greedy capitalist What it means to be paid well How to think about setting your fees Fee-setting based on what you need to survive and thrive (not capitalist principles) The problem with “know your worth” The big cognitive shift required to move from community mental health pricing and work-life balance, fees Tying money to quality of life, not specific monetary goals Getting to “enough” not more and more Capitalism versus money exchange The wealth of knowledge we have as therapists (and how therapists take it for granted and/or devalue it) Sharing your knowledge as a mechanism of accessibility to your whole community To practice self-care, you have to be able to afford it

Peer Support SpecialistsIt’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.Interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFTKemisha Fields, MSW: Kemisha Fields was born and raised in South Los Angeles, CA. As a former foster youth, she has taken a professional interest in the commitment to serving the needs of children and families as a Children’s Social Worker working in Dependency Investigations. She has studied many modalities to bring healing to those in need. Kemisha is a life, long learner inspired by the abundance of opportunities available to enrich the lives of the people she serves. She earned her Bachelor of Science Degree in Psychology from the University of Phoenix. She received her Master of Social Work degree from the University of Southern California. Currently, Kemisha is a Doctoral Student of Business Administration with an emphasis in organizational leadership.Jeff Kashou, LMFT: Jeff Kashou, LMFT is a manager of clinical product and service design for a mental health tech company that provides telemedicine to those with serious mental illness. Previously, he ran a county mental health program where he helped develop the role fo peers for adolescent programs county-wide and collaborated with peers to create management practices to support their professional development. In this position, Jeff developed a practice guideline for the utilization of peers in behavioral health settings for the County of Orange. Jeff has also served on the Board of Directors for the California Association of Marriage and Family Therapists, where he helped lead the association to support the field of Marriage and Family Therapy and those with mental health issues. He consults as experts in mental health for television productions, to ensure the accurate and helpful portrayal of mental illness and treatment in the media. Most recently, Jeff and his wife Sheila wrote a children's book, The Proudest Color, that helps children of color cope with racism that will be on shelves this Fall.In this episode we talk about: What a peer support specialist is, how they work What peers can uniquely bring The hiring process, qualifications, and what that means for individuals seeking these jobs The difference in perspective that peer and parent partners can bring to treatment teams The importance of lived experience Comparing holistic versus medical model treatment The medical model and the recovery model complement each other The importance of advocacy for individuals (with the support of the peer support specialist) How peer support specialists are best integrated into treatment teams and programs The potential problems when the peer support specialist role is not understood How someone can become a Peer Support Specialist Certification and standardization of the peer support specialist role SB803 – CA certification for Peer Support Specialists Legislation Ideal training for these professionals How best to collaborate with a peer support specialist What it is like to implement one of these programs The challenges of hiring a peer support specialist Exploring whether there are systems in place to support peer support specialists with their unique needs The recommendation for a tool kit and a consultant to support programs in implementing best practices The Recovery Model and peer support specialists in practice Multidisciplinary teams may have pre-existing bias and prejudice against folks with lived experience, the role of stigma in the interactions

Is Your Practice Ready for Paid Digital Marketing?An interview with John Sanders, owner of RevKey, about Google and Social Media Ads. Curt and Katie talk with John about the importance of a solid website, effective sales process, and metrics when considering paid digital advertising. We also explore what to expect when you create Google or Facebook Ads. We also talk about why you may want to outsource this and the financial risks for getting this marketing wrong.  It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.Interview with John Sanders, RevKeyJohn is an expert in paid search, specifically, Google Ads (which used to be called Google AdWords). He holds a BBA and MBA, and he has put this education to work in a variety of positions in the marketing field, including inside sales, purchasing, E-Commerce, and marketing management. Once he found Google Ads, John was hooked. He enjoys helping businesses generate leads through Google Ads that will help their companies grow, and he has partnered with businesses in a range of professions, including medical offices, B2B companies, and national product brands. John can help your business achieve its full potential.In this episode we talk about: Google Ads and other digital advertising (social media for example) The mistakes folks make in purchasing digital ads, typical pitfalls Specific to Google Search Ads: why not to use smart or dynamic ads Keywords and negative keywords The importance of tracking your results and what results you’re looking for The difference between social media and Google ads What a good ad looks like and what page it goes to What’s needed on a website before starting Google Ads (sufficient, relevant content and pages) Service pages and the specificity of the search How social media ads work (e.g., Facebook and Instagram) Building an audience within social media to target with your ads The value of an ideal client or niche when using social media ads Social media is more of a branding exercise than Google Ads Facebook has a lot of specific rules for advertising What return on investment you should expect, the goal of placing ads How to assess what is not working Looking through the full sales cycle to determine where to improve efforts (including answering your phone) The technical savvy that is needed to run and assess these ads The usefulness of Google analytics Determining DIY versus hiring out advertising How to outsource paid digital advertising How to determine the average value of a client Advantage of paid digital advertising versus Search Engine Optimization (SEO) The potential to lose money if this is done wrong The benefit if it is set up properly Setting up a multitier marketing plan including Google Ads and SEO 

Conspiracy Theories in Your OfficeCurt and Katie chat about clients who bring conspiracy theories into therapy. We talk about differentiating between psychosis and believing in conspiracy theories, the characteristics of folks who may be likely to subscribe to these theories, and the importance of the relationship in working with these folks. We also look at steps we would like professional organizations to take to support clinicians.It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.In this episode we talk about: How to handle when clients bring conspiracy theories into your office Distinguishing between delusions, shared psychosis, and conspiracy theories Reality testing, obsessive research, and other factors that may distinguish between psychosis and conspiracy theory The impact of internet research and social media algorithms The characteristics of folks who are more likely to believe in conspiracy theories How fear of uncertainty, lack of trust can play into this dynamic Societal impacts like advertising certainty The different responsibility that therapists have when someone brings in a conspiracy theory Hesitation in addressing these theories both in the room and at the professional org level The continuum of engagement with conspiracy theories (from “entertainment” to going down the rabbit hole) The level of investment in the theory, groups forming around these theories, and cults The risk factors and legal/ethical responsibilities related to harm Allen Lipscomb’s BRUH modality (Bonding Recognition Understanding and Healing) The problem with direct challenging The importance of identifying is it a conspiracy theory or is someone actually out to get you, especially with clients who are in traditionally marginalized communities Building trust within the relationship through deep understanding of the client’s experiences Societal measures that can help (like deplatforming leaders of the theories) Starting from compassion and curiosity; managing reactions Exploring the nuance of challenging irrational fears versus conspiracy theories Seeking common ground and identifying impacts The call to action to professional organizations for guidance and taking a stance (and the understanding of why they balk at doing so)

Therapists Shaming TherapistsAn interview with Katie Read about therapists shaming each other when they raise their fees or start playing bigger. Curt and Katie talk with Katie about the puritanical culture within the therapist community that leads to group think, public shaming, and milquetoast messaging to mitigate their fear that anything different will be attacked. We look at reasons behind this (jealousy, guilt, shame, and moralism) as well as what therapists can do to step outside of this culture to create more success. It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.Interview with Katie Read, LMFT, Six Figure FlagshipKatie takes lessons from her nearly-20 successful years in the field to help clinicians grow...then OUTgrow...their practices.Immediately upon licensure, Katie was made Director of a large Transitional Aged Youth program in Oakland, CA. Later, she was recruited to Direct one of Sacramento’s largest Wraparound Programs, and from there she moved into the role of Director of Clinical Supervision, personally supervising 40+ interns towards licensure.Concurrently, Katie had private practices in multiple cities, taught graduate psychology students, and wrote and created therapist training materials.Katie is also a special needs mom and loves helping other moms tune into their own intuition and lead their best-possible lives by taking the sometimes-scary leap into following what’s best for them, deep down.She is the creator of:The Clinician to Coach® Academy,The Clini-Coach® Certification,and the Six-Figure Flagship™ Program.She’s a little bit obsessed with helping therapists get profitable doing the creative, out-of-the-box, authentic work you're called to do!In this episode we talk about: How therapists are treating each other The concept of trolling, piling on, shame The Article in the Atlantic – New Puritans – and the concept of the illiberal left How identity plays a role and the group dynamics within therapist Facebook groups The shaming related to increasing your fees Katie Read’s origin story as an on the street social work The value placed on sacrifice and avoiding guilt for the difference in privilege when working with clients who are impoverished Socially-prescribed perfectionism, self-imposed perfectionism The fine line about what is acceptable to charge or make as a therapist Cancel culture and the lack of allowance for errors Echo chambers, factions, and exclusion The fear of dissenting opinions The low context of the internet paired with the high context nature of a therapist’s job Milquetoast messaging to avoid getting attacked Dialing down authenticity to fit into what is acceptable Challenging our financial mindset Cultural and societal factors that frame us as cheap labor The seeming requirement for therapists to suffer in order to understand our clients The reality of therapists as business owners Therapist guilt for “earning money” Feminized professions and the expectation of doing things out the goodness of our hearts Rapidly changing social rules versus entrenchment in what has been How this identity shift is spilling over into real life Jealousy, guilt, and shame, and moralism The best therapists have the worst impostor syndrome How to navigate when you’re a therapist going against the grain The importance of every therapist doing their own money mindset work