How Do Therapists Manage Intense Caseloads?

Working for 988: Insider Perspectives Curt and Katie received feedback on our recent one year follow-up episode on the rollout of 988. We received responses from a person who was working within the 988 system as well as someone who started going through the training for the text crisis hotline. We were able to put more depth into our understanding of how this system works. We explored training, supervision, funding, potential equity issues, and concerns for staff. We also share ideas for advocacy.  Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode we report back on employee experiences within the 988/crisis response system We share two insider experiences working within the crisis response system around 988.  Listeners shared their experiences with training as an emergency worker within the 988 system: For the text crisis hotlines, there were concerns about insufficient, online-only training models that lack supervision and focus on formulaic responses. For the call center, there was a report of extensive initial training (9 full time weeks of training) but minimal supervision post-training. What are 988 insider concerns regarding AI and Data Privacy? Ethical concerns around AI tools used for measuring empathy and issues with data collection practices. Balancing AI integration with trauma-informed care and caller anonymity. How does 988 Funding work and what are potential equity Issues? Fragmented funding models tied to sources like Medicaid lead to inconsistent protocols and potentially inequitable care. Federal funding is needed to standardize practices and improve service quality. An insider report on 988 Call Center challenges: High burnout rates among staff due to limited resources and support. Gaps in follow-up care for callers due to funding and staffing constraints. Takeaways and Solutions for 988 and the full crisis response system: Advocacy is needed for dedicated federal funding to ensure consistent training, equitable care, and trauma-informed practices. It would be best to have standardized protocols to strengthen the 988 crisis hotline system. Thoughtful integration of AI to enhance efficiency while maintaining ethical standards. Support for call center staff to prevent burnout and improve service outcomes. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

How Do Therapists Get Paid? Curt and Katie chat about how community mental health as well as insurance, hybrid, or private pay practices get money and pay their workers. We emphasize the importance of recognizing the financial realities of the mental health profession and how advocacy can drive change in the field. We also encourage therapists to understand the systems we work in and engage in conversations about financial transparency and sustainability.  Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode we talk about how compensation is set up There have been a lot of conversations about how therapists get paid and whether associates or newer therapists are being exploited. We decided to pull the curtain back to identify how money actually works in this profession. What do therapists need to know about how finances work in mental health? ·      How income is allocated across salaries, rent, insurance, and administrative costs. ·      Why clinicians’ salaries represent just a fraction of total practice income. ·      The impact of government contracts and insurance reimbursements on budgeting. ·      • The Financial Dynamics of Therapy Practices: ·      How income is allocated across salaries, rent, insurance, and administrative costs. ·      Why clinician salaries represent just a portion of what practice owners need to pay. ·      The impact of government contracts and insurance reimbursements on budgeting. What are common misconceptions about group practice owners? ·      There is a view that all group practice owners exploit therapists. This is often very far from the reality of group practice owners sacrificing their own pay for payroll ·      We highlight the financial risks, responsibilities, and long hours owners take on. Understanding Community Mental Health Budgets: ·      Breaking down how agencies allocate funds from government contracts. ·      Challenges like unfunded mandates and balancing clinician pay with program needs. Managing Budgets in Group Practices: ·      The complexities of balancing overhead costs, clinician pay, and sustainable growth. ·      How practice owners often work unpaid hours to cover supervision, billing, and other administrative tasks. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

How to Scale Your Therapy Practice to 7 Figures So You Can Sell It: An interview with Nicole McCance Curt and Katie interview Nicole McCance about her journey to selling her 7-figure group therapy practice. We look at common challenges therapists face in this process as well as ideas and methods Nicole teaches to help others scale their practice more easily. Nicole shares systems, hiring, and leadership strategies. We also look at some important considerations when planning to sell your practice. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we talk with Nicole McCance about scaling your practice Nicole McCance scaled her practice and then sold it. We dug into her systems and thought processes in creating a sellable group practice. What do therapists typically get wrong when growing their group practices? ·      New group practice owners often don’t have their systems written down ·      Unreasonable expectations of the difficulty in hiring clinicians ·      Not knowing which path to take regarding marketing and other group practice decisions What is Nicole McCance’s model for growing a group practice? ·      Systemize your operations ·      Build your dream team (with your first hire being your mini me) ·      Attract clients with digital marketing ·      Converting clients using free consults ·      Retain clients with follow ups What are important steps to get your practice ready to sell? ·      Your branding must not be your name ·      You will need to be able to sell your clinicians and move clients into their caseloads ·      You need to move into the role of CEO and not get stuck in the clinician role ·      Take the time you need to make that transition What should therapists consider when deciding whether to scale their practice to a group? ·      If you’re feeling isolated, find a community ·      There are a lot of steps, systems, and processes that you’ll need to develop (or purchase from someone else) ·      If you don’t like change or don’t do well with pressure, don’t go into group practice ·      You will need to have the ability to read the market to guide hires and growth ·      Focus on excellence and service needs, not growth for growth’s sake ·      Build a culture that supports your clinicians and helps decrease clinician turnover ·      Figuring out how to pay your clinicians may be more complex than you realize Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

Going No Contact, Relationship Recovery, and the NY Times: An interview with Patrick Teahan, LICSW Curt and Katie interview Patrick Teahan, LICSW after he was featured in an article on going no contact in the New York Times. We explored his experience of his work being sensationalized and the fallout from that article (and the string of duplicates). We also dug into how he actually works. We talked about the Relationship Recovery Process (RRP) and what it can look like when someone makes the challenging decision to cut off their family members. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we talk with Patrick Teahan on his NY Times interview on Going No Contact We read and had a big response to a NY Times article on going no contact, reacting to the sensationalized portrayal of Patrick Teahan’s work with adults who come from abusive families. After learning how he really works, we reached out to him to explore the impact of this article as well as what his model is for working with these individuals.  Reflecting on the NY Times Article: Is Cutting Off Your Family Good Therapy? ·      Patrick was interviewed due to his viral videos and online presence on YouTube ·      He talked with the interviewer about the process of Going No Contact and his work with childhood trauma survivors ·      He felt like the process took a turn into his personal story and then sensationalized his work ·      There were a number of duplicate articles (even in different countries) that led to misunderstanding of his work and hurting clients who have made the decision to go no contact with abusive family members What is RRP (the Relationship Recovery Process)? ·      Work to finishing business with family members ·      Reclaim intimacy ·      Group Psychotherapy focused on normalization of the experiences of survivors of abusive families and childhood trauma ·      The work can include individual work prior to joining the group ·      Late in the process (potentially years into the process) a client may make the decision to “get distance” from their family if they are not able to continue their healing process due to ongoing triggers and abuse ·      Patrick is doing research on the RRP model and will be publishing those results soon What is the process for Going No Contact with family members? ·      It is a very complex decision, usually after communication with family members has not led to any work on their part and repeated boundary crossings that make it impossible for a client to continue their work to heal ·      It is better to transparently and clearly communicate the decision to go no contact, rather than ghosting family members, when safe and possible ·      The decision to go no contact does not need to be total or permanent. Clients can seek space without making the decision to never talk to their family member again Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

How Do Therapists Manage Intense Caseloads? Curt and Katie chat about how to manage clients with high needs. We look at risk factors as well as how therapists can take care of themselves while working with challenging caseloads. We also talk about clinical strategies and effective risk assessments and safety planning as important elements for effective practice. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode we talk about how therapists can manage high levels of risk in their caseload As part of our “Survival Guide” we have been asked to talk through how to manage high intensity caseloads. What is a high intensity caseload? ·      High levels of suicide ·      Impulsive or aggressive clients ·      Families with a lot of challenges (like trauma, poverty, etc.) What are the risks for therapists who have high intensity caseload? ·      Burnout ·      Vicarious Trauma ·      Moral Injury How can therapists take care of themselves when their caseload is challenging? ·      Scheduling breaks and other self-care practices ·      Timing clients with bigger challenges at times you have more space to address them ·      Managing caseload size (i.e., you may have to see clients more than once a week) ·      Don’t be alone with challenging cases ·      Looking at which problems are structural and which are based on your individual effort ·      Assessing your capacity for seeing clients and working with clients ·      Understanding how your personal life can impact your ability to work with clients ·      Building support and cohesive teams (e.g., DBT Consulting Team) ·      Balancing work and personal life effectively What are clinical strategies for working with high-risk cases? ·      Separating your emotions from your clients ·      Making sure you get yourself into wise mind before you engage with crisis ·      Meet your client where they are, not where they “should be” ·      Creating a treatment team ·      In-between session contact should be structured and boundaried ·      Move away from savior or protector role for clients ·      Effective risk assessment and safety planning Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

Bipolar Disorder - How Can Therapists Support Clients and Their Families?: An interview with Dr. David J. Miklowitz, PhD Curt and Katie interview Dr. David Miklowitz about his work with people with Bipolar Disorder and their families. We look at what therapists can often get wrong when working with patients presenting with this disorder. We explore differential diagnosis, treatment options, lifestyle coping strategies, and family support. We also talk about how to walk the line between self-responsibility and accommodation. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we interview an expert on Bipolar Disorder Many clinicians can miss or over-diagnose bipolar disorder. We wanted to make sure that our modern therapists have enough of the basics to identify if it is coming in their offices. We also talked with our guest about non-medication options to supporting bipolar clients and their family members. What makes it hard to diagnose bipolar disorder? ·      Therapists need to get adequate information, which is often self-report or family history ·      There are a number of rule outs and comorbidities such as depression (unipolar), anxiety, trauma, personality disorders, substance use ·      If someone is inaccurately dx, it can lead to the wrong treatments, including the wrong medications ·      It is challenging to differentiate normal adolescent behavior from bipolar, so careful assessment is needed. What can get in the way of treatment compliance for bipolar disorder? ·      Desire to be more creative or feel all of ones emotions can lead to lack of meds compliance ·      Perceptions about productivity during hypomania ·      Substance use and abuse can cause a lack of compliance or efficacy with medications, substances can also lead to exacerbation of symptoms ·      Medication side effects can be challenging, which requires active communication with psychiatrist to adjust dosages What role can the family and loved ones play in supporting someone with bipolar? ·      Family-Focused Therapy (FFT) is a protocol that can be helpful ·      Family members can provide accommodation for client ·      There is a balance to be struck between family support, medication, and personal responsibility ·      Boundaries are very important Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

Is Your Informed Consent Based on Magical Thinking? Curt and Katie chat about the strange, manipulative, or outright illegal and unethical policies that therapists put into their informed consent. We talk through court, payment, and jurisdictional policies (among others), exploring why these policies are so bad. We also give some advice on what to do instead.  Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode we talk about the ridiculous things therapists put in their informed consent An old article from our friends over at CPH resurfaced talking about all the ways that therapists try to skirt laws or mandates with their informed consent. We thought some of this stuff sounded a bit like magical thinking.  What goes into an informed consent? ·      Policies and procedures ·      Risks and benefits for treatment ·      Social media and court policies ·      More information here: What are the biggest concerns with therapist informed consent? ·      Forcing clients to sign illegal policies is in fact illegal ·      Putting undue force onto a client is wrong ·      Court avoidance clauses are not realistic and may be illegal ·      There are limits to the fee structures you can have clients agree to ·      You have to complete your legal responsibilities, even if a client signs something that says you do not have to do so ·      You can’t have someone agree to waive jurisdiction when they travel or consent to calling your services something different What do therapists need to do with their informed consent? ·      Make sure you don’t have any illegal or unethical practices in your informed consent ·      Don’t try to “game” the system to protect yourself from your legal and ethical responsibilities Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

Is Artificial Intelligence Bringing Bias into Mental Health Treatment? Curt and Katie chat about the responsibility therapists hold when they use AI applications for their therapy practices. We explore where bias can show up and how AI compares to therapists in acting on biased information. This is a continuing education podcourse. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode we talk about whether therapists or AI are more biased With the inclusion of artificial intelligence tools into psychotherapy, there is more access to mental health treatment by a larger portion of the world. This course addresses the question “Do the same biases that exist in in-person delivered psychotherapy exist in AI delivered treatment?” at the awareness, support, and intervention levels of mental health treatment. How is machine learning used in “AI” for therapists? ·       There are different types of AI used in mental health, machine learning, neural networks, and natural language processing ·       AI can be used for awareness, support, and/or intervention ·       There is a potential for bias within AI models Where can bias come in when AI models are used in mental health? ·       Source material, like the DSM ·       Human error in the creation ·       Cultural humility and appropriateness Are human therapists less biased than AI models in diagnosis and mental health intervention? ·       The short answer is no ·       A study shows that ChatGPT is significantly more accurate than physicians in diagnosing depression (95% or greater compared to 42%) ·       ChatGPT is less likely to provide biased recommendations for treatment (i.e., they will recommend therapy to people of all socioeconomic statuses) ·       There is still possibility for bias, so diverse datasets and open source models can be used to improve this What is a potential future for mental health treatment that includes AI? ·       Curt described therapy practices being like Pilots and autonomous planes, with the ability to provide oversight, but much less intervention ·       Katie expressed concern about the lack of preparation that therapists have for these dramatic shifts in what our job looks like Key takeaways from this podcast episode (as curated by Otter.ai) ·       Enhance the training and validation of AI algorithms with diverse datasets that consider intersectionality factors ·       Explore the integration of open-source AI systems to allow for more robust identification and addressing of biases and vulnerabilities ·       Develop educational standards and processes to prepare new therapists for the evolving role of AI in mental healthcare ·       Engage in advocacy and oversight efforts to ensure therapists have a voice in the development and implementation of AI-powered mental health tools Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide Continuing Education Approvals: Continuing Education Information including grievance and refund policies. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

Why Are So Many Adults Getting Diagnosed with ADHD and Autism?: An interview with Dr. Monica Blied Curt and Katie interview Dr. Monica Blied about adults getting diagnosed later in life with Autism and/or ADHD. We look at why people (especially individual assigned female at birth) are getting diagnoses later in life. We also explore skills, strategies, and accommodations to support neurodivergent individuals in navigating life. We also talk about unmasking and helping adults talk with their family members about diagnosis. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we look the trend of adults getting diagnosed with ADHD and Autism During a recent conference, Katie saw Dr. Blied talking about later in life ADHD and Autism diagnoses and loved what she had to say. We figured it was time to talk some more about neurodivergent adults. Why is there an uptick in adults getting diagnosed with ADHD and Autism? ·      There is more information that is being shared on social media ·      Therapists and psychologists with ADHD and/or Autism are sharing information more freely ·      Increase in diagnoses in children, leading to other family members getting their own assessments How can therapists support clients who believe they are neurodivergent, but may not meet the criteria? ·      Exploring what a neurodivergent identity means to the client ·      Provide psychoeducation on some differential diagnosis ·      Seek formal assessment for autism or ADHD What strategies can therapists utilize in working with clients diagnosed as neurodivergent as an adult? ·      Confirm and validate experience, normalize ·      Somatic exercises to bring clients into their bodies (and out of their brain) ·      Executive functioning skills (e.g., using timers and the pomodoro technique) ·      Premack principles? ·      Use the principle of inertia (start with something small, to get in motion) ·      Understand available workplace accommodations (and where assessors and therapists can support in that process) ·      Learning how to tease out when skills, accommodations, or self-acceptance are needed ·      Support acceptance and unmasking ·      Help clients walk through the grief process that comes with diagnosis ·      Learn about autistic burnout and the 5 S’s from Dr. Joey Lawrence of Neudle Psychology ·      Provide support to clients to talk about diagnosis with their family members Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

AI Therapy is Already Here: An interview with Dr. Ben Caldwell Curt and Katie interview Dr. Ben Caldwell about the state of Artificial Intelligence in therapy. We look at the “AI Therapists” that are already working as well as how they are being regulated (or not). We talk about how AI therapy chatbots are being received and likely next steps in innovation. We also explore what “human therapists” can do to protect their practices and address the influx of low cost, always available AI therapy. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we look at the latest developments in Artificial Intelligence in Mental Health Our friend Dr. Ben Caldwell has been writing some articles on the current state of AI in therapy. We decided this information needed to come to the podcast, so we invited him back on the podcast. What is the current state of AI in the therapy profession? ·      There are chatbots providing “therapy” or mental health support ·      Some apps are going the path of becoming registered as a medical device with the FDA, some are staying in the coaching space Who is regulating AI therapy? ·      Licensing boards for “human therapists” may have no ability to regulate the use of the term therapy by apps, medical devices, or “AI therapists” ·      State legislators may be the avenue for regulation, but there may not be an appetite to do so ·      FDA can regulate apps that get registered as a medical device Who wants AI therapy? ·      Clients or patients will seek out AI therapy as a very cost-effective and available option for mental health support, also AI therapists will not judge clients and will always remember what clients have said ·      Insurance providers will see AI therapy as a way to expand networks ·      Legislators will likely purchase AI therapy for state and county Medi-caid services as well as support expansion to address mental health shortages ·      Basically, everyone wants AI therapy except for human therapists What are the concerns about AI therapy? ·      It is only approximating the relationship between therapist and client ·      An AI therapist doesn’t have morals and values, ethics ·      The apps are working only from manualized treatments ·      It may be only psychoeducation, without current ability for deeper work What can therapists do to protect their practices now that AI therapy is here? ·      Make sure to vet any AI services or applications that you use ·      Shift to services that AI therapy doesn’t provide (like diagnosis, or more niche services with children, families, and couples) ·      Move to overseeing AI as an adjunct to therapy (i.e., “prescribe” a particular chatbot or AI therapist and check in with clients periodically or when the client is in crisis) ·      Work with AI therapy companies to train the AI therapists Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist’s Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/