Nontraditional Modalities of Psychotherapy and the Standard of Care

Posted by Ivan Perkins, JD

October 23, 2017 at 11:59 AM

 

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Are all modalities of psychotherapy equal under the law?

Well, not exactly. The general “standard of care” is the reasonable care that would be taken, under the circumstances, by a practitioner trained and experienced in the particular school of therapy being practiced—as long as that school of therapy is recognized by a “respectable minority” within the profession.

If the school of therapy does not even have a “respectable minority” behind it, you are truly going out on a legal-ethical limb. This also goes for one-time interventions—for example, giving a “far out” homework assignment like telling a client to go skinny-dipping or attend a shamanic ritual. Just recognize that in the event of a lawsuit or board complaint, your treatment might be deemed below the standard of care.

But even for those therapeutic modalities supported by a “respectable minority,” you incur greater risk to the extent they are outside the mainstream. Non-traditional therapies include, for example, aromatherapy, light therapy, and animal-assisted therapy. The solution, other than avoiding non-traditional modalities, is to consult with a colleague, document the consultation, and document the client’s fully informed consent. We address informed consent in depth in our CE Course: Minimizing Legal-Ethical Risk in Psychotherapy, which provides a template informed consent form.

What should this documentation look like? Consider the arguments you would need to make, later on, if anyone alleged that your treatment was negligent. The documentation should support these arguments:

  1. you carefully considered the use of this modality for this particular client;
  2. you consulted with a capable and qualified colleague;
  3. you and the colleague reasonably believed the modality would not entail serious or undue risks for this client;
  4. you and the colleague reasonably believed the modality could benefit this client; and
  5. you fully explained the risks, limitations, benefits, and potential alternatives to the client, who voluntarily consented to this treatment.

Don’t be afraid to use this particular language in your notes, while fleshing them out in concrete detail. For example, specify why you think the modality does not entail serious risks, who your colleague is, and why you consulted with him or her.

The more “non-traditional” the therapy you are considering, the more it makes sense to provide an abundance of information, such as books or websites on the topic. You may also ask the client to sign a confirmation sheet that you have provided extensive information, they understand the nature of the treatment, and they are comfortable with the techniques you will use. This will show that their consent to treatment was truly “informed.” You could include all this information on your standard informed consent form.

Also, review your malpractice policy—and/or contact the insurer or an insurance agent—to find out if a particular treatment modality is covered. Insurance policies contain exclusions, and you want to avoid, if possible, a mismatch between your policy and your practice. See our guide to malpractice insurance contained within our CE Course: Minimizing Legal-Ethical Risk in Psychotherapy.

If you purchase any of our CE courses during the month of October, you'll receive a special introductory discount of 20% off! Just enter CEBLOG20 in the coupon code box at checkout. This code can be used one time per user. This offer will only last through October 31st, though, so act now for a great discount! You will have access to the courses for a year!

Sign up for a CE Course  TODAY!

 

 

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Topics: Professional Development, Continuing Education

Providing Psychotherapy or Counseling to a Minor in California

Posted by Ivan Perkins, JD

October 16, 2017 at 11:59 AM

bigstock--207902956.jpgWhat if a teenager shows up at your office or clinic? What if she is willing and able to pay for counseling on her own? Can you just start treating her? How does this work in California?

If she is 18 or over, there is no problem. As an adult, she may consent to treatment purely on her own, just like someone in her 20s or beyond.

If she is 17 or younger—i.e., if she is a “minor”—precise rules apply. Parents or guardians can always provide effective consent for treating a minor, but many minors can also consent to treatment on their own.

Minors Consenting to Their Own Treatment

In California, you can treat 12-year-olds who simply show up at your office. The rule is: “a minor who is 12 years of age or older may consent to mental health treatment or counseling services if, in the opinion of the attending professional person, the minor is mature enough to participate intelligently in the mental health treatment or counseling services.” (Cal. Health & Safety Code § 124260(b).) This rule applies only to outpatient mental health treatment or counseling.

This law, however, does not appear to apply to any trainees, or to Associate Clinical Social Workers (ACSWs), although it does apply to Marriage and Family Therapist and Professional Clinical Counselor interns/associates, as well as to Licensed Educational Psychologists. Therefore, it remains unclear whether a minor could consent to treatment, on her own, with a trainee or ACSW. Given the uncertainty on this point, it is probably best to avoid such treatment until the legislature provides clarity.

If a minor shows up on his or her own to outpatient mental health treatment, document exactly why you think this minor is “mature enough to participate intelligently” in the treatment you are providing. During the informed consent process, you may need to explain more carefully, and in language that the minor can understand, how your treatment works. Also, in the case of someone who is 12-14 years at the oldest, it is best to verify his or her age, and document such verification. You don’t want to find out later that the child was only 10 or 11.

Involving Parents

Even if the minor herself can consent, California law still requires “involvement of the minor’s parent or guardian” in the minor’s treatment—UNLESS you, after consulting with the minor, determine that such involvement would be “inappropriate.”

You are explicitly required to document, in your notes, either of the following two things:

  1. The reason why, in your opinion, it would be inappropriate to contact the minor’s parent or guardian; or
  2. Whether and when you attempted to contact the minor’s parent or guardian, and whether the attempt to contact was successful or unsuccessful.

There is a financial kicker to this rule. You cannot hold a parent or guardian responsible for any fees incurred, unless the fees involve services rendered “with the participation” of that parent or guardian. Make sure your young client is paying as she goes, or you may never collect.

If any psychiatrists and neurosurgeons are reading this, please note that a minor cannot receive psychotropic drugs, convulsive therapy, or psychosurgery on their own consent.

Also, even if a minor could consent on their own, a parent or guardian can also provide the necessary consent—and sign an informed consent form—on that child’s behalf. In this case, however, only the minor has the right to access his or her treatment records or authorize other disclosures. See our second CEU, Confidentiality and Client Access to Records, for more on this issue. 

Summing up

The four bottom lines in California:

  • You can treat 12-year-olds who can participate intelligently;
  • You still have to involve parents unless you deem it “inappropriate” in a particular case;
  • Document the inappropriateness or your efforts to contact parents; and
  • When a parent consents, a minor who could consent holds the keys to her records and treatment information.

As a California therapist, there are a number of legal concerns for you in this area. These range from steering clear of custody battles to obtaining consent from other relatives. You can find detailed guidance in our third CEU, Managing Your Practice under California Law. 

If you purchase any of our CE courses during the month of October, you'll receive a special introductory discount of 20% off! Just enter CEBLOG20 in the coupon code box at checkout. This code can be used one time per user. This offer will only last through October 31st, though, so act now for a great discount! You will have access to the courses for a year!

 

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Topics: Professional Development

Are You Starting a Private Practice? Check this out!

Posted by Asya Mourraille

October 13, 2017 at 11:44 AM

It's all in the name!

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Welcome back, entrepreneur. My name is Asya Mourraille, LMFT 51838 and I am leading you through a monthly blog series to help you launch your own private practice. Last month we focused on creating a vision for your ideal private practice. As a result, hopefully, you have a pretty good idea of what you want your practice to look like. But the dreaming part is not over yet. At this point, you get to come up with a name for your business. And even though this part is usually really fun, it carries some weight to it as well. Why is it so important, you ask?

Well, have you ever heard of personal branding? The name for your business is a big part of the brand you create for yourself. It can either add value to your brand or take away from it. For example, what is the very first thing you think of when you hear of Dr. Phil? Or Oprah? Or Kim Kardashian? Or Donald Trump? All of those are examples of names that are also associated with specific brands. And, whether you like it or not, those brands are powerful and well known. The name of your business is going to be part of the image you portray and it is worth your while to sit down and decide what you want that image to be.

A lot of people use their personal name in their business brand, and there are a lot of advantages to that. For one, it is much easier to remember a person by name, rather than their fictitious business logo. I have never once referred to “Sunny Counseling Services” but I have referred to Alice so and so, or Dr. So and so. Plus, it is easier to find a person's website when I know practitioners' names. It adds a personal touch and makes people feel closer to you. However, if you have a tricky name to spell, tough name to pronounce, or, better yet an unfortunate name like Ben Dover or Filet Mignon (my sincere apologies to all those with these names), you might want to consider filing your business under a fictitious business name. Plus, if you get married and change your name or if you plan to sell your practice in the future, it might be easier to use a DBA (doing business as), as opposed to your personal name.

Once your come up with a few contenders, be sure to run them by your friends and family. See what reactions you get. What are the initial images or associations people have? Then double check that your name is not already in use. Google it to make sure that such a business does not already function in the next town over. And certainly check to make sure the domain name you want is still available. You do want your website to match your name as it will make it easier for people to find you.

Your business name is certainly not the only thing that makes up your personal brand. The look of your business cards, your website, your social media presence, the feel of your office, as well as your personal charisma are all going to be part of it. It is best if there is a sense of cohesion between all of these elements, such as a similar color scheme and a unified font. And the name of your business should help pull it all together, so when people hear it they instantly get a certain feel- sort of like you do when you hear of Ellen DeGeneres for example. You can do with your brand as you please. Just be mindful of the message you are sending out there and try to be consistent over time. Think of how your name and your brand fit in with the vision board you have created for yourself. It takes years to carefully craft the image you want to put out there, but it is well worth the work. One day, when your name speaks for itself, and people associate it with high quality and integrity, you will be very pleased with yourself indeed.

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Topics: Professional Development, Private Practice

The Black Hole of Confidentiality

Posted by Ivan Perkins, JD

October 9, 2017 at 11:36 AM

Imagine that you see a psychiatrist for many years. During your sessions, you lower inhibitions and open mental floodgates. You explore how you really feel about people in your life. You delve into things you find shocking, embarrassing, and disturbing.

You end treatment. Eight years pass. Suddenly, you find that your former psychiatrist is publishing a book—and much of it presents your intimate case history! The book does not name you, but it is loaded with details, including your profession, the university where you work, and other telling clues. These make it clear to people in your social and professional circles that you are the client.

The book broadcasts your secrets, obsessions, and fantasies verbatim, and diagnoses your mental illnesses. Your friends, colleagues, and students read it with prurient interest. Your professional standing and livelihood are threatened. Humiliated, you retreat into isolation.

This was a real case, Doe v. Roe, brought by a client in New York during the 1970s. (Doe v. Roe, 93 Misc.2d 201 (N.Y. Sup. Ct. 1977).) There was established legal theory in New York at the time on this issue, but the judge had no problem finding a new cause of action based upon scattered precedents, medical principles dating from the time of Hippocrates, and his own palpable outrage. The judge accepted that the defendants thought they had concealed the plaintiff’s identity—which barred him from ordering punitive damages—and the judge called their actions “merely stupid.”

The defendants’ hopes of publishing an influential book were dashed. The judge awarded monetary damages to the plaintiff, and ordered a permanent injunction against any further circulation of the book beyond the 220 copies already sold.

Obviously, protecting confidentiality in psychotherapy is a big deal. The law certainly views it as such.

It’s time for a space metaphor.

In astrophysics, a black hole is a region with overwhelming gravity. Once an object passes the black hole’s “event horizon,” it can never return to the universe outside. It will gradually accelerate towards the center, a point of infinite density. Light itself cannot escape. To a distant observer, the black hole appears as a blank circle in space. Objects, energy, and information fall in—but they never come out again.

Most clients probably hope that their therapist is something like a black hole. It is nice to imagine that words uttered in therapy remain forever contained within the therapist’s office. But this is inaccurate. For example, therapists may update insurance companies on a client’s progress, send an email to the wrong person, or get hacked.

The law itself may require disclosures. Over the last fifty years, state laws have increasingly required therapists to break confidentiality and tell other people about dangerous and worrisome situations.

Every state now requires therapists to report suspected child abuse. Therapists must protect actively suicidal clients, which can include involving the client’s family or friends, or even calling a crisis team. If a therapist learns about an imminent threat of violent harm to a specific person, they may be required to warn the potential victim and take other preventive steps.

These releases of information are sort of like “Hawking radiation” coming from a black hole. Scientists used to think that nothing came out of a black hole, ever. But as Stephen Hawking showed, when particle-antiparticle pairs pop into existence just inside a black hole’s event horizon, one particle will speed toward the center, as the other escapes into the outside universe. In this way, black holes emit some mass and energy, though this is often dwarfed by the stars, planets, and space debris they swallow.

Likewise, therapists sometimes have to disclose precise bits of information about their clients. Also, there are some situations where disclosures are inevitable; by sitting in your waiting room, clients disclose the fact that they are seeing a therapist to each other.

In all of these areas, the law is growing increasingly stringent and precise. Some laws seek to protect clients’ privacy, while others dictate that privacy must give way to other goals, such as preventing abuse, suicide, and murder. Confidentiality and access to records are among the most contentious and litigated issues in psychotherapy.

This is why we paid close attention to confidentiality when we designed our system of three law and ethics CEUs for therapists and social workers. CEU No. 2, Confidentiality and Client Access to Records, focuses on both aspects of confidentiality: the duties to protect privacy in various situations, and the laws mandating or allowing an occasional release of therapeutic information. (This CEU comes in two versions: one for “covered entities” under HIPAA, and one for the more-fortunate among you!)

Happily, you do not need to be a quantum physicist or Stephen Hawking to master the laws of psychotherapeutic confidentiality. You just need to take CEU No. 2, incorporate the rules into your practice, and use our model forms.

For an overview of your confidentiality rules, see the graphic below. It shows all the situations where you must or may break confidentiality and emit some client information. (This version is for California therapists who are covered by HIPAA.)

 

Infographic #1b (HIPAA-Cal. Conf. Excepts)

 

If you purchase any of our CE courses during the month of October, you'll receive a special introductory discount of 20% off! Just enter CEBLOG20 in the coupon code box at checkout. This code can be used one time per user. This offer will only last through October 31st, though, so act now for a great discount! You will have access to the courses for a year! 

Sign up for a CE Course  TODAY!

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Topics: Professional Development

Answer and Rationale for FREE Question on Record Keeping

Posted by Robin Gluck

October 6, 2017 at 11:59 AM

In honor of TDC's launch of our new continuing education courses, yesterday's practice question explored the legal issue of record keeping. Today we have the answer and rationale for you!

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QUESTION:

A therapist worked with a couple for several years following mutual infidelity. The couple separated after two years in treatment and is in the midst of divorce proceedings. The husband requests access to his records. What actions should the therapist take to address the legal issues presented in this case?

a. Inform the husband that the records belong to both the husband and wife and would require a release of information from both.

b. Request a written release from the husband and turn over all of the records, but redact information deemed detrimental to the wife’s well-being or therapeutic relationship.

c. Determine how access to records would affect the therapeutic relationship and the well being of the husband and wife.

d. Inform the husband that records belong to both the husband and wife and request the wife sign a release.

Answer:

  • The best answer to this question is A. The husband is requesting records, but the client is the couple and the therapist would need both members of the treatment unit to authorize release of records before doing so.
  • Answer B is too limiting in what would be redacted. Without a release from her, the therapist would need to redact all information for the wife, not just information that could be detrimental.
  • Answer C would be an option if an individual were requesting records, but that is not the scenario provided in this question.
  • Answer D is incorrect because the therapist is requesting the wife sign a release, which is inappropriate. Answer D would be better if the answer had the therapist asking the wife what she would like to do in response to the request, but the therapist should not request the wife sign a release.

This topic is explored in much greater detail in our second CE course and our social work and MFT programs prepare you for all of the legal and ethical questions that could show up on your exams!

Which answer did you choose? Does the rationale fit with your understanding of the law and how you would apply it in a clinical setting? Or did you learn something new with this scenario? If you have any further questions feel free to check in with a TDC coach. We are here to support you all along the way. And if you came up with the same answer-great job! You are on the right track to getting licensed.

Still haven’t signed up for an exam preparation program? Or have you already passed the exam and need to complete your continuing education requirements? Our structured, straightforward approach will provide you with exactly what you need!

You can learn more about our social work licensing exam prep HERE, our MFT licensing exam prep HERE, and continuing education courses HERE. If you’d like to connect directly with one of our coaches, you can do that HERE.

We look forward to helping you PASS your exam with confidence!

 

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Topics: MFT, Exam Prep, Professional Development, Continuing Education

FREE Practice Question: Record Keeping

Posted by Robin Gluck

October 5, 2017 at 11:59 AM

This week, we are excited to expand TDC’s professional development opportunities for therapists with the launch of our first continuing education courses. This first set of courses focuses on the laws and ethics of our profession. In honor of these courses, this week’s free MFT practice question will explore the legal issue of record keeping. More specifically, we will examine who has the right to access client records.

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When it comes to working with couples, record keeping is more complex than working with individuals. Some therapists try to simplify the process by maintaining separate files for each member of the treatment unit, with one record for partner A and another for partner B. However, this may not be advisable since the client is the couple and all treatment goals and case notes will pertain to the dynamics within the treatment unit. Thus, it would make more sense to keep a single file for the client (the couple) with this file containing information regarding both partners. It is important during the informed consent process to make this policy clear to your clients.

If you maintain a single client file, what happens if one member of the treatment unit wants to access the records? Since the records include information about more than one person, you would need to take steps to ensure confidentiality is being protected adequately for all members of the treatment unit. There are two options available to a therapist in this case. To meet the legal requirements of confidentiality, you would either want to set a policy that requires each member of the treatment unit to sign an authorization of release before sharing records with either party OR you can provide records to one member of the treatment unit with only an authorization of release from that member, but you must then redact (black out) all information related to the other member(s).

With this in mind, let’s take a look at the question.

QUESTION:

A therapist worked with a couple for several years following mutual infidelity. The couple separated after two years in treatment and is in the midst of divorce proceedings. The husband requests access to his records. What actions should the therapist take to address the legal issues presented in this case?

a. Inform the husband that the records belong to both the husband and wife and would require a release of information from both.

b. Request a written release from the husband and turn over all of the records, but redact information deemed detrimental to the wife’s well-being or therapeutic relationship.

c. Determine how access to records would affect the therapeutic relationship and the well being of the husband and wife.

d. Inform the husband that records belong to both the husband and wife and request the wife sign a release.

So, what would we do here? Leave your answer in the comments below and be sure to tune in tomorrow for the answer and a discussion of the rationale!

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Topics: MFT, Exam Prep, Professional Development, Continuing Education

Pathways to Success: Ryan Lindsay

Posted by Heidi Tobe

September 25, 2017 at 11:23 AM

So often when I see a successful clinical social worker who is a leader in their area of expertise I find myself asking “how did they get where they are today?” and wondering what their first few years out of grad school were like. Each month we are interviewing and sharing the story of a clinical social worker’s “pathway to success” that has brought them to where they are today. It will share insights, hard earned wisdom, and tips that we hope will encourage and inspire you no matter where you are on your own pathway to success.

It’s incredibly fitting that our Pathways to Success interview during Suicide Prevention Month is with the Assistant Dean of Social Work at the Brown School of Social Work and co-founder of St. Louis Center for Family Development (STLCFD), Ryan Lindsay, MSW, LCSW. Ryan Lindsay is known for his leadership in evidence-based treatments, in particular Dialectical Behavior Therapy (DBT), a treatment modality used with clients who experience chronic emotion dysregulation, suicidal ideation, and self-injurious behaviors. We are excited to share his unique pathway to success and hope you will it as encouraging and inspiring as we do.

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TDC: What drew you to the field of social work?

Ryan: I understand now that I have a high compassion predisposition: I feel the pain of others, I see it in others, and I desire to make it less in others. Throughout my life, I’ve been sensitive to the difficulties that others experience. While I was originally focused on psychology in undergrad, I always felt it was too person focused. I was minoring in sociology and anthropology and found the contextual piece very interesting to me. People live in environments and contexts matter. I realized it’s not enough to look solely at the individual person. We must look at that person within the context of their environment. I decided to major in social work because it fit with my values and my understanding of the world, and was also a faster track to doing clinical work.

TDC: During graduate school where did you complete your internships?

Ryan: I went to graduate school at the University of Michigan and completed my internship at the University of Michigan Mental Health Center. I spent half of my time at the Department of Psychiatry in their outpatient clinic and the other half at a community mental health center on a DBT team. When I landed the internship, I didn’t know what DBT was, but it became formative for my career path. After I graduated with my MSW, I applied for and completed a post-master’s fellowship at the University of Michigan.

TDC: What came after your fellowship?

Ryan: After I completed the fellowship, I worked at an organization called Ann Arbor Consultation Services, which was a very, very large group practice. During my fellowship program, I helped get them prepped to start their own adolescent DBT program and when I went to work for them, I got the DBT program up and running. Once I became licensed, I started the Ann Arbor DBT Center with two friends whom I met through my internship. This was the first DBT oriented practice in Ann Arbor. While working at these two practices, I also applied for a half-time position with Washtenaw County in their Youth and Family Services and I started the first community mental health adolescent DBT program in Michigan. It was both a first for the state and something I genuinely loved doing.

TDC: It sounds like you did a LOT during those first few years out of grad school. What gave you the confidence to accomplish so much so early on in your career?

Ryan: Arrogance. And stupidity. [Laughter] And strong supports that encouraged me along the way. I was never doing all of those things in isolation. I had supervision and a strong network of other social workers around me. It was definitely a lot, though. At one point I was working six days a week, in three different practices, at four different locations and had a part-time job with the county doing crisis stabilization.

TDC: Four jobs! Did that burn you out?

Ryan: Oh totally. Around three and a half years out, I was getting really burned out. I had recently lost some mentors that were no longer accessible to me. I had my fingers in a lot of things and I needed to focus, but didn’t really know how to do that. On top of that, there was this expectation of high, high, high performance. I had a lot of people on my caseload and started to burn out big time. I came to a place where I had to decide whether I was going to stay in this profession, go back to school, give up, or approach my work differently.

TDC: So you were considering being done with social work?

Ryan: Oh yeah. Part of what drove that was the realization that in order to make a living in social work, you have to hustle, and I didn’t know if I wanted to hustle for the rest of my life. Additionally, I was getting paid very little and was working with chronic suicidality, self-injury, and extreme trauma. So there was a value piece to that. Ultimately, I decided to go to therapy myself, which was extremely helpful. It helped me put priorities back in place and organize myself in new ways. By that time (about four years out) there was also a level of competency that was under my belt. Fortunately, every single day wasn’t a learning curve like it was those first few years out of graduate school.

TDC: So what brought you from Michigan to St. Louis?

Ryan: I moved to St. Louis in 2008 when my husband got into an MBA program. Since he moved to Ann Arbor for me during my fellowship program, it was time I invested in my relationship.

TDC: What was it like leaving behind everything you’d worked so hard on?

Ryan: It was a really difficult thing to pack up everything I’d built and leave a place where my name was established. No one knew who I was in St. Louis, so nothing I’d done back in Ann Arbor meant anything here. I was also moving to a system here in Missouri where evidence-based treatments and practices weren’t really talked about-people didn’t even have a clue what DBT was. The positive side to this was that there was a tremendous opportunity to fill that gap, which is what led to founding our organization, St. Louis Center for Family Development (STLCFD). We wanted to create a place where quality mental health services existed, ideally for the people who need it the most.

TDC: STLCFD is known for delivering quality mental health services, but it’s also known for the training it provides to its clinicians. What inspired that focus on clinician training?

Ryan: Back in Ann Arbor, I had an experience where I was sitting in the basement of Huron Valley Child Guidance Center playing ping pong with one of my clients after they did some really good work. There was this other therapist down there who was not there to reward his client for hard work, but who was instead engaging in shame based therapy. He was belittling the client and shaming him. I found myself thinking, “this is not just or equitable. Why does my client get a therapist who cares about him and knows what they’re doing, while this other client gets a shaming therapist?” After that, doing one-on-one therapy wasn’t as satisfying for me in terms of the overall impact I wanted to make. I realized I had a privilege; I had opportunities to learn from the best in the country in a very organized and structured way. I wanted to figure out a way to recreate that so other people could have opportunities to receive excellent training. So when we started STLCFD, it was both to create an organization that provides stellar quality services, but also to build and train phenomenal clinicians.

I also started working as an adjunct during that time at the Brown School of Social Work. While I like being able to provide training and consultation and help shape behaviors of providers who have been in the field for years,  it’s a whole lot easier to set a trajectory than change a trajectory.

TDC: You’re at the Brown School full-time now. How did that transition occur?

Ryan: It was really the universe coming together. I was at a place organizationally where I had six people doing what I used to do myself. In the year leading up to the transition I decided to take a year off from providing trainings after a previous very hectic year, so I actually didn’t have a lot to do. When the opportunity came to join the faculty here as the chair of the mental health concentration, it just made sense personally and professionally. Choosing between two very good things was probably the hardest decision I’ve ever had to make, but I had to do what was best for me. My own personal growth had stalled, so I needed to find a community that would foster that growth.

TDC: Shortly after becoming the chair of the mental health concentration, you had another pretty big transition. Tell us about that.

Ryan: After about a month at the Brown school, I was presented with the opportunity to be the Assistant Dean of Social Work. It wasn’t on my radar and I had no idea what it entailed at the time, but I decided I would give it a try. I had spent the previous 10 years building STLCFD and logging a lot of hours. The intensity of that work was worth it for the time, but I also learned that work is not everything. In terms of satisfaction in life, there’s really something to be said for not being tired all the time. Academia here is a well oiled machine and this job allows me to have a greater balance in my life.

TDC: What are you hoping to accomplish during your time at the Brown School?

Ryan: I want to build on the strengths of our program. My immediate goal for the mental health concentration was to ensure we could actually build competencies and create a more organized structure and path towards what people want to do. That wasn’t as clear when I landed here and I’ve done a lot of work on that. I’ve revamped a lot of required courses to make sure people are getting what they need by the time they graduate.

In terms of the assistant dean position, I actually don’t have a vision yet. My first year was spent really learning about the position and my second year will be about our reaccreditation process. After that, the next step will be revamping our entire curriculum and concentration options as a school.

TDC: Final question: What advice do you have, especially for social workers just entering the field or who are in the process of getting licensed?

Ryan: Dream big and take it one step at a time. Understand we are all vulnerable and fallible humans and no one expects you to be perfect. Learning is uncomfortable, but learning is what will get you there. Don’t hide your difficulties-that leads to fatigue. It leads to burnout. It leads to people leaving the profession.

Know that you don’t have to know it all. The people who we help care most that we care about them, and for the most part they aren't concerned that you’re still learning. As long as you have their best interest in mind- and they know that and you feel that- that’s the juice that’s necessary for change. The technique stuff comes over time. There’s a shift that occurs at some point, about six or seven years out. Eventually you’ll feel more competent and steady. You’ll get to a space where you stop worrying about being incompetent and start embracing it. If there’s anything I’ve learned, it’s that it doesn't scare me that there’s an infinite amount of knowledge; it excites me that there’s an infinite amount of knowledge.

We are encouraged and inspired by all that Ryan has done in his career so far and all that he will continue to do. If you know a clinical social worker or MFT who should be highlighted in an upcoming "Pathways to Success" story, email Heidi at [email protected]

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Topics: Professional Development, Suicide Prevention

Private Practice Part 3: Envisioning Your Ideal Practice

Posted by Asya Mourraille

September 20, 2017 at 12:00 PM

Welcome back. My name is Asya Mourraille, LMFT 51838 and I am leading you through a monthly blog series on starting your own private practice. Last month I led you through a reflective exercise to help you determine whether pursuing private practice is the right path for you at this time. For those of you who decided private practice is the route you want to go, now the fun really begins! You get to dream. You get to create a vision of what your ideal private practice looks like. I know this might seem silly or trivial compared to all of the tangible business steps you have to take, but this process is a very important part of being an entrepreneur.

Have you ever heard of having a business plan? Well, this is exactly how that plan begins to emerge. Having a clear vision for your business will help you make decisions, determine a direction for your efforts, keep you on track with your values, and most importantly, infuse your practice building activities with inspiration and excitement. Trust me, the energy generated by having a clear, motivating vision is going to come in handy when you are gearing up for a networking event or are introducing yourself to a perfect stranger and trying to promote your business.

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I encourage you to pause, make yourself a yummy cup of tea, pick an inviting, comfy spot, and cozy up with the worksheet below (or a notebook!). You can either write your answers to these questions right away, or you can close your eyes first, dream up a vision, and write it down later. The key is that you come to your vision from a place of openness, curiosity and leisurely exploration and not from a place of fear and hurry. This is the energy that will surround your practice. A certain amount of pragmatism is of course healthy, but try not to get overly caught up in your head. Let your heart, your soul, and your spirit do the work here. There will be plenty of time for your practical mind to get involved later.

Here is a list of questions for you to consider as you begin to envision your ideal private practice. Think of what you would like it to look like 2-3 years from now. Take your time and answer each of these questions in as much detail as possible. 

 

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Private Practice Vision Worksheet

 

 

Where are you located? What does your space look like? Are you subletting or practicing out of your own office?

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How many clients do you have? Are you working full time or part time? Do you have a waiting list?

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How many days a week are you working? Which days are those? Do you see clients in the morning? Afternoon? Evening? What does your work/life balance look like?

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Are you working by yourself or in a group setting? Do you have interns or other practitioners working with you?

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What type of services are you offering? What are your clients dealing with? How many individuals, couples, and/or families are you seeing?

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How much money are you making? What is your hourly rate? Do you take insurance or only private pay? Do you do your own billing?

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Do you have any other sources of income? Are you teaching? Consulting? Supervising? Writing books? Offering workshops?

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How do you take care of yourself and your business?

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This is, by no means, an exhaustive list of questions to ponder. Please let your creativity blossom here. Give yourself an opportunity to keep on dreaming. And then write down your answers without judgment or censorship. Once you are done, bookmark the feelings of inspiration and expansion that you are filled with. Bottle them up and return to them as often as you can.

And of course, be sure to check back next month for part 4 of our private practice series.

    

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Topics: Professional Development, Private Practice

Suicide Prevention Month

Posted by Bethany Vanderbilt

September 7, 2017 at 10:24 AM

 

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It’s a week into Suicide Prevention Month and I haven’t heard it mentioned once. Not on social media, where I’m fairly well surrounded by mental health providers and people who are well versed in mental health issues...not on the news...not anywhere. There are other, extraordinarily important things going on right now (hurricanes, wildfires, the rollback of DACA).

And yet…

If we know anything about suicide, it’s that people are suffering all the time. Any of us might be one of them. Suicide does not discriminate.

Some statistics, courtesy of the American Foundation for Suicide Prevention and Project Semicolon (www.afsp.org and projectsemicolon.com):

  • Each day, an average of 121 people die by suicide.
  • Of those, 22 are veterans of the US Military.
  • That totals over 44,000 people per year, 8,000 of whom served our country.
  • The rate of suicide has increased in the last 10 years.

This is an issue that touches all of us, both personally and professionally. As mental health providers, if we haven’t dealt with it directly yet, we will. Here at TDC, we want to create a space for open conversation and make suicide prevention something we are actively and regularly preparing for and educating ourselves about, so we’ll be devoting the rest of month (with a few small exceptions) to opening up a conversation about suicide. We’ll be featuring organizations that provide assistance to those in need (a couple of them have been mentioned above), identifying how this issue might show up on the exams, and hopefully getting you to think about ways you can help- help yourself, your family, your friends, or your clients.

One of the statistics that stood out most to me:

  • FOR EVERY PERSON THAT DIES BY SUICIDE, THERE ARE 25 OTHERS WHO ATTEMPT AND DO NOT COMPLETE THE ACT. That’s over a million people who need help, caring, support, love, compassion, and understanding. We are in a unique position as helping professionals to make a difference in people's lives- a difference that can truly be a matter of life or death. We hope you will join us on this journey and delve into these challenging, but vitally important, conversations with us.
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Topics: Professional Development, Suicide Prevention

Is Private Practice Right For You?: Part II

Posted by Asya Mourraille

August 23, 2017 at 2:42 PM

Welcome back to part two of our conversation about private practice. My name is Asya Mourraille, LMFT 51838 and I am leading you through a series on starting your own private practice. Today we are going to explore whether pursuing private practice is the right path for you at this time. Having done both agency and private practice work myself, I have identified a number of questions I will encourage you to ask yourself while considering your choices. Keep this in mind: there are no right or wrong answers here. Each element of private practice and agency work have pros and cons associated with them. It is all about your preferences and finding a work environment that best suits you. So, let yourself sit with these questions for awhile, listen to the answers that naturally emerge, and welcome whatever comes up for you with curiosity and acceptance.

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Business Ownership

One of the biggest questions I encourage you to ask yourself is whether or not you are up for owning a business. Does the idea of having such responsibility electrify you or does the thought of it create a sinking feeling? Do you have an entrepreneur in you waiting to come out or do you prefer to focus purely on clinical work while letting someone else deal with the commercial end of things?

I remember this question was a big one for me. No person in my family has ever owned a business, so it was simply not in my DNA. For generations, my family worked diligently in hospitals and schools, so I had no blueprint to follow in this realm. I really wish I knew at the time that having your own business is akin to having a garden: it will blossom if you consistently tend to it and wilt if you don’t.

Being Your Own Boss

YES!!! No more agency politics. No more unreasonable expectations around paperwork. No more demanding directors and unresponsive managers. You get to set your own schedule, pick your own office, and determine the course of your career. You are the one who gets to decide whether or not you want to work with a particular client. You are the one who determines which conferences and trainings you will invest your time and money in. And you are the one who sets the framework around the paperwork you will complete. It sounds tremendously exciting at first. And if you are a motivated self-starter who likes to make decisions, it can be. If you are someone who feels more comfortable with externally pre-set structures or a person who is indecisive in nature, though, this aspect of private practice may be tough for you.

While it is a pain to get all your notes and assessments done for a monthly file review at your agency, at least you know that all your files will be in order at the end of each month. Can you guarantee the same thing if no one is looking over your shoulder making sure you get them done? And although it often feels like too much is deducted for taxes out of your wages each pay period, you know that taxes are being taken care of with minimal effort on your end. Will you be as diligent as a human resource department when it comes to paying your quarterly taxes and tracking all of the business expenses yourself? Being your own boss can be both liberating and daunting depending on your personality and work style.

Policy Structure

You know what else comes with being your own boss? Setting your own office policies. Some practitioners decide they want to a have a weeklong cancellation policy while others set a 24-hour cancellation policy. Some practitioners charge for phone calls that are over 10 minutes long. Guess what? That is their prerogative, and it will be yours too should you go this route. The kicker, though, is that you are the one who has to enforce each of the policies you set. If you find it difficult to confront clients when they are consistently late- let alone charge them for missing a session- you may decide that you want to stick with working in a setting that does this for you.

Fluctuating Income

Having a private practice can be very lucrative, but it can also take some time to get there. In the meantime, you will not have the consistent check you are used to getting every couple weeks or every month. Instead, your income will have a wave-like quality to it, with some months being more profitable than others. In addition to client cancellations, you will need to account for your own sick and vacation time and put some money aside as a cushion. Some people do not do well with such financial instability; it is either too anxiety provoking or their current financial situation does not allow for it. Others are better able to deal with these fluctuations- they either have another source of stable income or faith that what goes down will eventually come up (or both). How will you weather the ups and the downs? Do you feel like your wallet and your nervous system can take it?

Networking

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You know how the organization you worked for used to supply you with a steady stream of clients? Well, you can kiss such set ups good-bye once you start your own private practice. You alone have to get out there and bring in your own business (unless, of course, you work with an insurance company. In that case, though, you need to make peace with having lower rates). Either way, establishing a web presence and effective methods of advertising will help keep your business afloat. Most therapists I know absolutely despise having to network. Most ofus do not have the skills or the drive to invest our time and energy into regular marketing activities. We idealistically hope that once our doors are open, the clients will flock in on their own. Ask yourself this: how comfortable are you with talking about yourself? Can you clearly summarize the work you do in under a minute? Do you see yourself getting out there on a regular basis and asking for referrals? These are important questions to consider, especially if you want to stay busy (and even have a bit of a waiting list!).

Coworkers

Do you like to be surrounded by people and consult with coworkers during your lunch break? Or do you prefer to work alone, finding yourself annoyed each time someone asks you a question while you are trying to catch up on notes? Even though agency politics can get dramatic at times, if you are the type of person who thrives in a collective environment, private practice may be a challenging adjustment for you. Even in a group practice setting, you will find that your fellow practitioners are busy and you will likely not see them as often as in an agency setting. While establishing a support network for yourself is recommended for anyone pursuing private practice, it is important to recognize that private practice work is substantially more isolating than working at an agency.

As you can see, having a private practice can be a gratifying and profitable endeavor, but it is certainly not for everyone. I have attached a free worksheet here for you to explore these topics further. Take your time to ponder each question and write down some of your thoughts. Next month, I invite those of you who have decided to take the leap and start your own practice to join me here as we discuss the initial steps of starting a business.

 

 

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Private Practice Worksheet

 

Does the idea of owning a business electrify you or does it create a sinking feeling? Do you have an entrepreneur in you waiting to come out or do you prefer to focus purely on clinical work while letting someone else deal with the commercial end of things? __________________________________________________________________________________________________

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Are you a motivated self-starter? Can you set and meet your own goals and deadlines or do you feel more comfortable with externally pre-set structures? __________________________________________________________________________________________________

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Do you like to be in charge of making decisions or is decision making difficult for you? __________________________________________________________________________________________________

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How do you feel about enforcing rules with clients? Do you find it easy to confront your clients or do you struggle in this area? __________________________________________________________________________________________________

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How do you feel about having a fluctuating income? Will you have another job to offset the instability? What will it feel like when a client cancels when your income depends on it? __________________________________________________________________________________________________

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How comfortable are you with talking about yourself? Can you clearly summarize the work you do in under a minute? Do you see yourself making time for networking and asking for referrals? __________________________________________________________________________________________________

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Do you like to be surrounded by people or do you prefer to work alone? Can you see yourself building a support structure for yourself or would you prefer to work in a setting where such structures already exists? __________________________________________________________________________________________________

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Topics: Professional Development, Private Practice