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Medical Necessity or Personal Growth? Why Documentation Matters in Therapy

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Medical Necessity or Personal Growth? Why Documentation Matters in Therapy

Curt and Katie talk about medical necessity in therapy documentation – what it is, how it shows up in clinical work, and why it matters for insurance reimbursement, disciplinary boards, and private practice. We explore the overlap between personal growth, coaching, and therapy, and how therapists can protect themselves through strong documentation.

Transcript

Click here to scroll to the podcast transcript.

(Show notes provided in collaboration with Otter.ai and ChatGPT.)

In this podcast episode: Medical Necessity in Therapy Documentation

We dig into the complicated relationship between clinical work and the requirement to prove “medical necessity.” Therapists often struggle with what to write in their notes, how to justify continued treatment, and where the line is between therapy, coaching, and personal growth. In this episode, we break down the role of insurance companies, state boards, and professional standards—and share practical strategies to help therapists avoid fraud while maintaining flexibility in private practice.

Key Takeaways for Therapists on Medical Necessity in Documentation

“What we’re advocating is that you’re going to be held to the standard. Put medical necessity into your session notes so that you can continue to be reimbursed…Don’t lie, don’t commit fraud. Because that is not what we are advocating here at all. What we’re advocating is that you’re going to be held to the standard…of the field.” – Curt Widhalm, LMFT

Medical necessity is often tied to insurance reimbursement but also shows up in disciplinary board reviews and professional standards.
Over-diagnosing or misrepresenting symptoms for insurance reimbursement is fraud and can harm clients in the long run.
Good documentation includes diagnosis (or rule-outs), treatment planning, progress notes tied to goals, and updates showing ongoing clinical reasoning.
Private practice offers more flexibility, but clinicians still need to conceptualize cases and maintain clear records.
Distinguishing therapy from coaching or personal growth requires assessing for underlying mental health concerns and documenting accordingly.

“What we’re saying here, really, is it’s all about documentation… maybe it’s not about sufficient medical necessity, it’s about sufficient documentation.” – Katie Vernoy (27:28)

Resources on Medical Necessity and Documentation

Clinical necessity guidelines for psychotherapy, insurance, medical necessity and utilization review protocols and mental health parity (Lazar et al., 2018) – Journal of Psychiatric Practice
Why You Need to Start Talking Like a Nurse: What You Need to Know About Parity and Medical Necessity – By Barbara Griswold, LMFT
Related conversation with Melissa McCaffrey née Hall on clinical documentation (linked at mtsgpodcast.com: Make Your Paperwork Meaningful: An Interview with Maelisa Hall, Psy.D.)

Relevant Episodes of MTSG Podcast

Meet the Hosts: Curt Widhalm & Katie Vernoy

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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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/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements)

.… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists, about the things in our professions that we have to do, things that we might not want to do. And I promise that there’s actually a really good discussion in this episode even if you don’t think that you need to listen to it, you should listen to this. And all of our other episodes.

Katie Vernoy 0:38
All of them.

Curt Widhalm 0:39
There’s lots of importance in this. Some of this might not be the most exciting sort of thing. I’m doing a great job of selling people at the beginning of this episode.

Katie Vernoy 0:49
But you’re not, you’re not encouraging anyone to listen.

Curt Widhalm 0:53
But you know, you could almost say the same thing about what we’re talking about today, which is documentation.

Katie Vernoy 0:59
And medical necessity.

Curt Widhalm 1:01
Specifically, what we’re talking about is having medical necessity in your notes. Now, some of you who might work for agencies or have insurance companies that reimburse your sessions might be quite familiar with what medical necessity is, and that is basically proving that your clients needs therapy.

Katie Vernoy 1:23
Yes.

Curt Widhalm 1:24
It’s a weird concept when you say it out loud. That, hey, people, that we’re providing healthcare services, we actually need to do this. And a lot of times that we’re what we’re doing is we’re separating out the health insurance companies, government funded sorts of things. They want, the people who actually need the services, that’s good money going to those people getting services. That’s what they want. We’re going to talk a little bit later in the episode about private practices, or private pay sorts of things, and how that might fit into things. But medical necessity. Katie, you had a lot more experience in DMH, and why don’t you talk about how that worked out in your documentation there, and how you ever approached medical necessity in your work?

Katie Vernoy 2:14
So DMH is Department of Mental Health that can be community mental health, public mental health, however you want to define it. When we’re talking about medical necessity in those settings, we’re looking at Medicaid funding. I’ve also had insurance contracts, so there’s also insurance reimbursement. And my sense of medical necessity, my training around medical necessity, is that first off, you’re wanting to prove that they have symptoms that are causing functional impairment that would require them to treat them to be able to be, you know, wonderful, upstanding citizens, and that there’s actually treatment needed. And so part of that is putting together and identifying the symptoms. The other thing, and this is something that I don’t know, that I had mentioned to you that I was going to talk about, but popped in my head, is diagnosis. And so especially with Medicaid, or in California, was MediCal, or is MediCal, there are diagnoses that different types of providers can use. And so even if a symptom profile says it’s diagnosis one, if your agency doesn’t get reimbursed for that diagnosis, then you might be motivated to do diagnosis two, which is, for example, you’re thinking it’s kind of an adjustment disorder with depressed mood, and yet, if adjustment disorders aren’t covered, maybe it looks a little bit more like dysthymia, or maybe it looks like major depressive disorder mild and so there’s a lot of different things about medical necessity that feel a little bit problematic when we’re talking about getting reimbursement, because there are parameters around what is covered, which potentially impacts what people write. And then there’s the whole problem with the medical model that I have, which is it’s so disease focused and dysfunction focused. And so we’re looking at these folks who are coming in as, what is the problem that you’re facing, what’s wrong with you, and how do we make sure that we’re documenting that there’s something enough wrong with you, that insurance, or, you know, the government, will pay for the services that you provide. So that’s my, I guess, two cent definition of medical necessity, and how I saw it show up in community mental health.

Curt Widhalm 4:42
So I’m gonna rely, at least for the first part of this episode on a 2018 article by Lazar et al, and this is in the Journal of Psychiatric Practice called Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. And I think that a lot of our discussion in preparation for this episode is really around the idea of utilization review, and that’s where medical necessity, for the vast majority of people who are going to need to prove it, will run into it. We’ll talk a little bit later in the episode about disciplinary boards and how that might come into things, but in this article, they emphasize that medical necessity really became even more tantamount in in response to the Mental Health Parity Act. That by putting mental health on the same level as medical health, we actually have to have medical necessity for a lot of our treatments, and that’s the ways that a lot of the insurance companies ended up interpreting this and then holding practitioners accountable. Now they spend quite a bit of this article, and we’ll include a link to this in our show notes over at mtsgpodcast.com, talking about how insurance companies love these short term treatments that you know really utilize everything that all of us therapists, you know, shake our fists and say you can’t have just very simple hand selected people for all of these randomized control studies that have only ever had one diagnosis, ever. People are more complex than that when they show up in our offices. If you ever want really good review to go to this article, because it does a great job of saying in much more detail that, yeah, randomized control studies should not be the gold standard because people are more complex than what those studies are. Getting into medical necessity though, the Lazar article, they talk about that medical necessity criteria is what is used to assess a treatment’s eligibility for reimbursement, and that this emphasizes, still that cost and resource utilization and providers who don’t give that medical necessity in their documentation during these utilization reviews are failing to meet this treatment standard. And so therefore the emphasis of this podcast episode is you should put medical necessity into your session notes so that way you can continue to be reimbursed for your sessions.

Katie Vernoy 7:29
I want to add a caveat to that, because I feel like I need to put this out there: over diagnosis or, or honestly lying on what is being presented is as bad as not having medical necessity present. And I think partly because it’s fraud, but I think the other part is that if you’re over diagnosing your clients so that they can get insurance reimbursement, those diagnoses potentially can impact other things, whether it’s clearances at jobs where clearances are required, whether it’s life insurance, whether it’s some other thing; for kids, it could be going into a cume file, like there’s there’s stuff here where we need to pay attention to what we’re labeling our clients with. That being said, there was a client I had a very long time ago where using their insurance, and I did do an adjustment disorder, because it was legitimately an adjustment disorder. I had a utilization review. I was able to make the case that the adjustment was ongoing, there were ongoing transitions that were happening, and the response to those transitions, to those things were, in fact, adjustment and weekly therapy or, I think at that by the point I got to a utilization, utilization review, bi weekly or once a month therapy was required to continue the improvement that had been seen. But that goes into, and I’ll link to some of our friend Maelisa’s episodes, it goes into the clinical loop. It goes into accurate documentation, showing, yes, there is still some sort of ongoing medical necessity. There is improvement, and the treatment is working, but there’s still more work to be done. And to me, it requires knowing what you’re talking about. It requires understanding diagnosis diagnoses and diagnosis itself, and being able to make the case if you’re called out on it. So, I think tread lightly with this and really make sure that you’re following best practices. And that’s so vague, but, but but make sure that you’re actually doing what we’ve been taught to do, versus just trying to slap on a diagnosis so that someone can get insurance reimbursement without being able to actually continue and show in your documentation that you are doing work designed towards that diagnosis, towards these presenting problems and that things are improving or not getting worse, or if they are getting worse, that it makes sense that they are and that you’re doing and adjusting your treatment to address ongoing or new areas of problems and medical necessity that’s coming up.

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Curt Widhalm 10:16
I’m really glad that you make that distinguishment early in the episode about: don’t lie, don’t commit fraud. Because that is not what we are advocating here at all. What we’re advocating is that you’re going to be held to kind of the standard. And I think that we perpetuate this rumor as practitioners in the field about how insurance companies look at things. It might be true, but there is a lot of conjecture that we throw around around insurance companies only want your clients in for 20 sessions. They’re gonna kick your clients out forever. These are rumors and…

Katie Vernoy 10:58
And they may be true in some situations, but insurance companies are all very different. A lot of different payers are very different. And so I think it is something where you need to actually do your own due diligence there.

Curt Widhalm 11:09
And part of the part of the problems that Lazar et al point out is that, given the overlap of a lot of symptoms, and Katie, you talked about this at the top of the episode, that can go to a number of different disorders; talking about things like depressed mood or neuroticism. That could be looked at as anxiety. It could be looked at as an adjustment disorder. Could look at it as a trauma response. That what the documentation should show is your thought process around considering all of these things, because research does show that you can get more sessions if you are proving that your clients need more sessions, and if you prove it because you’re thinking about things in a professional way, and you’re showing that thought pattern in your records, that’s what is providing the medical necessity. That it’s the use of some of the standardized tools, but it’s by no means that you are only limited to utilizing those standardized tools in order to prove that your treatment with clients meets the standards of the field. So part of the things that you want to make sure are in your notes are diagnoses. And if you don’t have a diagnosis, that you’re ruling out diagnoses. And for those of you who are practicing in non-diagnostic theories, you need to put a diagnosis in, and that is going to be what evaluators are looking at as part of standards of the field, and especially in response to this Mental Health Parity Act. Sorry, folks, the medical model is what we are currently burdened with, and if you are especially in something where your notes are going to be looked at for utilization review, that’s a standard that is going to lead to the next thing, which is you need to have a treatment plan. And the treatment plan should be differential diagnosis. It should be addressing specific symptoms that are presenting as part of those diagnoses, and each of your session notes should be looking at some way that ties back to what those diagnoses and that treatment plan entail, to show that you are consistent with your treatment from beginning through the middle, whether you’re asking for more sessions, whether insurance companies are looking to claw back money, that you are doing your job.

Katie Vernoy 13:45
I agree with all of that. I think that if you are working with insurance payers, whether they’re, you know, governmental or private payers, that all makes sense. I think the the thing that brought us to this episode, and is kind of the part where I think we get into stickiness, is if there’s not an insurance company or a government looking over your shoulder and saying whether or not you’re meeting medical necessity, whether or not you’re doing the things that insurance companies say to do; if you’re in private practice, it seems to me that there’s a lot more latitude in what types of issues you can you can work with. There’s, is it Z codes now? There’s, there’s a lot of adjustment disorders, there’s, there’s personal growth. There’s a lot of things that I think people come into therapy with at this point, and the concept of medical necessity, as I’ve seen it, described for insurance, I don’t see that in at least the CAMFT ethical code. I’ve not looked at some of the other ones as close. But I feel like there’s, there’s not a lot of guidance on what the standard of care is when we’re in private practice. And if you listen to, you know, like the Tiktok therapists and all the things, and especially the New York Times, it seems to have a bee in their bonnet about therapy. People are going to therapy just to to get credit for working on themselves. And so for me, I think that’s where it gets stickier. I’m not saying that my clients wouldn’t meet medical necessity if they were trying to get insurance reimbursement, and I like the flexibility to work with someone who’s saying, hey, my life is pretty good, but I have a little bit of dissatisfaction, and I want to work on this thing. And I don’t think that they are at a clinical level of depression, for example, or a clinical level of anxiety, and I feel like that’s where things get sticky.

Curt Widhalm 15:51
The other place that I’m going to frame this episode from, I mentioned this earlier, is from the disciplinary side of things.

Katie Vernoy 16:02
Sure.

Curt Widhalm 16:03
And kind of working backwards from there. The yes people will come to therapy for a number of personal growth-esque type things, whether it be Z codes, whether it be career issues, whether it be any number of things that don’t neatly fit into an F code diagnosis. Still diagnose people correctly, still frame exactly what your treatment plan is, because in the handful of times where consumers of this kind of therapy are going to file complaints with licensing boards, what I have seen from board experts in reviewing their decisions and their opinions on cases is, if medical necessity is missing from the session notes that is not meeting the standards of the profession, and when you are having somebody else who is dead set on finding things that you are doing wrong, going through your notes, one of the easiest things that you can do for yourself is, at the very minimum, make sure that you have a comprehensive treatment plan that fits in how this problem that a client is coming in with can be resolved in therapy, and that you have a plan that you’re following in order to do so. Now, most of the problems that I see through the couple of boards that I follow most routinely, admittedly, they’re California boards, but I’m assuming that there is very similar practices across the country, is documentation problems are ultimately what people end up getting in trouble for, for a lot of things. It’s not the only thing, but documentation seems to get tacked on even when there’s other problems that are there. And one of the issues is, is, if it’s not clear where medical necessity is, then that is then that is another potential way that you’re opening yourself up to liability in the complaint process.

Katie Vernoy 18:08
And what is the definition of medical necessity in our ethical or legal codes? I don’t see it. I searched the CAMFT ethics code for quote, unquote, medical necessity. It does not exist there.

Curt Widhalm 18:20
So largely, the definition on this is going to be: what would a reasonable and prudent practitioner do with the same information with this client?

Katie Vernoy 18:32
Okay, that’s a whole lot of nothing. It’s not saying anything.

Curt Widhalm 18:36
It’s basically a way of defining what are the standards of the field.

Katie Vernoy 18:40
And so has that been defined somewhere else? Are we talking about because insurance companies have become focused on whether or not something’s reimbursable, that de facto, we go to insurance company definitions of medical necessity?

Curt Widhalm 18:56
Not necessarily. And I don’t think that we actually want this to be super defined. The very nature of being a professional is that we go through years of study and years of supervision in order to be independently practitioning and be able to make decisions on a case by case basis that doesn’t treat everybody exactly the same. And kind of the same problem that we talk about insurance companies using only randomized control studies that force brief therapy onto everybody. We don’t want super strict legal definitions that force us into having to treat everybody exactly the same. A reasonable and prudent practitioner with somebody who comes in and says, Hey, I want personal growth for therapy, and if that’s agreed upon and documented, as far as here’s a treatment plan of what your personal growth plan looks like, and it seems to be something that is worked on in therapy, a review of case notes and a client file on something like that should show: continued client consent, continued updates to the treatment plan. If this is years long therapy, if that client is filing a complaint, Hey, you took advantage of me forever. Your documentation should show yeah, we updated our treatment plans every three to six months, and you continued to sign off on them and agreed that this is where you wanted to direct your therapy to go. You collaborated in this whole process. A reasonable and prudent practitioner would look at that case file and say, yeah, that client consented all along. So ‘Reasonable and Prudent’ really comes around: how would most of us end up doing with the same information? Not just how would the best and most expertise of people do with this, but how would the general practitioners in the field end up following along with this?

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Katie Vernoy 20:51
But how is personal growth medical necessity?

Curt Widhalm 20:54
That is something that you would have to lay out with your client. So let’s take something like career issues as as an example here. And I know that this is a area of your practice that…

Katie Vernoy 21:09
Yes.

Curt Widhalm 21:10
If you want good career therapy kinds of things, go to Katie Vernoy at katievernoy.com.

Katie Vernoy 21:15
Thank you.

Curt Widhalm 21:16
The issues that would look at, where does this end up resolving things in psychotherapy versus career coaching? For example. A reasonable and prudent practitioner would look at, are there mental health things that are also tied to this? Are there anxieties? Are there mismanagement of stress? Are there negative coping patterns that are delegated out into other pieces of their life that end up having an effect on their mental health or even potentially on their physical health, and the way that they are responding to their career. In the absence of those as a handful of the examples, and not a complete list of everything that could be there; if there’s none of that, that’s somebody who needs to be referred to career coaching, not having therapy about career advancement or career seeking out aspects.

Katie Vernoy 22:18
I think this is a good example, because it feels very messy. And I would argue almost every person who’s coming in with mainly career issues could benefit from either career coaching or career therapy. And so looking at: when is it only career coaching? I think it’s I think it gets hard to determine. If someone’s having difficulty communicating with their subordinates or with their peers or with their their bosses, or whatever it is, that can be a coaching issue, skills issue. It can also be years of trauma have led to some sort of difficulty with being able to manage relationships and trust people.

Curt Widhalm 23:04
So on, so on that point, if you a assess for the trauma in the background that would be leading to those problems, that would prove some medical necessity, as far as therapy, and then you would need to work on the trauma aspects of things. That’s where that makes it more into therapy, rather than here are just better ways to communicate with your staff.

Katie Vernoy 23:29
And yet, there are definitely folks who are doing therapy that is skills based with some cognitive restructuring that also so a CBT approach to someone with communication struggles would also potentially meet medical necessity. So I’m making the argument, I guess, on both sides. So let me try to clarify. I think anyone coming to therapy and wanting therapy, we can potentially document medical necessity because they’re identifying a problem that may have mental health concerns: I’m getting anxious, I’m getting depressed, I’m struggling with my relationships, whatever it is, all of those things are also potentially in the realm of normal human experience and may not rise to some mythical medical necessity, where it’s actually a mental health problem. It might just be someone managing the day to day things of life, and wanting to have someone help them out. And so I think this is where it gets really dicey for me, because I’m great at putting medical necessity in. I’m not worried about it for my own charts. I’m thinking that if there are folks who are working with people who are coming in and saying, my life is good, but you know, I have this one thing that’s really hard at work, or I’m having this one thing that’s really hard with my my spouse, or whatever it is, and that person describes it in that little way. It’s now not therapy, and potentially sets the groundwork for saying; that what I’m doing, even though I’m I’m documenting all of the other pieces, it’s still some person having one issue with their spouse, wanting to have some discussion around how to manage their own side of the street and bring that forward. And now I’m having to make my argument about medical necessity, because someone else is potentially more simply describing some of the stuff that happens in therapy.

Curt Widhalm 25:28
Couple of responses to what you’re saying here. Number one, for people who are facing life issues, we want to be careful not to pathologize life.

Katie Vernoy 25:38
Yes, exactly.

Curt Widhalm 25:40
So there are instances the when the DSM 5 TR came out, and discussions around prolonged grief or complicated grief as a diagnosis. Some of the discussions that I saw around that is, oh, we’re pathologizing feelings now.

Katie Vernoy 25:57
Yes.

Curt Widhalm 25:57
Death is a part of life. Grief happens. Should people who are grieving go to therapy? My answer is, if they need to.

Katie Vernoy 26:06
If they need to, or if they want to, right.

Curt Widhalm 26:09
So and if they come in, whether it’s this example, whether it’s the career example, part of what you’re identifying that makes it therapy is you’re identifying what kind of therapy modality you’re using, you’re identifying specific aspects that ideally can be measured, as far as improvement. If you’re documenting supporting someone through a divorce that’s not really measurable and doesn’t really distinguish you from somebody who’s a good friend, and your documentation should be able to say focusing on improving daily living activities as measured by going out with other friends, number of nights out of the week where you’re able to fall asleep within a targeted time due to reduction of ruminating thinking at night. You know the I hear hairdressers from time to time talk about, oh yeah, I’m a therapist too, and I ask them, how’s your documentation going? And then this is the difference between talking with people about their problems and giving good advice and the standards of the profession and being professionals in independent practice, and how we’re evaluated in that way.

Katie Vernoy 27:28
So what we’re saying here, really is it’s all about documentation. I think the reason I get concerned is that folks are getting in trouble for not having sufficient medical necessity. And maybe it’s not really about sufficient medical necessity. It’s about sufficient documentation.

Curt Widhalm 27:46
Sufficient conceptualization, coupled with the: if it’s not written down, it didn’t happen.

Katie Vernoy 27:54
Fair, fair enough.

Curt Widhalm 27:55
And that thought process that goes throughout your notes, even if you end up being wrong, you’re allowed to change course. Somebody presents with one issue, and you get new information because you’re using psychotherapeutic techniques in order to elicit new information.

Katie Vernoy 28:13
For sure.

Curt Widhalm 28:14
That is using medical necessity along the way, in order to be able to show that you are doing professional work. If what your documentation is just kind of some sort of vague narrative that doesn’t really speak to the core of the issues, you’re going to have a lot harder time whether it be a utilization review from an insurance company or really, if you find yourself in hot water with a disciplinary board. That’s where it’s really going to get you in trouble.

Katie Vernoy 28:44
I think another conversation we may have already had it, I’ll put that over in the show notes at mtsgpodcast.com if we’ve already done that. But another conversation really is, how do we determine when medical necessity is no longer met? There’s a lot of folks who do resolve some of the primary presenting problems, and it becomes more like hanging out with somebody. And I’m great at documenting these things and making sure that medical necessity is still documented, and there’s certainly a concern if someone’s hanging out with me and not doing any work, so that becomes a different presenting problem. But I think maybe there is a conversation about when we as clinicians are required to actually say, hey, even though you still want treatment, it is no longer needed. And I don’t always, you know, or if not, what does that mean? Because I’ve sometimes had a different even definition of of the therapeutic relationship with my clients that are in longer term relationships with me. So so maybe that’s another conversation for a different day.

Curt Widhalm 29:49
Really, what I hear about you saying is what you document along the way continues to provide that. And that’s where that trend goes from session note to session note, that shows that you’re working on something. And if you are updating your treatment plans at least somewhat regularly, that you continue to have kind of an overview of overall where you’re going. This is not to say that people shouldn’t be in forever therapy. Some people are going to be and you should update things from time to time in order to continue to do this. This should not be a shocking revelation to people who are doing it as you’re describing. It’s Hey, okay, you’ve kind of worked through some of your issues around this career thing. How do you maintain stability? How do you maintain some of the positive aspects that you’re doing? What other kinds of work are you going to be talking about? What people who are reviewing the documents don’t want to see is: well, they continue to show up, and we continue to talk about whatever the newest show on Netflix is. But we’d love to hear your thoughts on this. Let us know on our social media. Join our Facebook group, the Modern Therapists Group, to continue on with these conversations, you can find our show notes. We’ll include our couple of resources that we’ve referenced in this show over there at mtsgpodcast.com and until next time, I’m Curt Widhalm with Katie Vernoy.

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Announcer 31:25
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