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Beyond Reimagination: Improving your client outcomes by understanding what big tech is doing right (and wrong) with mental health apps

Curt and Katie chat about the big tech “disruptors” in the mental health space and what therapists can learn from their tactics to support clients. We look at who is using mental health apps, what mental health apps are getting right (and wrong), and how therapists can take what is working and work differently to more effectively serve our own clients. This is a continuing education podcourse.

Transcript

Click here to scroll to the podcast transcript.

In this podcast episode we look at what therapists can learn from big tech disruptors in mental health

We have seen more and more tech companies and apps come into the mental health space and have heard more and more folks worried about how their private practices will be able to survive. We are revisiting a topic we covered in a presentation at our Therapy Reimagined 2021 conference to help modern therapists navigate this new mental health landscape.

Looking at the gaps in mental health treatment and how big tech is working to “fix” them

  • Exploring the goals from the Rand report on fixing mental healthcare in the United States
  • Mental Health apps (with many broad definitions)
  • Access to lots of different types of services and self-help
  • A one stop shop with a full range of services
  • Direct negotiation with insurance companies

The types of technology used in mental health apps and the risks and benefits of these advances

  • Algorithms
  • Geo location data
  • Complex payment structures
  • Outcomes and feedback

What mental health apps are doing well for clients

  • Getting clients into therapy much more quickly
  • Decreasing costs for consumers
  • Increasing flexibility and availability
  • Not requiring for things to happen in real time (asynchronous therapy)

What mental health apps are getting wrong

  • McDonaldization and commoditization
  • Proprietary treatment methods and incentives for specific worksheets or staying within the app
  • Misalignment between the goals of the client and the goals of the corporation
  • Self-driven, leading to folks to potentially getting insufficient resources
  • Individual versus community focus
  • Caseloads and potential for therapist income (as well as burnout and poor care)

Concerns about the additional risks that can happen with mental health apps

“[In] this profit versus service model… there’s this idea that you are not a client, not a patient, you are a consumer and someone to market to. And so you’ll be marketed to as a client throughout the app. And as a clinician, you become a marketer for those things behind the paywall. And that is terrifying. Because it’s not based on treatment.” – Katie Vernoy

  • The apps are not bound by HIPAA, but instead the SEC
  • Data sharing and Alexa suggesting supplements to address client mental health concerns
  • Additional legal and ethical risks

Who is using app-based mental health services?

  • Therapy veterans are moving to apps
  • Access is not actually improved
  • The reasons that clients are moving from a traditional therapist to therapy apps
  • Outcomes across different types of apps and different types of clients
  • Niche apps are more effective than generalist apps

What we can do to move our therapist practices forward?

“Now I’ve seen a number of people describe… if these therapy apps are going to be the McDonald’s of therapy, well, we’re the prime rib! You actually have to consider are you providing actual prime rib? Or are you more like a Carl’s Jr?” – Curt Widhalm

  • Using the benefits of technology to decrease friction for your clients accessing therapists
  • Increasing flexibility and creativity
  • Be a better therapist and understanding the digital therapeutic alliance
  • Paying attention to laws and ethics, scope of practice, and treatment planning

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Turning Point Financial

Turning Point Financial Life Planning

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Be sure and visit turningpointHQ.com and download the free whitepaper “7 Money Mindset Shifts to Reduce Financial Anxiety”

OOTify

OOTify. “OOT” or “uth” (उठ) means “lift up” in the Hindi language. OOTify is a digital health solution that acts as an evidence-based hub to unify relevant mental health resources. Community, Connection, and Collaboration are critical to OOTIFY.  As they lift the mental healthcare system, they ensure providers are part of the process. OOTIFY is a platform for providers, built by providers, and owned by providers. OOTIFY is the process of lifting up mental healthcare, while lifting each other up.

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We’re going to go through trials and tribulations. But if we can work on our mental health, proactively, our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, “Hey, listen, I’m going through this too.” Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/courses/beyond-reimagination-improving-your-client-outcomes-by-understanding-what-big-tech-is-doing-right-and-wrong-with-mental-health-apps

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

TR 2021: Beyond Reimagination – Moving the mental health field from thought to action (video course)

Thrizer (payment and billing platform)

Economides, M., Ranta, K., Hilgert, O., Kelleher, D., Arean, P., & Hoffman, V. (2019, November 1). The impact of a remote digital health intervention for anxiety and depression on occupational and functional impairment: an observational, pre-post intervention study. https://doi.org/10.31234/osf.io/rhfpa

McBain, R. K., Eberhart, N.K., Breslau, J., Frank, L., Burnam, M.A., Kareddy, V, and Simmons, M. M. (2021). How to Transform the U.S. Mental Health System: Evidence-Based Recommendations. Santa Monica, CA: RAND Corporation, 2021. https://www.rand.org/pubs/research_reports/RRA889-1.html.

*The full reference list can be found in the course on our learning platform.

Relevant Episodes of MTSG Podcast:

Special Series: Fixing Mental Healthcare in America

Fixing Mental Health in America: An interview with Dr. Nicole Eberhart, Senior Behavioral Scientist, and Dr. Ryan McBain, Policy Researcher, The RAND Corporation

Online Therapy Apps

Why You Shouldn’t Sell Out to Better Help

Non-Traditional Therapy Series: Part 1 and Part 2

Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.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

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie 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.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Consultation services with Curt Widhalm or Katie Vernoy:

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Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

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):

Curt Widhalm 0:00
This episode of Modern Therapist’s Survival Guide is brought to you by Turning Point.

Katie Vernoy 0:04
Turning Point Financial Life Planning helps therapists stop worrying about money. Confidently navigate every aspect of your financial life from practice financials and personal budgeting to investing taxes and student loans.

Curt Widhalm 0:17
Visit turningpointhq.com to learn more and enter the promo code modern therapist for $200 off any service.

Katie Vernoy 0:25
This episode is also brought to you by OOTify

Curt Widhalm 0:28
OOTify is an immersive digital mental health ecosystem. It’s designed to help minimize the fragmentation, trial and error, and overwhelm felt by both patients and providers in the process of giving and receiving care. OOTify is the process of lifting up mental health care while lifting each other up.

Katie Vernoy 0:45
Listen at the end of the episode for more information.

Announcer 0:48
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 1:04
Hey, modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com.

Katie Vernoy 1:36
Once again, hop over to moderntherapistcommunity.com for one CE once you’ve listened. Woo hoo!

Curt Widhalm 1:42
Welcome back modern therapists. This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is another one of our continuing education eligible episodes. This is Beyond Reimagination. This is a workshop that Katie and I had done at the 2021 Therapy Reimagined Conference and we decided that this would be a good topic to bring up to our audience here, you can do the continuing education steps that you heard in the intro of the episode. This is also available live over on our learning platform if you want to see the video version of us. But this is really something where a lot of the zeitgeist in therapist circles is around. What do we do about some of these mental health apps and telehealth services that seem to be taking over our profession? What can we can do as practitioners, other than just complain in internet forums about them? But what are things that we can actually do about our practices in order to start to address this in some real tangible ways?

Katie Vernoy 2:58
Yeah, I think the biggest piece, I keep thinking about therapists kind of traditional therapists that are not on these app based therapy things as taxi drivers to Uber or Blockbuster or to Netflix, you know, kind of holding the line and saying no, no, we cannot let this go forward. These folks are awful, and some are. But I think there’s some stuff that we need to learn. And I think it’s definitely important that we pay attention to how therapy is changing, or dare I say how therapy is being reimagined. And have a have a seat at the table and do what we can to really move along with progress.

Curt Widhalm 3:42
Moving us from thought to action. So we’ve got some learning objectives here. Our first learning objective is identify three characteristics of clients that are seeking out and benefiting from app based therapy. Our second learning objective is describe three laws that impact brick and mortar psychotherapist when adding these steps to practice and compare and contrast the long term effects of app based therapy with traditional outpatient and telehealth psychotherapy.

Katie Vernoy 4:10
Alrighty, so getting into it, I think there’s some goals that we have for fixing mental health care, what big tech has done, what they’ve gotten right and what they’ve gotten wrong, and really looking at what needs to be done. And so the first thing I do want to refer us back to a series that Curt and I are working on Fixing Mental Health Care in America. In the first episode of that series, we highlighted the authors of the RAND study, and they have some really good points and so I want to just bring them up as kind of a broader kind of umbrella for us to look at because they’re, they’re talking about some of this stuff as well. But really looking at more of a systemic mental health solution versus a kind of entrepreneurial mental health solution or a big tech version of it. So looking at the stated goals that they have for fixing mental health care in America, the first one is promoting systematic mental health education. And I think that’s across the lifespan so we have more knowledge ahead of the game. So we’re not becoming adults and have no idea how to take care of ourselves. Integrating behavioral health expertise into general health care settings; integrating medical and mental health care; developing a mental health diversion strategy centered on community behavioral health; strengthening mental health parity, regulation, and enforcement, which of course, we have also advocated for; reimbursing evidence based behavioral health treatments at their true cost, which listen to our interview with him I think we go into that in a little detail what that means. And some controversy that we have around that; expanding access to digital and telehealth services for mental health, which is what app based people are doing. But there’s, there’s more to it, including making sure that there’s consistent Wi Fi in a lot of places that don’t necessarily have it. So these apps aren’t actually reaching there. But I’m previewing, I’ll get back on track here. And the last one is including patient important outcomes and treatment planning; and assessments of care quality. And a lot of this stuff, I think sounds familiar, because anyone who’s worked in community mental health, a lot of these things have been some of the standing goals for years. But I think being able to figure out how this applies to us. And what we’re doing, I think can be helpful. But big tech is actually taking some of this on.

Curt Widhalm 6:43
And it’s important to highlight and recognize that there’s no centralized definition of mental health apps. So well, those who are familiar with the podcast are used to us complaining about some of the bigger players like Talkspace, and BetterHelp and such that included in a lot of this research here is also going to be mindfulness based apps or apps that just focus on like meditation, all of those in the research are going to be included in some of the research that we cite here today. But in all of this discussion, big tech’s fix is that things are completely digital. Things are either through telehealth or techspace, their messaging services, whether there is a human on the other end of those treatments, or whether it is moving more and more into AI driven mental health treatment sort of things. All of this is so…

Katie Vernoy 7:43
Like the Woebot

Curt Widhalm 7:44
Like the Woebot, like many of the other AI machine learning sort of things that are being developed out there. All of this stuff is big tech is trying to address things digitally. Big tech also is doing this in a number of different areas. And like I just highlighted that not all of this is just straightforward therapy. Some of it’s about psychoeducation, some of its coaching, you can also get medications prescribed online now. And within all of this research, part of what big tech is doing is taking a lot of what we as traditional therapists have been either devoting some of our session time to or just kind of shoving some books or articles at clients to be like, Hey, go and read this. It’s now a lot more readily available to clients at the push of a couple of digital buttons.

Katie Vernoy 8:40
Yeah, I think that idea of a one stop shop really does provide the whole range of care that I think the RAND folks were talking about. I think the other thing, and this is something that we’ve talked about, and we do you have some concerns with, and I know individual practitioners do, especially. But a lot of these big tech companies, especially if they are hiring lots of clinicians, whether they call them their clinicians or just users of their app to connect with clients. They do direct negotiation with insurance panels. And I think this is something where that can be amazing for consumers if it’s done well, if the clinicians are paid well, but it can also be something where clients are still paying a lot of money, their insurance isn’t necessarily exactly lined up and the clinicians are still not making very much. But before I get too into the weeds on that the fact that they are directly negotiating with insurance panels, it’s huge panels of therapists and sometimes that means that they will get higher insurance reimbursement, and individual or small group practices are getting left out in the cold as far as those things.

Curt Widhalm 9:49
Now, some of the apps that are being used are, like I said, using machine learning to be able to determine different kinds of patterns that show up. And in some cases, this is looking at linguistic patterns and the ways that people give permission to have either their text messages read by some of these apps or whether it’s communications that are used within the apps themselves, have gone so far as to be able to identify client’s risk for things like attempting suicide, having bipolar episodes. And using some of these linguistic patterns that can be operated are things that human therapists are just woefully inadequate to, being able to do, of noticing the changes in your using first person language a lot more frequently in a frenetic pace. Some of these apps are also using geolocation data, particularly early research on this has been done in more rural and areas that don’t have as many mental health providers, but being able to track people to where they’re going can help predict things like substance abuse relapses.

Katie Vernoy 11:08
Wow. Yeah, like I’m heading towards the bar and I get a little a little message from my AI therapist saying, Are you sure? Do you really want to walk in? Oh, that’s creepy. I think another element and this is something that I don’t know as much about Curt, but I think there’s, there’s this idea around using some of this stuff to be really very, you know, hands on and involved, and kind of monetizing every little piece of it. But what that means is that there are complex and dynamic payment strategies for services. There’s a lot of things that are happening in there and so you know, what people get paid what people are paying, like, nobody really seems to know what’s going on there.

Curt Widhalm 11:55
And we highlighted that in a previous episode, where we had talked to some therapists about their experiences working with some of these mental health apps. And they described a number of different payment structures that were based on anything from the client’s happiness of how their sessions went, to the number of words that were typed back and forth between the therapist and client with no clear structure on predictability.

Katie Vernoy 12:23
So I mean, there’s writing I guess, are they doing outcome measures as well?

Curt Widhalm 12:26
So a lot of these apps are using outcome measures, which Katie and I do espouse as being a very, very good thing. When it comes to clients being able to track and monitor their own progress in determining whether or not therapy is helpful.

Katie Vernoy 12:42
What you’re describing is that outcome measures are actually sometimes baked in, and whether that they’re good outcome measures or not as to be seen, but we’ve got everything kind of one stop shop, lots of things monetized, complicated payment services, but there is some sort of feedback and rating that’s coming back and forth between clients.

Curt Widhalm 13:05
Yes, there is. Yeah, all right. What a lot of these apps are doing correctly, is they are reducing the friction points that clients have to go through in order to get into treatment. If you think of kind of the the traditional therapy model, somebody has to find your website, make a phone call, wait for you to call them back, because a lot of therapists just don’t pick up the phone when it’s a strange number that’s coming up, and then if it’s not an appropriate time for you, or somebody from your office to call back, then you’re playing phone tag sometimes for several days. But by the time that you actually talk to them and negotiate price points, because if it’s not listed on your website, they don’t know what they’re going to be paying and whether or not you take their insurance.

Katie Vernoy 13:56
Yeah.

Curt Widhalm 13:57
And then there’s things like sitting through traffic, getting through parking up to your office and into see you. Every single one of those things becomes a friction point for clients to come in. And where some of these apps are a lot more appealing is it really reduces the number of friction points if, hey, I’m paying this fee. I can talk to a counselor, whether it’s at my scheduled time, wherever it is that I’m located. I am matched up with somebody that has taken out several of those friction points already.

Katie Vernoy 14:30
Well, and I think that a lot of therapists, once the pandemic hit, I think a lot of therapists became more available online, but there’s still those initial pieces around actually getting scheduled, getting paperwork completed, all of those things, you know, and so I think that regardless of whether you’re online or kind of in a brick and mortar therapy practice, I think there are friction points that are gone with that base therapy. And I think they’re doing that right. I think being able to get folks into treatment right when they want it is pretty awesome. This decreased healthcare costs for consumers is one of the ones we put down here. And I think that that is something that consumers definitely want, that therapy feels very expensive for a lot of folks, some people don’t see it that way. But there are folks that see it as as unapproachable financially. And so the fact that these apps are providing this type of health care at a decrease cost is something that they’re getting right, I think the problem is, obviously, sometimes it’s on the backs of therapists getting paid very little.

Curt Widhalm 15:40
And when it comes to some of these one stop shop, sort of things that sometimes for clients, the trade off is well worth it, if they can go one place and get their psychoeducation, their coaching, their therapy, their meds, all within a singular app, or a singular stop for some of the decreased healthcare costs, compared to just some general run of the mill therapist, that’s, you know, maybe in an office down the street, that this might be a worthwhile trade off. Because of that convenience. And because of that decreased cost, that this is something that I’m going to have to face regularly. Yeah, any therapist is as good as any other. And if I can get all of this stuff done with the clicks of a few buttons on my own time then makes a lot of sense from a client end of why they might be adopting these kinds of things.

Katie Vernoy 16:32
They also oftentimes have a lot more availability to connect with therapists between sessions, whether it’s texting or quick calls, it seems like sessions also are flexible in length. You know, I think, so many different apps here, right. So I think there’s a lot that that’s not discussed here. But when you’re able to have some continuity of care from one session to the next. I think that’s actually really good for clients. I mean, some clients will like the 50 Minute, every week, once a week, and some really need some additional kind of in the moment, coaching calls or that kind of stuff, and DBT therapists are the most notable in my mind who do these types of things. But this availability to connect with your therapist between sessions in a prescribed way, I think is something that big tech is getting right.

Curt Widhalm 17:19
And one thing that these apps do allow for, in a very trauma informed treatment sort of way, is because things don’t necessarily have to always happen in real time. It gives clients an opportunity to be able to compose their thoughts, and be able to really take the time and being able to express themselves. You don’t have a therapist sitting menacingly at you across the room, scribbling things down on their clipboard. While you’re trying to be like, Well, how do I feel I’m just going to work something out, but with some of these apps…

Katie Vernoy 17:57
Are we menacing? We’re menacing?

Curt Widhalm 18:02
But what some of these asynchronous apps do is they allow for clients to be able to pause, take a moment, write out how they’re feeling, determine if that actually is how they want to express themselves. And there are many clients who report that this is a lot less threatening way to deal with emotions and deal with mental health problems because they have the time to look at themselves and don’t feel pressured by somebody to answer right in that time.

Katie Vernoy 18:32
Yeah, I think that can be very helpful. We talk in one of our previous one, I guess, two of our previous episodes on non traditional therapy, types of therapy and, and, and really, in looking at that it’s something where being able to step outside of the confines of your office can be really empowering for clients, because they can, you know, walk side by side with you in this regard. They can, they can text back and forth with you. I think there’s things that we miss if we feel like we must be looking someone in the eyes, either virtually or sitting in an office.

Curt Widhalm 19:10
Is that why you come, do you expect us to talk about is all the great things that big tech…

Katie Vernoy 19:13
Yeah. That’s not why you you tuned in, you’re wanting to know what they’re getting wrong. So what are they getting wrong, Curt? What’s the biggest thing?

Curt Widhalm 19:23
Oh, in economics, there is a thing called the McDonaldization. And this is a criticism of the ways that things kind of based on the McDonald’s model tend to have to meet certain kinds of requirements, no matter which store that you go into. And a lot of what we thrive on as modern therapists is being able to utilize the certain aspects of creativity, the individuality of our own personal experiences and the ways that we relate to clients. But these kinds of things don’t scale and so what ends up happening with trying to appeal to more and more consumers is that this commoditization of the profession ends up trying to look the same no matter who the therapist is. And so we see these things in things like efficiency, no matter which therapists that you’re going to use on our app, we’re going to try and get you through here as fast as humanly possible. And we’re going to try and have quantifiable measured results. And it’s going to be standardized. So that way, if your therapist leaves the app, the next one who comes in is going to be doing the exact same thing. And it’s going to be predictable, no matter what happens, just like a Big Mac is a Big Mac is a Big Mac, no matter which McDonald’s you go to, globally.

Katie Vernoy 20:46
Yeah, and I think we’ve talked about this a lot. So we don’t need to harp on it too much. But I think this cookie cutter element, I think just, it just, it sucks my soul out of my ears, I just don’t love it. I think the other thing and this is when I’ve worked in, in kind of these evidence based practices that were poorly implemented, as well as some of these other things, but what I what we’ve heard from some of these folks is that there are some sort of proprietary treatment methods. And then there’s, there’s these incentives to use them. So people are wanting to, they’re being told, therapists are being told to keep them in the app, keep bringing them back to the app, we’ve got these worksheets, use these worksheets, don’t use those, don’t let them off the app. And so it becomes, we want you to stay within this tiny little frame of what treatment is for, quote unquote, evidence based practice reasons. But also for financial reasons. We need them to stick we need them to get up sold on the on the platform. And so it is very concerning to me clinically, that there is there’s this incentive to do stuff based on the corporation’s needs versus a client’s needs.

Curt Widhalm 22:07
Within these proprietary treatment methods clinicians not only are incentivized to use them, but then it becomes kind of a opportunity to not have any customization and being able to treat clients differently because of, I don’t know things like intersectionality, or unique personal experiences that allow for clinicians to be able to use all of that graduate school training and all of the training towards licensure that we have to be able to make new and novel treatment suggestions to clients. If it doesn’t already exist within the app, it might not be something that some of these apps really allow for clinicians to be able to use. And that creates a potential lack of alignment between what the client’s goals are and what the goals of the app are. And oftentimes just incentivizes making somewhere from the fastest route of having symptoms to defining to where clients no longer have those symptoms, whether or not it actually addresses their mental health issues in any sort of deep, meaningful and long lasting way.

Katie Vernoy 23:17
Yeah, there are positives to a lot of different, you know, technological solutions, but there is evidence that there is an ability to have a digital therapeutic alliance. And I think we can do that. So we’ll talk about that later. But I think the problem with the apps, especially these ones that are so streamlined, and are so self driven by the clients, which could be positive, but if there are, if there’s a lack of insight into what I’m grappling with, what I need to work on, I’m just upset, I’m just horrible. I’m just whatever. I think that there can be a funnel for especially, you know, the concerns I have it’s there’s a funnel for the seriously mentally ill clients to not get the the level of solutions that they need. So they’re individualized, they’re self directed, positive, but it doesn’t, it doesn’t address that there are potentially more specific solutions that would be better for them. If you’re going into a general app versus a specialized app, because you don’t know what your diagnosis is. You don’t know what you’re working on. You just want to feel better. I think you can get caught into a place where there’s insufficient resources because you’ve been been insufficiently screened. But I think it also kind of promotes this idea that it’s an individual solution that’s needed versus more of a social solution where we’re looking at how do we, as a society address some of these larger mental health concerns versus continuing to put it on the individual.

Curt Widhalm 24:51
Always paired with this is the treatment of the therapist. And we’ve made reference to this other episodes, but the mailers that I get stuffed into my mailbox at my office every so often promise that you can make $120,000-$130,000 working for some of these apps, but working through the little convenient sliders that they put on their websites. Sometimes that would mean having 50 sessions per week, every week out of the year with no time off.

Katie Vernoy 25:25
Oh, my gosh, yeah, that’s ridiculous.

Curt Widhalm 25:28
And in order to fill case loads with that would mean that people would be having caseload somewhere near 80 to 90 clients to be able to actually schedule and fit in that many hours per week. People are rushing out of BMH why for these?

Katie Vernoy 25:44
Yeah, well, and we’ve talked about this in a number of other episodes. But if you have a gigantic caseload, and you’re burning out the likelihood that your clinical outcomes are high, drops dramatically.

Curt Widhalm 25:58
And part of the clinical concerns on this is that, well, therapists themselves are bound by HIPAA. The apps themselves are not because they call themselves and are recognized, so far, as being therapist matchmakers. Not as actual mental health professionals. And what this does is this moves the guidance of where your data is stored out of the healthcare sector and into SEC, the Securities and Exchange Commission, which has much different requirements as far as how data is stored. Now, if you think that this is something where that’s scary enough as it is, there now allowed to share this data across, you know, their own platforms, across any of their third party marketing sort of people, and when we start looking at things like Amazon moving into health services that, that could easily be shared with Alexa popping up in your room as far as your suggested things like, hey, it’s time to refill your Lexapro prescription. Have you also considered these supplements that other buyers like you have potentially wanted?

Katie Vernoy 27:21
Oh, dear. So then Alexa, start selling us supplements without a dietician or medical degree?

Curt Widhalm 27:32
Right.

Katie Vernoy 27:33
Oh, no! That is awful. That is awful. And so to me, when we’re, when we’re looking at this, there’s a risk for clients engaging in these really convenient therapies. And to me, I think, as a society, there’s a lot of us that have just decided that we are going to engage in this stuff, because it’s convenient. But what you’re describing Alexa suggesting supplements, and probably it’ll align with also the supplement recommendations you got in your Facebook group, and what’s on your Google search. All of a sudden, you are getting a lot of things to pay for, without professional advice. And that’s the other piece about this is kind of this profit versus service model is that there’s this idea that you are not a client, not a patient, you are a consumer and someone to market to. And so you’ll be marketed to as a client throughout the app. And as a clinician, you become a marketer for those things behind the paywall. And that is terrifying. Because it’s not, it’s not based on treatment.

Curt Widhalm 28:54
You know, this can be true of any online retailer. But I’m going to talk about my experiences of shopping on an online retailer that might be named after a South American river. But a lot of times when I go into purchase something that it says, oh, here is our brand name version of this, or have you considered buying our brand name version of this instead of this thing that you’re looking to buy. And not only now are we talking about the potential of proprietary mental health treatments and worksheets that have to be used, but also potentially any of these companies that would want to go into manufacturing their own medications, as…

Katie Vernoy 29:41
Oh my goodness.

Curt Widhalm 29:43
I don’t know that this is something that anybody is actually doing at this point. But it the jump from where we’re at now to that I don’t think is as far off is what any of us have really ever even considered.

Katie Vernoy 30:01
That is very scary. I mean, to me, we already have a really tough sell to move into a space that is more private, more individualized, just because there’s so many pieces to the system that love this idea of efficiency and evidence base and all of those things. And not that those things are bad. I love efficiency. I love making sure that what I’m doing has evidence. But when it becomes this, you know, going back to that word McDonald, McDonaldized, McDonaldization…

Curt Widhalm 30:38
McDonaldization.

Katie Vernoy 30:40
It becomes a McDonaldization of our profession. I think it just it loses, it loses so much in what actually makes therapy work. I know, you’d also talked about some other legal and ethical concerns,

Curt Widhalm 30:56
As we’ve covered in some of our other podcasts before, there’s also concerns around the ways that therapists have to follow their own licensing laws. But some of these apps just don’t make it easy to do. Some of the potential attraction to some of these apps for consumers is that, hey, I can be anonymous on here. I can, I don’t have to share my name and location data. But for those therapists who are working with clients that pose potential risks to themselves or to other people, including pretty much every telehealth cloud in the country is needing to know where your client is at, at the time of services. That’s if the anonymity is there, that this creates a potential block to being able to adequately work with clients in a safe way. There are licensing limitations as far as seeing clients in different jurisdictions. And while we have things like the Counselor Compact and PSYPACT that seem to be moving in directions that allow for people to practice in multiple states, you can still likely get matched with people who are still outside of areas that you are legally allowed to practice. And that becomes a sticking point for you and the employer in the situation as far as whether you choose to follow the law or choose to have employment.

Katie Vernoy 32:23
Yeah, and I think that the the piece with that is, if you don’t know where they are, you’re really caught. You know, it just it there’s so much that clinicians have to grapple with if they’re working within these, these apps that I think it’s something where really being very clear on the laws and ethics around where your clients are, what that means for liability as well as whether or not you can actually practice therapy with them.

Curt Widhalm 32:53
The ways that a lot of these apps end up charging customers is based on a subscription model, you pay X number of dollars per month, and you’re allowed to have so many sessions or so many communications with your therapist. Which in theory sounds good. But for those clients who don’t use those services, many of the laws that therapists have to follow in brick and mortar type settings, are that you have to give the money back for services you don’t use. And this is again, where the business practices kind of force people to either use services that they may or may not necessarily need. Or if it becomes something to where I find my consumer trying to reach out to my therapist and one of these platforms, but they’re booked up over the last couple of weeks of the month, because everybody else is also trying to get in their third/fourth session out of the month, and there’s no availability. This actually does create inadvertent barriers to treatment, that the subscription model just kind of forces consumers to have to eat the cost on.

Katie Vernoy 34:02
Well, or if they need more services, like they, you know, they get ready to send a text and they are like, oh, we’ll pay more to be able to finish this up. You know, someone’s in crisis. And there’s not that that freedom of movement to use more services easily. Or people are using services they don’t need or whatever. I mean, it’s just it’s bad because it’s finances driving frequency of treatment, although now that I’m saying it, I do have clients that meet more or less depending on their fee or what they’re where they’re at with their finances. So it’s not completely different. But the subscription model, I think, is especially problematic, because of what many laws and ethics say about it.

Curt Widhalm 34:47
I can just imagine therapists being like, you have not unlocked this part of the app yet. And, you know, it’s just this grayed out zone of their treatment plan and, you know, subscribe at this higher level in order to get the rest of your treatment plan as being something that’s potentially going to happen down the road.

Katie Vernoy 35:07
Well, and it to me, it’s just another thing that therapists are having to do is reminding clients to use all their sessions, cutting clients off, if they don’t have the money for sessions, to add more sessions. I mean, it’s just, it’s heartbreaking. I mean, it’s, maybe it’s enforced boundaries on one of the things, but it’s not necessarily really that because there’s not appropriate downtime and boundaries, right? Like their clinicians are basically on call 24/7 with a threat of bad reviews, to crease client referrals, or docked wages like it’s, it’s something where this model puts so much on the clinicians to either pursue more money, or to be available all the time and provide services at the risk of getting, you know, getting a bad review from a client. It doesn’t seem sustainable for certain, but I think it also feels like it’s very much against a strong clinical treatment planning model, as well as a strong therapeutic alliance. I mean, it just, it feels bad.

Curt Widhalm 36:16
Let’s shift gears here a little bit.

Katie Vernoy 36:18
Sounds good.

Curt Widhalm 36:18
Let’s talk about who the consumers are, that are utilizing these services.

Katie Vernoy 36:25
Sounds good.

Curt Widhalm 36:26
Now, audience, I want you to kind of picture who you think are using these apps. Because a couple of research articles one by Nitzburg and Farber was published in 2019. And another one that’s out for press by Marcelle et all, are describing that the typical app based therapy consumer, typically female 74 to 79%. Typically, white 70.8%, the median age of 32 to 33 years old, 79.4% are college educated, or more. And 85% have been in therapy face to face before with an average of three to nine years of treatment. Now…

Katie Vernoy 37:14
So these are our clients, these are people who are therapy veterans, moving to apps.

Curt Widhalm 37:20
These are therapy, veterans moving to apps. Now, a lot of what we have talked about whether it’s with the RAND people, whether it’s in setting up better telehealth for people to be accessing things in rural areas, people who have never received mental health treatment before. The statistics on the people who are actually utilizing these apps, don’t support any of those really wonderful feel good arguments that we’ve been espousing for years as a profession of this is a great way to reach people in rural areas who’ve never had mental health treatment before. These are literally clients who’ve been in our offices now replacing us with people who are more convenient.

Katie Vernoy 38:08
So there’s the convenient element. But I have to imagine it’s not just convenient, somebody that’s been in therapy for three to nine years on average, is not, is not leaving just because it’s more convenient to get on an app.

Curt Widhalm 38:21
Well, and they are leaving because they’re citing things like therapy is too expensive. It takes too much time, not only in the sessions of sitting there for 45-50 minutes at a time, 53 minutes for those of you billing it, CPT codes that reimburse a little bit more. It’s not just that it takes too much time in session, but it takes too much time to drive to sessions, to park, to do anything else that you know, it’s not just one hour out of the day, it’s potentially two or three depending on how close your office is.

Katie Vernoy 38:59
Sure.

Curt Widhalm 38:59
Which speaks to the inconvenience factor or that insurance doesn’t cover it. So all of us who provide superbills or just don’t provide superbills at all, that end up being things that also contribute to just kind of feelings of is it actually worth it? Because some of these people who have been in therapy for three to nine years are even saying therapy just wasn’t working at all for them. Or, like I mentioned earlier, that it can be too intense or overwhelming to have to sit face to face with somebody and have to talk about things like trauma or talk about things in like attachment when a really disorganized childhood ended up making it very difficult to relate. That the reasons that they’re moving is because these things actually suit the clients better for what they’re seeking out of therapy, not necessarily what we as therapists have been told clients must fit into.

Katie Vernoy 40:02
Well and when it’s described this way. I mean, I can understand not wanting to pay a lot more money for something that’s terribly inconvenient, uncomfortable and doesn’t work.

Curt Widhalm 40:13
Yes.

Katie Vernoy 40:15
Ah, okay. So when you did some more research on these app based therapy programs, just tell me a little bit more about what they’re, what’s what they’re getting, right, what they’re getting wrong with what what we’re doing?

Curt Widhalm 40:29
Economides et all 2019 article here looked at what some of these app based therapies are getting right? How effective are they with clients who are seeking them out. And what they report is that after six months, clients presenting with anxiety related issues, after six months anxiety reduction maintained in 95% of patients. In the same article, they reported that depression was reduced and maintained for 12 months in 95% of patients. These are all basically the same results that people are getting out of face to face. And but less than 5% of users go from month one to month two in treatment.

Katie Vernoy 41:16
So wait, wait, wait. So what you’re saying is 95% of folks are dropping off before the second month, they sign up, they don’t continue past the first month. So the 95% of folks who are getting these good results, or are of that 5% that stayed?

Curt Widhalm 41:35
People are either getting what they need really, really effectively.

Katie Vernoy 41:40
Super fast.

Curt Widhalm 41:41
Super fast. And with things like anxiety and depression, have the ability to maintain their gains six and 12 months later. But there are a number of people who aren’t staying with the apps, who are not getting the same kinds of successes. And these are really where we start to parse out the different kinds of mental health apps. Apps that focus on specific diagnostics, here’s an anxiety app, here’s a depression app, tend to hold more market share, and get better results out of their clients. As compared to more generalist apps that Hey, come here for your mental health issues. We’re gonna have commercials and fill your Facebook feeds and talk about how this is the greatest app for everything that you could possibly want under the sun with it, licensed therapists, tend not to actually have as much success maintaining clients. You know, we’re gonna call this more generalist.

Katie Vernoy 42:46
So the generalist apps are promoting a lot, getting a lot of folks in. And they’re only keeping about 5% of the clients. But they’ve also taken in all of that data, which they might, if they, if they have these practices in place are now sharing with third party partners.

Curt Widhalm 43:09
Are doing not only that, but they’re also claiming that they’re using all of these evidence based practices, despite there not being any sort of regulation on what evidence that they’re actually using, whether it’s proprietary, or whether it’s based in research. And I’m sure that a lot of them are some sort of CBT flavored structured sort of things. But when it comes to actually getting good client treatments, the research that we’re citing here is from Marcelle et all in that still waiting to be published document, as well as Fredericks et all in 2020, the more specific that an app is to a treatment, to a diagnostic. And this goes beyond kind of anxiety and depression, which I think a lot of therapists consider is kind of the run of the mill diagnostics, even into things like eating disorders, and psychosis has their own special apps that are showing much higher levels of success in clients. Now, we’ve known this for years, we’ve coached you In early episodes of this podcast, there’s plenty of other business coaches out there who will tell you the same thing. What this really means is having a niche practice works.

Katie Vernoy 44:30
Yeah, I think, to me, I think being able to understand how they’re actually working is really helpful. I think about the the niche apps and my sense is that some of those apps that are for folks with a specific diagnostic are being referred from therapists with a confirmed diagnosis and insight into what and how to use these apps. And so leading into what can we do as modern therapists to to not become taxi drivers of the world, which further problems with that, but that’s a whole other conversation, I think it’s important to look at what they’re getting right and do some of those same things. You know, learning from the mistakes and the innovations, whether it’s decreasing the, decreasing the friction points, being able to really access innovations, I think there’s, there’s a lot of things that tech can really help with. And I think if we say all big tech is bad, we are really missing a lot in what we can do with our practices. I think we also have a lot that we can do that apps can’t. I mean, you talk about the things that can’t scale, those are the things we should be doing.

Curt Widhalm 45:52
That is, again, really common with a lot of themes that we’ve talked about for years in the podcast, in our conferences, as far as really being able to present who you are, make it kind of a really nice boutique, sort of, here’s the approach that I take that allows clients to be able to opt into that to be able to make a brand value decision, as long as you’re able to follow up on that clients will move away from the McDonald’s of the worlds and more into things that feel great and feel tailored to them.

Katie Vernoy 46:33
Yeah.

Curt Widhalm 46:34
But it’s also not ignoring that these apps are out there. That we can incorporate some of these apps into our treatment. It’s not necessarily the ones that are delivering, you know, extra therapy sessions. But hey, here’s this mindfulness app that allows for you to be able to implement mindfulness strategies that were working in sessions. Here’s a mood tracking app that allows for you to be able to conveniently track things down and not have to worry about like, how was I feeling earlier? But mostly, if you focus on actually being a better therapist and communicating that, that, here’s the successes that I have, here’s the types of clients that have success with me. That kind of improvement actually does end up making you competitive with people who end up, you know, being frustrated with the apps, makes you more appealing to them, Hey, this is somebody who actually gets the results that I’m not getting through some of these apps.

Katie Vernoy 47:41
Exactly. And I don’t know how many clients I’ve had come to me that have been on some of these, this some of these therapy apps that are surprised at what therapy actually is because they’ve gotten such a watered down Big Mac. So some of the innovations that I think are really good to incorporate, whether it’s the technological considerations, you know, being able to, to look at where stuff could fall in, I mean, that’s an obvious one, like actually use the tech. But some of these other things that I think are really important are being able to provide some psychoeducation and self assessment with some caution. You don’t want to be providing therapy outside of therapy, but having folks be able to find you through some resources, or being able to provide them with opportunities to do some of their, their work on their own, I think is really helpful. So many folks, I think, get really worried about having clients have a band aid, fix something before they get into session. But I think in truth, letting folks kind of take a chance with it and do a self assessment and and say like, oh, yeah, no, I absolutely do need to go see Curt, or, Oh, no, I am not a match for Curt. Could be helpful.

Curt Widhalm 49:06
And you should lean into that, because those are the clients who are more likely going to be successful with you in the first place.

Katie Vernoy 49:13
Yeah

Curt Widhalm 49:13
And creating an understanding of lived experience or personality matches or anything like that. But also reducing any sorts of friction points that happen not only in getting clients into treatment, but being really quite flexible with clients when it comes to, you know, some of the innovations that we can also continue on here is where appropriate, be a one stop shop. If that’s partnering up with other therapists who work kind of like you but maybe in slightly different ways. If it’s working within a group practice that helps to serve clients, but each of you have your own specialty niches. This is not trying to be the one stop shop like, you know, the McDonald’s of like, here’s a salad and a hamburger and sometimes, sometimes when the ice cream machine is working, but being very cognizant about how you’re presenting yourself out there and evaluating if you’re actually treating the clients that you are actually effective at treating, and making adjustments along the way to go and work with those kinds of clients or be a resource for those kinds of clients, helps out.

Katie Vernoy 50:30
Yeah, and to me, there’s, there’s so many pieces to it. And I think part of the evaluation that you want to do is on the therapeutic alliance, which isn’t always done, I think, within these apps. And I think finding that if you are flexible in how you communicate, you have a way to connect between sessions and or have some sort of continuity of connection or care between sessions. I think those things, although folks, I think find them very uncomfortable, because it’s like, oh, I want my time away, I want to I want clients to communicate with me in one way, I, you know, I have to set these hard boundaries. But if you can design that mechanism to really be available within appropriate boundaries, that you’re able to take care of yourself, I think it is one of the innovations that I think can be very helpful. I mentioned earlier, I think DBT therapists do this really well. They have great boundaries, they make sure they’re in wise mind, but they do coaching calls 24/7. I will never do coaching calls 24/7. But I’m not going to not do any coaching calls, because I think they do have some benefit. And so it’s looking at within your practice within the niche that you work with, your specialty, I think identifying what flexibility of communication, connection and care can really help your folks to get what they need, and make more therapeutic improvements more quickly.

Curt Widhalm 51:55
A lot of what you’re talking about, and I’ll be a lot more blunt about it is it’s making therapy and our business practices decrease friction. So that way, it’s a better client experience than it is about things that make things convenient for the therapist.

Katie Vernoy 52:13
Absolutely. I mean, I think that we probably disagree on some of the elements of this, because I do think therapists need to have sustainable businesses. You agree with that, but I think you’re more like buck up and deal with it. This is a job. And I’m like, no, no, we need to still take care of ourselves. So I think there’s, there’s room to negotiate there. But to me, some of these, some of the stuff that decreases friction is are things that are super helpful. I mean, there’s electronic health care systems and practice management systems that basically make it so people can schedule communicate, fill out, you know, paperless intakes, do all that stuff. One of our partners this year, is Thrizer is doing like all of the billing for folks. So like you just sign up and, and you get your insurance billing taken care of. And so there’s, there’s, there’s a lot of technological solutions, where it decreases friction for clients and it helps you to do less work. And to me that that helps align the therapeutic relationship because the clients are happier and better taken care of and you are doing less work. And so you are less resentful of clients having needs outside of the therapeutic needs.

Curt Widhalm 53:27
Oh, I also, you know, want to encourage that, you know, many people that I talk to are absolutely appalled at the idea that somebody who they’ve never met before can book a session with them on the same day.

Katie Vernoy 53:46
I’m one of those people.

Curt Widhalm 53:48
But if we really are talking about removing friction for clients, if somebody is going around the internet do do do do do Oh, I need, I’m in the market for buying a therapy session today.

Katie Vernoy 54:02
Yeah.

Curt Widhalm 54:03
I, you know, willing to pay top dollar for a good therapist, and I see that somebody has availability today. And I can click click, and it sends me a video link and boom, now I’m a lifelong therapy client with this person because they were available.

Katie Vernoy 54:19
I see that and I think that it’s, it’s, it is something that different clinicians are going to have to look at. Some people have the flexibility to meet someone brand new today without any notice. Some folks need to have a little bit of advanced prep work, I can see clients in a couple of days, I do want them to fill out paperwork and so that happens automated so they can schedule an appointment today. And won’t necessarily, you know, and we’ll get started with the process, but they won’t necessarily get appointment for a couple of days because I need the chance to kind of prep for it.

Curt Widhalm 54:55
But this is, this is my point as far as if we’re talking about the consumer side of things.

Katie Vernoy 55:01
Sure.

Curt Widhalm 55:02
That if you have an online calendar that, hey, I have clients in the morning, I have a couple of hours in the middle of the day that are open and unscheduled and I have clients in the evening. It makes good business sense to be able to have somebody be able to opt into that time. I mean, you and I both have like automatic, you know, intake paperwork that gets sent out to people do this. These are things that, alright, I have to be uncomfortable for an extra five minutes out of the day to review some paperwork, because something that got added onto the schedule that I put my own availability on.

Katie Vernoy 55:46
I see what you’re saying. And I think that for me, yes, I think you put your own availability, and you determine how much time you would need to be able to get through the paperwork to get through the things. I think for me, there’s the immediate availability versus the quality of the care. And so I like to take a few minutes to read through the paperwork to kind of make a little bit of a plan and that may not be available on the same day, just depending on my schedule. So I would of course, address my schedule in the same way. I think it just depends on how you show up and how, how much you like to wing it. But to that point, I do think getting rid of phone tag is really important. You know, so that people can schedule they can get on your calendar, they’re not waiting for you to call back. They’re not waiting for you to have availability, that they have no idea about. It can be very, very helpful to have that ability for folks to schedule, whether it’s a an actual session, or even just a free initial concept call. Having that freedom to be able to do that I think it’s really important. I think the other thing is, even if you don’t take insurance, I think being able to find a mechanism to bill, like I do courtesy billing, like I mentioned, Thrizer does that courtesy billing for you and chases down benefits, like there are really easy ways for you to help people get out of network benefits, even if you’re not on the panels. And then you know, if you’re on panels, that’s a whole other thing. But I think it’s important to help folks utilize benefits that they have, because it makes it so much easier for them. And it’s truly a customer service activity. But it can help folks stay longer in sessions.

Curt Widhalm 57:33
It’s also really utilizing things like appointment reminders. That when I started implementing them by no show rate went down to almost nothing. And occasionally, when I forget to put a client on there, they’re like, I didn’t get the reminder, like are you out? Like clients are, you know, really responding and utilizing those as well. Yeah, as we’re coming out of full pandemic practice, I know a lot of clinicians are choosing only to continue working in telehealth. And, you know, this might be shutting off part of your market and not embracing that clients want to be seen both in the office and online, a bricks and clicks type approach. And well, it might over it might reduce your overhead as far as not having to pay for an office space. It’s something where for those clients who would benefit better by being seen in person, it is something that you might want to consider if you’re actually talking about creating access for clients.

Katie Vernoy 58:42
I was trying to think of an x that would would align with going to the park but I didn’t think of one. But I think like having a truly flexible practice for me has been a real game changer. And so again, I’ll tell people to go back to the non traditional therapy approaches things to get more about that but having the flexibility to meet clients where they are in the modality that they are, and potentially shifting from one week to the next I think can be very, very empowering for clients. Some will be like, sure. And then they are a telehealth session once a week at the same exact time. And then there are some folks that they have really their schedules are all over the place, or they really prefer in person and a telehealth session is only used when they need to reschedule to a time that you’re not in the office. But it just allows for more continuity of care if you’re providing a lot of different modalities because I think it meets clients at different stages. I think another element is actually being flexible in session length and type. I mentioned coaching calls. I’ve moved to a model where I’ve got 90 minute sessions, 60 minute sessions and 30 minute, kind of just in time coaching sessions and I, You know, coaching, meaning coaching call therapy sessions. And I think in that regard, clients can have the type and amount of therapy they need at the moment. And, you know, I do quick calls too, that are that are just part of like being my client. But I think it’s, it’s something where being able to meet client’s needs in the moment, I think it can be great. And on top of being more responsive between sessions, you know, within whatever the treatment plan and model is.

Curt Widhalm 1:00:29
So you’re suggesting that people might actively choose to bill for even like, a 32 minute insurance session.

Katie Vernoy 1:00:40
Because I active, actually want to, Yes.

Curt Widhalm 1:00:43
And well, that, again, is an inconvenience to you, as a therapist, consumers are showing that they’re willing to pay less, if what they need is 32 minutes of therapy, they will find places to get 32 minutes of therapy, it’s your choice on how you schedule that, and how you make your business decisions around those kinds of things. But, again, this is a podcast about competing with the changing mental health landscape.

Katie Vernoy 1:01:14
This isn’t about doing more of the same and hoping that the clients learn that it’s that that’s actually what they need. It’s determining how can you really think through what clients are asking for in moving to these apps and what your clients might benefit from, because when we get too rigid into the 50 minute hour, once a week, I think there is a risk that clients either terminate too early because they don’t need weekly therapy anymore, or they stay too long and don’t get benefit because they actually need more frequent contact. And so I think really leaning into unique, really creative treatment planning, I think is something that we can do that the McDonald’s of therapy apps cannot do.

Curt Widhalm 1:02:05
So just to remind you of the legal and ethical considerations, you’re still going to need to follow confidentiality laws, HIPAA privacy, your state licensing laws. You’re still going to want to work within your scope of practice, that’s definitely a thing. But as you’re considering increasing the types and frequency of contact, you’re also really going to want to consider the impact of dual relationships, that, you know, you are probably more accessible to your clients than what you were taught when you were in grad school. That, you know, those are based on systems where that communication wasn’t readily available to clients all the time. So really consider what your responsiveness is, what your responsive times are, and the expectations that that creates for clients. And one of the best ways that you can do that is set it up as part of your treatment plans. These are the kinds of boundaries that we’re describing, these are the kinds of things that you can reach out for and when and what you can expect as far as response time.

Katie Vernoy 1:03:08
I think we’ve also talked about this being something that if folks want to include coaching sessions, that being cautious to make sure that it aligns with treatment planning so that there isn’t a dual role there. Right?

Curt Widhalm 1:03:21
Right.

Katie Vernoy 1:03:23
So as long as that’s built in, I think it can be something that can be very, very helpful, especially for folks who are are enjoying doing coaching in a different business, being able to pull some of that into your therapy practice as part of their therapeutic treatment plan, I found that to be extremely helpful I for myself, I’ve got folks who I’ve got, you know, elements of their relationship and kind of executive functioning and all of those things. Those goals, part of those include some executive coaching, which I think is really, really helpful to kind of pull everything together for the clients.

Curt Widhalm 1:03:59
So to start closing this out, let’s talk about what you’re able to do that big tech can’t. Now I’ve seen a number of people describe in online forums or some of the conversations that we’ve had, that if these therapy apps are going to be the McDonald’s of therapy. We’re the prime rib you know we’re, you actually have to consider are you providing actual prime rib? Are you more like a Carl’s Jr?

Katie Vernoy 1:04:33
A little bit better? I guess some people might say that’s a little bit worse. I guess. People do have their own brand loyalty.

Curt Widhalm 1:04:39
Insert your other brand here. Chipotle.

Katie Vernoy 1:04:44
So is it McDonald’s? Or is it Chipotle?

Curt Widhalm 1:04:50
You have to actually have some idea of what you’re actually presenting. Just because you’re not a therapy app doesn’t make you buy default prime rib.

Katie Vernoy 1:05:01
No, you have to actually be a good therapist.

Curt Widhalm 1:05:04
You actually have to be a good therapist. You have to have that human connection and accountability, that really makes it feel like a very strong, worthwhile, healing relationship.

Katie Vernoy 1:05:17
Definitely. And I think some of these apps, I think there’s, there is an isolation, you can be in your, in your house, on your phone, interacting with a robot and I think that’s something that could be extremely helpful for folks not ready to engage with the world or with a live therapist. But if folks are ready to engage with a live therapist, I think it can be very connecting, and it can be very helpful for bringing folks out into the world in a healthy way. I mean, if all you’ve got is the robot, and Instagram, and all you’ve got is this unhealthy, unhelpful, social comparison, I think it can be really, really bad. But if you are a real person taking real care for your clients, I think that can be just so enriching. And to that end, you know, being able to provide really individualized treatment in a concierge or boutique way. So that this is a a truly deep connection, very individualized treatment plan, more hands on, I think that that also is something that allows for maybe more of a prime rib approach, but also that that connection, and that really being taken care of.

Curt Widhalm 1:06:36
And what a lot of these big tech companies are going to be bound to at some point or another, is quarterly earnings reports. At the end of the day, they’re gonna be backed by venture capitalists, they’re going to be looking at stock prices. For instance, BetterHelp, hit $700 million in revenue in 2021. And they expect to grow more in 2022. And these are things that are going to push the stock price of their parent company and TelaDoc, up and down. And much like any other company that is beholden to investors, when those stock prices start going down, and dividends start going down, that’s when usually cuts to some of the things that make those apps or those kinds of businesses great, start to trickle down to, usually, first and foremost, the providers who are going to be sitting on there, but it’s also going to, in turn, end up having things that affect the client quality of care. You hopefully are not in a position where you are beholden to quarterly earnings reports. You don’t have the financial incentives to make more money next quarter by cutting, you know, a few dollars here and there off of being able to treat people. You know, are hopefully going to make good business decisions for yourself. But doing so in mind with the client and the service focus that the reason that people come to me as because I continue to focus on this service. It’s not just the 45 minutes or 52 minutes in the office, it’s

Katie Vernoy 1:08:27
53. 53 minutes.

Curt Widhalm 1:08:32
It’s also being able to have a convenient waiting room for people, it’s giving parents the Wi Fi password, so that way they have something to do while their kids are in therapy. It’s really focusing on the quality of care that helps people to come back in that isn’t just about the quality of care.

Katie Vernoy 1:08:54
When you’re talking though, I mean, there are a lot of us that are primarily online and so it’s also understanding the digital therapeutic alliance and how that benefits our clients. Because I think the initial thing was like, hey, only in person is this prime rib, but I do think that online therapists can also have a prime rib or Chipotle experience for their clients.

Curt Widhalm 1:09:28
So this is a quote from Williams in a 2021 article, Williams et all about the digital therapeutic alliance. “Digital mental health tools should be reframed as tools that can strengthen and augment therapeutic relationships, provided that there is a clear shared understanding about how and when they will be used.” Now in this article, they describe that the digital therapeutic alliance is different from a traditional therapeutical lines. While there’s still a lot of similarities as far as agreeing on what and how we’re going to treat and how we’re going to evaluate that we got there. What’s added in this digital space is a client’s belief in how well therapists are embracing the digital relationship. We go into digital therapy sessions as, all right, this is probably not going to be as good as in person, chances are, you’re gonna be right. But if there’s ways that you can augment some of this digital stuff into whether it’s your online clients, whether it’s your clients who are being seen in person, the more that you embrace the kinds and styles of lifestyles that your clients are bringing in, the more that they’re going to trust in your digital work together, and just the better the outcomes that they’re gonna have.

Katie Vernoy 1:10:58
So just to clarify, because you said a lot there. A lot of the digital therapeutic alliance is similar to a traditional therapeutic alliance. But this additional piece, the difference is that if you believe in and embrace the digital relationship as a therapist, your clients will get better outcomes.

Curt Widhalm 1:11:20
That’s what this seems to support.

Katie Vernoy 1:11:23
I mean, to me, it just makes a lot of sense to create a practice that is supporting you, as a clinician, make it efficient, make it really easy for your clients to access your services. That it’s interesting, work with clients that match with you and that you’re able to provide really high quality care for, and that it’s creative, where you can try new things with your clients and actually do the stuff that’s going to help them versus sticking to a cookie cutter one hour or a 50 minute hour once a week, with no real thought on how you can augment services with digital products or provide an additional level of communication, connection and continuity of care with kind of more creative interactions.

Curt Widhalm 1:12:11
You can find the references for this episode over at our website mtsgpodcast.com. If you’re choosing to go through with the continuing education, follow the directions at the beginning and the end of the episode here. And we’d love for you to follow us on our social media and join our Facebook group, the Modern Therapist group where you can discuss this episode and anything else that you might want that makes it past our moderators. And if you like this longer form content, please consider being a patron that we are able to devote more and more of our time and energy when we have more and more support from all of you.

Katie Vernoy 1:12:55
So if you find that you’re really wanting to connect with us more for our patrons over on Patreon, we do have an opportunity to do some what we’re calling our discussion lounge conversations where we can do some Q&A on this episode, or on any of the episodes that you are finding interesting. Become a modern therapists level patron over on Patreon if you want to get more more stuff going in our community.

Curt Widhalm 1:13:21
And until next time, I’m Curt Widhalm with Katie Vernoy.

Katie Vernoy 1:13:25
Thanks again to our sponsor, Turning Point.

Curt Widhalm 1:13:28
Wanted to tell you a little bit more about our sponsor Turning Point. Turning Point is a financial planning and coaching firm that helps therapists stop worrying about money. Dave at Turning Point will help you navigate every aspect of your financial life from practice financials and personal budgeting to investing taxes and student loans. He’ll help you move through that feeling of being stuck, frustrated and overwhelmed and arrive at a place where you feel relief, validation, motivation and hope.

Katie Vernoy 1:13:57
And for listeners of The Modern Therapist’s Survival Guide. You’ll receive $200 off the price of any service. Just enter promo code modern therapist and be sure and visit turningpointhq.com and download the free white paper “7 Money Mindset Shifts to Reduce Financial Anxiety.” Thanks again to Turning Point.

Curt Widhalm 1:14:17
This episode is also brought to you by OOTify.

Katie Vernoy 1:14:21
“OOT” or “uth” (उठ) means “lift up” in the Hindi language. OOTify is a digital health solution that acts as an evidence based hub to unify relevant mental health resources. Community, Connection and Collaboration are critical to OOTify. As they lift the mental health care system they ensure providers are part of the process. OOTify is a platform for providers, built by providers and owned by providers. OOTify is the process of lifting up mental health care while lifting each other up.

OOTify 1:14:53
We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our lives. We’re gonna go through trials and tribulations, but if we can work on our mental health proactively our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, Hey, listen, I’m going through this too. Do you want to be a part of the solution by joining a new web three community focused on mental health and wellness. Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

Katie Vernoy 1:15:34
Just a quick reminder, if you’d like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.

Curt Widhalm 1:15:49
Once again, that’s moderntherapistcommunity.com

Announcer 1:15:53
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