0:00

0:40:04

Good Enough, Safe Enough: Affirming LGBTQ+ Clients When You’re Not a Specialist

Apple Podcasts Stitcher Spotify Subscribe on Android Download Leave a Review Keep me updated!

Good Enough, Safe Enough: Affirming LGBTQ+ Clients When You’re Not a Specialist

When an LGBTQ+ client lands in your office and you are not a specialist, the standard advice is to refer out. That advice is well-intended, and sometimes it is exactly right. But it is not always available, not always safe, and not always honest about what is actually happening in the room.

Curt Widhalm, LMFT, and Katie Vernoy, LMFT sit with the harder version of the question: what do you do when there is nowhere to refer, when the wait list is too long, when virtual is not safe at home, when you are the in-network option, or when the specialist in your area is brilliant and also not warm? In this Pride Month episode, Curt and Katie talk about what it looks like to be the good enough, safe enough therapist for an LGBTQ+ client, and what the work requires of you when you decide to stay in the room.

They name where referral is the right call, where it slides closer to abandonment, and where it gets used as a polite substitute for doing the ally work. They also talk honestly about the invisible labor that affirming practice asks of clinicians, who pays for it, and how to set up a practice so that an LGBTQ+ client never lands on you cold.

Transcript

Click here to scroll to the podcast transcript.

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

In this Podcast Episode: Being a Good Enough Ally Therapist for LGBTQ+ Clients

Curt and Katie talk through what it means to be a stopgap therapist for an LGBTQ+ client when specialist care is not accessible. They distinguish between real scope of competence concerns and clinician discomfort dressed up as ethics, and they explore what therapists can actually do, between sessions, in consultation, and in the way they design their practices, to hold these clients well. The conversation also names the financial and emotional cost of allyship, the ethics of how that cost gets carried, and the specific moments when referral is still the right move even if access is limited.

Key Takeaways for Therapists: Scope of Competence, Referral Ethics, and LGBTQ+ Affirming Practice

“I am so tired of scope of competence being used as a polite way for therapists to avoid their own discomfort.”

— Curt Widhalm, LMFT

Referral can be the right call, and it can also be avoidance. Deciding which it is requires honesty about whether you are protecting the client or protecting yourself from discomfort. Both are real, and they are not the same.
Referral without a safe destination is not really referral. When there are no accessible local options, no virtual care that works for the client’s situation, no in-network specialists with openings, or no warm specialists at all, passing the client along can do its own kind of harm.
Good enough and safe enough are real categories. You do not need to be a specialist to hold an LGBTQ+ client well. You do need to hold the therapeutic frame, do the standard work you already do, and stay humble and curious about identities you have less experience with.
Most of the work is not about identity itself. Anxiety, depression, relationships, grief, trauma, and life transitions are still the work. Affirming care is the container around it. The set of issues that genuinely requires specialist knowledge or shared lived experience is narrower than therapists often assume.
Welcoming practice is the baseline; an emergency kit is a backup. The strongest version of this work is a practice that is welcoming to a range of identities by design: intake forms, language, cultural humility, and ongoing learning that are already in place when the client walks in. A short list of LGBTQ+ colleagues you can consult with is a useful safety net, not a substitute.
The invisible labor is real, and it is yours to carry. Stopgap work often doubles or triples your prep time and may include paid consultation. Those costs are part of the cost of doing this work well; they are not appropriate to pass on to the client whose identity you are still learning about.
Refer anyway when staying causes harm. If discomfort is showing up in the room, if bias is leaking in, if your own background is intruding in ways you cannot address, or if focusing on being a good ally is getting in the way of doing good therapy, the most affirming move may be to help the client find someone else.

“My hope is that folks would have intake paperwork that is open to learning about all different types of identities, basic cultural humility and practices, enough to be a warm, safe landing place.”

— Katie Vernoy, LMFT

Scope of Competence Is Not the Same as Personal Discomfort

Scope of competence is one of the most important frames we have in this profession, and it is also one of the easiest to use in ways it was not designed for. The same clinician who feels confident working with complex trauma after a weekend workshop may, sometimes without noticing, reach for scope of competence the moment a non-binary client books an intake. Both responses can come from real care for the client. They can also come from somewhere else, and it is worth being honest with ourselves about which is which.

Real scope of competence questions exist. WPATH-informed gender-affirming care letters, specific clinical acuity, and identity work that genuinely requires shared lived experience can all push past what a generalist should hold without significant support. Most of what comes up in session with LGBTQ+ clients does not. The harder question, and the one Curt and Katie sit with in this episode, is whether we are willing to do the reading, the consultation, and the inner work that affirming practice actually asks of us.

The Stopgap Frame: Meeting the Client Where They Are Until Specialist Care Is Available

One of the more useful reframes in this episode is that the stopgap therapist is not the destination. They are part of the journey. That can look like holding a trans teen safely until a virtual specialist becomes accessible, working through identity-adjacent material with a long-standing client whose needs have shifted, or being the safe enough relationship that helps a client stay in care while they wait for the one that fits better.

This framing takes some of the all-or-nothing pressure out of the decision. The goal is not to be everything for a client whose experience you do not fully share. The goal is to be honest about what you can hold, hold it well, and stay in real relationship with the parts of the work that live outside your expertise.

Practical Steps for Becoming a Safe Enough Stopgap Therapist

A lot of the work of being a good enough ally therapist is infrastructure. It is the kind of work that happens before a client ever walks in. A few places to start:

Make intake paperwork, your website, and your day-to-day language welcoming to a range of gender identities, pronouns, and relationship structures from the start.
Build and maintain relationships with one to three LGBTQ+ clinicians you can consult with, and budget for paid consultation when the situation warrants it.
Direct continuing education hours toward cultural humility and identity-affirming care, especially the trainings at conferences that tend to be the least attended.
Practice a short script for not knowing the answer in session. “That is new to me. I want to learn more about it before our next session, and I will come back with what I find,” is a good place to start.
Look at your profit and loss statement. If “affirming” is in your marketing but consultation with affirming clinicians is not in your expenses, that is worth sitting with.
Do not bill clients for the time you spend learning about their identity. The cost of becoming an affirming clinician is yours to carry.

When You Should Refer Out Anyway

Being a stopgap therapist is not a license to override the limits of safe practice. There are situations where the most affirming move is to help the client find someone else, even when access is limited:

The presenting issues require specialist knowledge or lived experience that you cannot hold safely, even with consultation.
Your discomfort is showing up in the room in ways that are not shifting, through repeated mistakes, over-correction, or freezing.
Your religious, political, or family background is intruding into the work in ways you are not willing or able to address.
You have become so focused on being a good ally that you are no longer doing good therapy.

When those are present, holding the client because no one else is available may cause more harm than the gap in care would. The invitation here is to assess yourself honestly before deciding you are good enough, and to keep doing the work so that next time the answer can move closer to yes.

Resources on Affirming Practice, Scope of Competence, and Ethical Referral

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!

Donald Winnicott’s concept of the “good enough” therapist, referenced as a frame for stopgap practice.
Modern Therapist’s Survival Guide back catalog of LGBTQ+ episodes (linked below).
WPATH Standards of Care, for clinicians considering whether identity-related referral is warranted.

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.

Join the Modern Therapist Community:

Linktree

Patreon | Buy Me A Coffee

Podcast Homepage | Therapy Reimagined Homepage

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

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):

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 Survival Guide. I’m Curt Widhalm, with Katie Vernoy, and this is the podcast for therapist about the things that go on in our profession, the things that go on with the clients that we serve, and we’re in the midst of Pride Month. Katie and I are talking about some of the work that we do as therapists, some of the wonderful guests that we have on this month to help illustrate things, and we’re talking again about being in this ally space. That part of the discussion that we have in the background of this episode is when do we bring on experts and lived experiences for the conversations that we’re having as part of this month, and recognizing why Pride Month is so important for all of our wonderful friends in the LGBTQ+ community. And when did Katie and I lean into our, our ally work, the work that we do. We’ve had our awkward ally episodes last week. It was amazing. If you haven’t listened to it, check it out.

Katie Vernoy 1:23
We hope it was good enough.

Curt Widhalm 1:27
And Katie and I were deciding, as we’re talking in this episode, about for being a stopgap therapist. Being the therapist that you can’t refer a client out to a specialist, for whatever reasons, we’ll get into that in a little bit, but when you’re the good enough therapist, the safe enough therapist for somebody who’s coming to you from the LGBTQ+ community, it might not be your specialty, it might not be a place that you are well versed in, and we were discussing whether or not this is an episode, or some of the other topics that we had considered for this month, of is this an episode that we bring in somebody who’s an expert in the field, and we kind of settled on if we’re not having this conversation holding ourselves and our field accountable, what the hell are we doing as allies if we’re not also holding people accountable? We want to prop up LGBTQ plus voices. We hope that we are doing that, not just in this month, but throughout the year. But we also know that they get tired of propping us all up all of the time, and needing to be the ones who are the only ones pushing forward these messages. So we are here to say you should be good enough, you should be safe enough. And if you’re not, we’ve got some ideas for you.

Katie Vernoy 2:56
We’ve heard a lot. Don’t practice outside your competence. You must refer. There is harm you’re doing if you aren’t capable, and I believe there is some harm should someone not be safe enough, and there’s this element of mental health deserts, insurance panels that don’t have a lot of providers, where there is a client in front of you who needs care, and you’re what’s available. And so to me, in some ways, we’re doing that here. We’ve taken trainings, we’ve done some of this work, so I think we feel competent to hold care, and both of us have clients, LGBTQ+ clients, and potentially we’re going to get feedback that we need someone to come in and do a deeper dive who does have this expertise. So, please feel free to reach out to us, but we’re going to hold down the fort for this episode. We’re gonna, we’re gonna do the work that we’re saying that folks should do in everyday life. And so starting with why would you not refer out if you aren’t the best therapist? I think that’s a really good place to start, because when we go into Facebook groups, there are, and I see this less lately, but there are folks who will say, well, you must refer out because you have a question about this, or you feel uncomfortable with this. And while we’re going to talk about when you absolutely have to refer, I think one of the things you said previous to hitting record, Curt, is if we refer out because we’re not willing to do the work. Is this an ethical issue? We’re not willing to do the consultation. We’re not willing to do what we need to do to be safe and good enough for our clients, and so maybe we start with why we wouldn’t refer out and then move into what we do when we just aren’t able to refer out, or it’s not potentially necessary to refer out.

Curt Widhalm 5:05
I almost feel like there needs to be just a dedicated segment of our episodes where it’s just called Curt Rants, and this might be the first time that we’re specifically calling this out, but I am so tired of this scope of competence being used as a polite way for therapists to avoid their own discomfort. We have people in this field who claim that they’re experts in working with complex trauma after doing a weekend webinar, but the second that a non-binary client walks in, they suddenly get all moral and ethical, and they have this epiphany that they aren’t qualified, and that they need to refer out. So I’m saying this right now, this is not an ethical referral, you’re just avoiding the labor of being a human being with literally a Google account and the ability to have the access of the world’s knowledge, where you can do the basic amount of work to be able to pick up on: how do I talk to somebody who has pronouns that don’t fit into a binary feature? So getting maybe off of my soapbox here a little bit, we’re saying that you don’t have to have a PhD in queer theory to sit with somebody who’s a human being, but there might be work that you have to do. Now, some of the reasons that I’ve, I’ve seen that people can’t refer out is, as you’ve mentioned, there are mental health deserts. You might be the only therapist in a particular area, you might be the only in-person therapist in a particular area, you can’t necessarily refer to somebody, even virtually, these days. I see this as another kind of cop-out. Is well, I can refer them to somebody else in another part of the state, but if it’s a trans teen whose parents are very anti this kind of identity, then this is not a safe referral out, because if there’s no safety at home to be able to talk to somebody virtually, you’re at the stop gap in this situation, and you know this might also apply to insurance panels, that you’re somebody who’s in network and the specialists are not, so or the wait lists are too long. These are all reasons that you might not be the one who gets to just pass along this client to somebody else, and that’s part of where this is an episode to really be able to say: you can do it. I believe in you.

Katie Vernoy 7:44
You can do it with caveats.

Curt Widhalm 7:47
Yes.

Katie Vernoy 7:48
You can do it with support. You can do it with good consultation, with a lot of potentially your own work related to bias, those types of things. I think I would shift the you can do it with you should figure out how to do it.

Curt Widhalm 8:06
And a lot of the stuff is stuff that you’re already doing, you know. There suddenly becomes this pressure to have all kinds of knowledge about every single, you know, queer developmental milestone, and I think that there’s ways that you’re still doing the job of a therapist by holding the frame of a therapy room, you’re still responding to anxiety, you’re still responding to depression, you’re still managing crises as they come up, and really the messy work in this is that you can still have clinical confidence, the ability to do those things that you do with every single client, while remaining humble and having some humility around identities. And this really does come from what I mentioned at the top of the episode, as far as: be good enough, be safe enough. You know, we’re not talking about having your client teach you every single thing along the way, this is still where some of your between session work ends up coming in, but just because this is somebody coming from a population that you might not have as much experience with, part of how you get experience is you’re open with your client about, hey, I’m learning along the way, I’m taking a course, I’m doing some consultation stuff. What you’re talking about is brand new to me. I can be respectful and I can be listening, and I can help support you through this. I’m going to bring these questions back to consultation.

Katie Vernoy 9:48
There are so many resources that are available that provide information. I’m thinking even just about what we have to offer, our backlog of episodes that has so much information, rich information with folks who are specialists who have lived experience, and so I think it’s something where if you aren’t figuring out what your client is talking about, you’re not looking that hard.

Curt Widhalm 10:16
Yeah.

Katie Vernoy 10:17
And so I’ll link to all of our LGBTQ+ episodes and our show notes up at mtsgpodcast.com depending on your relationship with Google or chat or Claude, or whoever, whatever AI slash search engine you have, you can even in your own time get a self-produced course, but better than that, there’s a lot of trainings that usually they, there’s self-paced courses that you can purchase. There’s a lot that you can do to learn about many of these topics, and so I think the question then becomes, what requires specialization, meaning I know enough, and I don’t have to have years worth of training before I can step into it, and what requires some of this additional outside of session consultation or training?And I think part of this framing is LGBTQ+ clients aren’t necessarily always talking about their identity as the clinical work, so any of that, it’s learn how to be a decent human in the room with someone who has a different identity than you, and do good therapy, so, so that’s that one. There is some specializations, WPATH-informed training for gender affirming care letters. There’s some specifics around transition or some different types of clinical issues that may be deeper or higher level of acuity or crisis than than you could hold with consultation. But so much of what we’re talking about in therapy with folks who are who have different identities than us oftentimes are along broad themes that we are going to work with with every client, and so it becomes about being affirming, humble, connecting, and being in that space where a client does not feel like their judge, their identity is being judged or misunderstood to the best of our abilities. We’re all humans, we’re all different, and so that I think that is the piece is determining what actually requires specialist care. It is pretty small what fits into that requirement. I think what’s huge is being able to be affirming and welcoming in a safe space, and so that is the work that I think all therapists should do, and that is something if you’ve got a client who’s different from you, especially for this episode in the LGBTQ+ population, that you need to make sure you’re doing that work and identifying where that bias, where that discomfort shows up because if that becomes too big, yes, you are harmful to the client.

… 13:08
(Advertisement Break)

Curt Widhalm 13:08
In our back catalog of episodes, one that I also want to include in our show notes is an episode that we did on Are You Sure That You’re a Specialist. Now, we had recorded that episode in the past about using specialist as a marketing term, and how specialist promises better treatment than the average therapist. Now, this episode is actually the inverse of that episode, and I can’t believe that we’ve never really stumbled into this before, but you don’t have to be a specialist.

Katie Vernoy 13:41
No.

Curt Widhalm 13:42
This is really the permission to be able to say, you know what, you can actually be a good average therapist than somebody who is a specialist, and this is really more of how to be able to navigate this in a way that is good enough, and shout out Don Winnicott, smart guy, did some good things for our field, and…

Katie Vernoy 14:08
Be the good enough therapist.

Curt Widhalm 14:09
Be the good enough therapist, because part of where the decision making in some of these referrals really comes is from this feeling of lack of competence, and there are ways to get more competence, as Katie just described. There are plenty of places to be able to get some of this information, but since we’re talking about ethics, Katie and I both serve on our professional association’s ethics board. Ethics are rarely black and white. There are situations where you can make a claim for yourself that this is a lack of competence situation, but we also have, if you refer out, that can be referral as abandonment.

Katie Vernoy 14:57
Yeah.

Curt Widhalm 14:57
And especially if who you’re referring people to are not providing a warm space. I mean, you and I have run into specialists, and I’m saying that as people who are legitimately at the top of their field in a number of different areas, both within our profession, within the medical profession, within the legal profession, and those people are assholes, and not everybody.

Katie Vernoy 15:28
Not all, not all.

Curt Widhalm 15:30
But there are some that are out there, and if what is really working in therapy with you is good enough, is the therapeutic relationship is actually what is helping a client, because they see that you are somebody who is safe enough. This is really where you can kind of embrace that and be open with your clients, as I’ve said before, that I might be the one that you see along the way to be able to get to the end of somebody’s wait list, where you’re able to pick up on more of the specialty kinds of things. I’ve worked with kids in the past who have, for a couple of years, been really anxious about how safe their parents are going to be when they identify to me much earlier, gender dysphoria and helping navigate, even to be able to get to those conversations that then help to facilitate and say, you know what, my part of your journey is done, I’m handing you over to somebody who can help you to be able to fulfill the next steps, and this is really something where you may not be the end part of the destination of a client’s life, but if they’re coming to you, continue to do this work, because you might be the one who stewards them along the way for a part of that journey.

Katie Vernoy 16:55
I like the element that you’re talking about here, which is meeting the client where they are with what you have, and holding them in a safe space until, and I guess if they need more specialist care. I’ve, I’ve had clients in the past where I was able to help with the identity work. We had done some different pieces around whether it’s trauma or career stuff that you know, my area of specialty, and when some of the things that were coming up were related to their queer identity, that their shifting identity, and we came across pieces that were not covered within our therapy, and what I found really interesting was it wasn’t about even competence, it was about lived experience and being able to work with someone who shared identities, and that was my job, was holding those clients in space with me in a healing therapeutic space with me until a clinician that shared live experience came available, and even having some crossover there, I think there’s ways to do good enough work, safe enough work, but I think the way that you described it, Curt’s really interesting being part of their journey without feeling like you’re doing harm or feeling like you’re doing not enough, it’s an interesting dynamic. I’m thinking of longer standing clients who’ve, whose identities have become more understood and relevant as time went on. So, when a client walks into your office, you may have a different response, but for longer standing clients, I think there’s a lot that we consider, and I think folks who are in that space may be more likely to try to do some of what we’re talking about here, and so I want to shift to the clients who come into your office, you’re the only person available, and it’s a newer client, because I think that requires some different assessment as well.

Curt Widhalm 19:03
And I think that this is where somewhere in the background the steps for you to maybe put into place today is start by just kind of having a just in time kit available for yourself. If this is not an area where you are necessarily generally practicing, your just in time kit can include who’s one or two or three LGBTQ plus colleagues that I can have on my speed dial, so that way, if a client comes in, I know who I can reach out to for consultation when and if this ever comes up. So that way it’s something where you know I’ve mentioned in other episodes before, you might have the best practice that’s marketed down to your niche in whatever issues that that might be, and you’re still going to end up with clients who come in who have identities or lived experiences that fall outside of that, or in addition to whatever it is.

Katie Vernoy 20:10
Yeah.

Curt Widhalm 20:11
And these are the times where you can do yourself a favor by being able to have some of these things readily available for you, or even just kind of practicing, here’s my list of go-to phrases in different ways to be able to say to a client, I don’t know the answer to that, but I’ll find out by next Wednesday when you come back. But I think that there are things that you can do, where I mean, number one, if you’re still listening at this point in the episode, congratulations, you’re already doing part of this work, but this is, you know, some of the DIY steps to be able to serve as a stop down. This is, you know, have the emergency kit in the trunk of your car, hopefully you never get a flat tire, you spin off to the side of the road and need to wait for hours, but it’s nice to be able to put five minutes of effort into this to be able to kind of be prepared to triage your practice in a safe way.

… 21:12
(Advertisement Break)

Katie Vernoy 21:16
As you’re talking, there’s there are some things that are rolling around in my brain that I, I’ll try to put into coherent thoughts here. My belief is that therapist practices should be universally welcoming to all identities. That being said, I recognize that that’s a pretty pie in the sky expectation, because humans, humans don’t fit into that mold. We break ourselves down into subgroups, we oftentimes have mistrust of others, and so, as you’re talking about this emergency kit, part of me feels sad, maybe that’s the right word, or disappointed that that there would need to be an emergency kit, versus folks having a good enough framework to support these clients. Being able to be welcoming to identities, even at a superficial level, maybe not with the depth of knowledge that a specialist or someone with lived experience might have, but enough to be a warm, safe landing place. So my hope is that folks would actually have intake paperwork that was open to learning about all different types of identities, being able to understand where identity fits in and where it doesn’t, some basic cultural humility and practices, and I come back to our quote unquote California privilege. I recognize that there’s different, there are different conversations happening here than in some of the other states in the United States, and obviously in other countries, there’s very different cultural expectations. So, for me, when you talk about the emergency kit, if you have an emergency kit, great. You know, who can I consult with? Who can I? What resources can I reach out to if I happen to have a client call me, and I’m the only one available. But if you’re struggling to get a sufficiently affirming practice, it may make sense that you refer out, even when it shouldn’t actually happen, because I think harm to folks and marginalized identities is is a risk, and if someone doesn’t have the basics in place, even if they’re the only therapist available, I do believe that could be harmful. Now, we could have a whole other conversation about, does that, is that a good enough therapist for the profession, and I don’t want to go there. That’s a whole rabbit hole, but, and you’re right, if people are listening at this point, they probably aren’t the folks that don’t have any, any way to be culturally competent or affirming. They’re already trying to do some of the work, so thank you for sticking with us on this.

Curt Widhalm 24:44
I want to talk about the invisible labor that goes into what we’re talking about here, because in a standard case, one that your years of experience, you’re and if you’re early in your career, your months or even maybe minutes of experience of working with clients, but your prep time is minimal when it’s standard cases, or it’s cases that you’ve already put a lot of the work into. For being a stopgap therapist, your prep time doubles, triples the and that is a surcharge, your time might be spending two to three hours outside of the session researching some of the stuff that we’re talking about, looking up gender affirming care as therapist, watching webinars, talking with consultants, that there are very natural feelings that come up for therapists. I hear this sometimes, as far as who pays for those costs? If I’m spending two to three hours more, my hourly rate just dropped 60% This is where allies can feel a lot of burnout, is if you’re eating that cost because you’re now needing to do unpaid labor to stay competent, these are feelings that come up, and it is something that you’re going to need to figure out how you best want to handle that from a business end of things. If you’re paying for a consultant that might be another $100 to $300 for an hour out of their time, and that might wipe out your entire profit for a client for a month, depending on what you’re doing. This is something where I don’t necessarily have an absolute recommendation on this. I want you to think about this as far as the ethics of your DIY allyship. If you’re not willing, unable to pay the consultation tax to a supervisor, a consultant, are you actually doing ally work, or are you just kind of coasting along, and you’re just a cheaper than the expert alternative who’s doing no harm, and this also gets confusing with insurance panels, because you aren’t necessarily going to get paid more by the insurance panel to do some of these kinds of work. I don’t work in insurance, I don’t bill insurance. I’m pretty sure there’s not CPT codes that are just, hey, go and pay consultants for things. So this is really dealing with a learning curve, is it okay to bill a client to research their identity? The answer to that one is no.

Katie Vernoy 27:48
Absolutely no.

Curt Widhalm 27:50
But this is a little bit of guilt that allies feel. I feel bad charging somebody an extra fee, because I have to pay for a consultant, but it’s also something that you’re going to wrestle with, as far as how much unpaid labor can I give to be able to be just a little bit better than I was last week.

… 28:15
(Advertisement Break)

Katie Vernoy 28:16
In thinking about that, I have two different thoughts. One is the privilege it might require to be able to be a sufficient ally, whether it’s doing this work that you’re talking about, or taking time to be an advocate, or correctly not charging clients from different identities surcharges to learn about them. And I think that the solution I see is really designing your continuing education that is already required for a lot of us to support clients who are different from you. I find at conferences I’ve been to that the quote unquote cultural competence, DEI, however they’re framed.

Curt Widhalm 29:12
Cultural humility, whatever.

Katie Vernoy 29:14
Cultural humility, those types of trainings are often the least attended of the different trainings that are available. That’s not okay. There is so much we don’t know about each other. There’s such diversity in who we are as humans, and to not take opportunities to learn from experts with lived experience in at a conference you’re already at, I think, is a missed opportunity. It’s a way to take time you’re already devoting and resources you’re already devoting to that effort. We all have a huge amount of CES that we have to take every couple of years, devote some of that to being a good enough ally.

Curt Widhalm 30:09
And if you’ve already completed your CES, get some more. It’s a minimum, it’s not a maximum, and you can always continue to grow, and I will say this, as especially if you’re somebody who’s putting social justice in your marketing. Actually look at your profit and loss statement. If you’re running your practice, if you aren’t spending money on consultation from communities that you claim to serve, your allyship is just a line item that you’re trying to get for free. You’re, you’re basically asking marginalized communities to subsidize your clinical training if you’re adding the surcharge onto them, just for the privilege of working with them, so you know, maybe I am settling it, pay the tax, you know, do that yourself, hire the consultant, take the affirming tag off of your profile, yeah, unless you’re willing to put the work in, because what we’re, what we’re trying to say in this episode, or at least some of the points, and Katie usually adds a lot that I forget to say when we’re summarizing things, is don’t be terrible, you might be fine just where you’re at. Continue to work on being better. You don’t have to be the expert in doing things, but do the things that move you slightly more towards being an expert to be able to help the client that you’re working with, and it’s potentially going to pay off and help the next one who shows up, or it might be an investment into making yourself have new areas of your practice that serve, that’s an actual good ROI, if you’re only looking at this from an investment in a business thing, also don’t do that, that just makes you greedy, but do it because you want to, and because it’s good, but in the meantime be good enough.

Katie Vernoy 32:10
So, before we close up, I want to talk about the no-go’s, when to refer anyway, what you should not do, and what you need to pay attention to. So, refer anyway, if it’s completely outside of your scope. If there are, if the presenting issues require such specialist knowledge or lived experience that you cannot be safe enough or good enough. The other the other reasons to refer oftentimes sit in who you are and how you’re showing up. If your identities are not aligned with the person in front of you, and you’re consistently showing your own discomfort, you’re constantly making mistakes, or you’re over correcting if you’re feeling very confused, if you get into this trap where you’re so focused on being a good ally that you’re not doing good therapy, I think that can be very problematic, or if your religious, family, or political background is showing up in the room and you’re not able to address it, or you’re not choosing to address it. There are ways that we can harm when we’re trying to hold down the fort, and so I don’t want to dismiss that. And I think there are ways around it, but if you aren’t doing the work, you need to refer out. If you’re not able to, if you’re not comfortable enough to be safe enough, you may need to refer out. I suggest doing the work first. I suggest digging in, but for all the reasons we said, you know that may be challenging, and so please do an assessment before you decide I’m good enough here.

Curt Widhalm 34:04
You can find our show notes over at mtsgpodcast.com. We’ll include links to a bunch of our back episodes over there. Follow us on our social media, let us know what else needs to be added to this conversation. We’ll gladly promote any of that kind of stuff, whether it be here or Facebook group, The Modern Therapist Group, continue the conversation on there. And until next time, I’m Curt Widhalm with Katie Vernoy.

… 34:30
(Advertisement Break)

Announcer 34:32
Thank you for listening to the Modern Therapist’s Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter, and please don’t forget to subscribe, so you don’t miss any of our episodes.