How Do Therapists Manage Intense Caseloads?
Curt and Katie chat about how to manage clients with high needs. We look at risk factors as well as how therapists can take care of themselves while working with challenging caseloads. We also talk about clinical strategies and effective risk assessments and safety planning as important elements for effective practice.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we talk about how therapists can manage high levels of risk in their caseload
As part of our “Survival Guide” we have been asked to talk through how to manage high intensity caseloads. We’re looking at
What is a high intensity caseload?
- High levels of suicide
- Impulsive or aggressive clients
- Families with a lot of challenges (like trauma, poverty, etc.)
What are the risks for therapists who have high intensity caseload?
- Burnout
- Vicarious Trauma
- Moral Injury
How can therapists take care of themselves when their caseload is challenging?
“I needed to have connection and a routine and positives outside of work, in order to not take so much of it on…It really was about understanding who I was separate from my work, and being able to tap into that when I was off work.” – Katie Vernoy, LMFT
- Scheduling breaks and other self-care practices
- Timing clients with bigger challenges at times you have more space to address them
- Managing caseload size (i.e., you may have to see clients more than once a week)
- Don’t be alone with challenging cases
- Looking at which problems are structural and which are based on your individual effort
- Assessing your capacity for seeing clients and working with clients
- Understanding how your personal life can impact your ability to work with clients
- Building support and cohesive teams (e.g., DBT Consulting Team)
- Balancing work and personal life effectively
What are clinical strategies for working with high-risk cases?
“A lot of times when we’re working with people, it’s what is really happening right now…Because if we’re not working on the same wavelength as the clients, that can lead to a lot of frustration and a lot of impractical sorts of advice…When crisis situations do come up, what I have found to be most successful is I just take the time to really be able to listen to what’s happening right now. What are the needs for right now?” – Curt Widhalm, LMFT
- Separating your emotions from your clients
- Making sure you get yourself into wise mind before you engage with crisis
- Meet your client where they are, not where they “should be”
- Creating a treatment team
- In-between session contact should be structured and boundaried
- Move away from savior or protector role for clients
- Effective risk assessment and safety planning
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!
MacKay, L. M. (2017). Differentiation of Self: Enhancing Therapist Resilience When Working with Relational Trauma. Australian & New Zealand Journal of Family Therapy, 38(4), 637–656. https://doi.org/10.1002/anzf.1276
Shamoon, Z., Lappan, S., & Blow, A. J. (2017). Managing Anxiety: A Therapist Common Factor. Contemporary Family Therapy: An International Journal, 39(1), 43–53. https://doi.org/10.1007/s10591-016-9399-1
Thériault, A., & Gazzola, N. (2006). What are the sources of feelings of incompetence in experienced therapists? Counselling Psychology Quarterly, 19(4), 313–330. https://doi.org/10.1080/09515070601090113
Relevant Episodes of MTSG Podcast:
REPLAY – Structuring Self-Care
Building Your Treatment Team in Private Practice: Essential Networking Skills for Therapists
What Can Therapists Do When Clients Don’t Get Better?
When Doing “No Harm” Isn’t Good Enough: Bringing beneficence to your clients
Quarantine Self-Care for Therapists
Risk Factors for Suicide: What therapists should know when treating teens and adults
Who we are:
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.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
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 0:12
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. This is the podcast for therapists about the things that we do in our practices, the things that we do with our clients, the ways that we take care of ourselves. And this is maybe a little bit of a greatest hits episode where we pull together some things from quite a few different episodes, but I promise there is new information in this one as well.
Katie Vernoy 0:15
We promise.
Curt Widhalm 0:17
So we have been asked to talk about, how do you manage having a high intensity caseload, or a caseload with a lot of high needs clients.bAnd this might be in a variety of different settings. It might be in community mental health. It might be in the way that private practice is scheduled. So,we wanted to talk about some of the ways to go about managing this, some of the ways that this might look at self care for you. This might look at some of the ways of clinically intervening. And part of this is also something that comes up with my group practice and my team, that a lot of times we get questions, or I get questions as the owner, how do you do this? How do you handle working with DBT clients? How do you handle clients who face chronic suicidality and be able to come in and do this day after day? And that’s what we’re going to get into in this episode. So Katie, I know that your private practice has shifted away into maybe not quite the same way, but you used to work in community mental health. What were some of the things that you found really beneficial at that point in your career?
Katie Vernoy 1:58
When I was in community mental health, I think the hardest thing for me was 24/7 coverage, because we were working with a lot of folks with crisis. There’s also I was for in California, it’s called LPS or Lanterman-Petris-Short, I think something like that, designated, which meant I could assess and have someone kind of get the initial stages to hospitalization. They were reassessed when they got to the hospital, but I was someone who could get them on the ambulance to the hospital, and there was a lot of chaos and crisis, and there was so much pain and suffering and poverty and generational trauma that I needed to have connection and a routine and positives outside of work, in order to not take so much of it on. And I don’t know that I was 100% successful at that, I did burn out pretty significantly. Part of it was the dynamics of the workplace, but some of it was really the stories I was hearing, the things I was interacting with in communities. I was driving to people’s homes and spending time with them in, you know, kind of the chaos that was their lives. And it really was about understanding who I was separate from my work, and being able to tap into that when I was off work. So, I don’t know, I don’t know if that starts too philosophically. I think we probably want to say a little bit about what we mean by intensity case loads, to get a framework. But before we do that, what’s been helpful for you, because you stayed with high intensity caseload, even in private practice, with to a certain extent less support, since you’re the practice owner and most of your folks are pre licensed, or much less licensed than you.
Curt Widhalm 3:56
I think before we get to that, I think we should go in the direction of what we are talking about with high intensity. And you know, for a lot of the clients that I’ve seen in my private practice over the years, the way that our group practice is built or marketed or niched is around a lot of suicidality, a lot of self harm, a lot of impulsive or aggressive behaviors within some of that impulsivity, where there might be risks of violence, and part of what I’ve seen over the years is when you know, some of my friends, some of my colleagues and other practices look at what it is that I do. I think that there are very learnable things. But I think that somehow during my training, I was taught, back when I was working in agencies, about being able to leave work at work. And I wasn’t always great at it, but when I see some of the other practices that work with clients like mine for a while, and then kind of shift out of working with these same populations is there’s a lot of burnout that happens, a lot of taking things very personally, because it’s a reflection of how good am I as a therapist based on what client successes are.
Katie Vernoy 5:27
Yeah.
Curt Widhalm 5:27
And some of being able to kind of deal with that is some of the stuff that I’m excited to talk about in this episode. But you know, it’s interesting when I onboard new therapists and talking with them, especially through the first six months to a year of when they’re working with me, is when they talk about being stressed out after work, at being worried about their clients. And I kind of compared where I’m at with some similar clients of my own, the things that keep me up at night, or the things that stress me out are oftentimes less and less about clients, and more and more just about running the business and so. So there is some things that are learnable, but I will say that part of this, I think, you know, from a very practical end of things starts with some of the stuff that we’ve talked about on the podcast. You know, the structuring self care thing that we did that, and I say the thing that we did because it was not only podcast episode, it’s a presentation that we do together about being able to just structure our work days and structure that transition back into the rest of our life that really allows for a lot of the basis for that success to start.
Katie Vernoy 6:50
We’ll link to that episode, and there’s a couple of episodes, I guess, that were pretty relevant there in the show notesover at mtsgpodcast.com. Some brief practical tips, I guess, are really looking at making sure you have breaks, making sure that you are scheduling folks who may have crisis at times when you can go over without getting in trouble with another client, or, you know, infringing on their their space. I think there’s also making sure that you don’t have too many clients on your caseload, because you’ll need to see clients more than once a week, or do some of these ongoing calls, those types of things. And so I think it’s really looking at, how are you, to the best of your ability, I understand with community mental health, sometimes you don’t have as much choice on how many clients you have, but to the best of your ability, the best you’re able to advocate if you’re able to keep your caseload manageable, it makes everything so much better. I think we can go into not being alone in it, whether it’s treatment teaming or consulting or supervision, I think there’s, there’s a lot of the basics that I think we’ve talked about elsewhere. But in truth, I think that that if we look at some of the risks that come, maybe we can kind of assess those and talk more specifically about how we avoid them.
Curt Widhalm 8:23
You know, I think from some of the philosophical side of things, you know, we can point to just the risks of burnout on this and…
Katie Vernoy 8:31
Sure, and vicarious trauma. And…
Curt Widhalm 8:33
Yeah.
Katie Vernoy 8:34
…moral injury.
Curt Widhalm 8:35
Yeah, no. And I was really going to dive into the moral injury, because we can get into this field, and like I mentioned earlier, base our worth as a therapist based on how successful our clients are. And oftentimes what we learn in our theoretical classes, and what insurance companies want, or, you know, government payer companies want, is this person with all of these combinations of very severe traumas and structural and societal problems isn’t fixed in 20 sessions, you suck as a therapist.
Katie Vernoy 9:10
Yes, yes.
Curt Widhalm 9:11
And that’s oftentimes just not a possibility for most people to be able to address all of those things. And that that risk is really, you know, a lot of what we hear from our community mental health listeners is there is this expectation that set on us to be perfect all of the time and to have perfect output. And if something just goes wrong, it’s a structural problem. It’s not a individual problem. And no matter what ends up happening, we end up taking those burdens on ourself, especially when there’s not a treatment team around us to be able to reflect on here’s what our capacity is. When our team was going through the DBT training, it was strongly emphasized to us that in our weekly team meetings that we talk about things in terms of capacity. One person’s capacity from week to week might be 20, 25, sessions, but if another person has 15 really high needs clients at a time that might be all their capacity is because of that need for multiple sessions, between session contacts. And so it’s being relative rather than absolute as far as what your capacity is, and that’s just dealing with your caseload, let alone anything that else that might be going on in your personal life that you’re also having to deal with. Now, I recognize that there’s a ton of privilege that we’re talking about on what gets scheduled for you and what you sign up for your schedule depending on your work environment here, but I think, thinking about it in terms of capacity, rather than productivity, is a way of being really healthy and fair for yourself when it comes to what you’re actually capable of doing.
… 11:08
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Katie Vernoy 11:11
I want to speak to when you don’t have opportunity or choice to do more of that high level caseload management, right? You’re going to get a new case. You’re going to have the going to have those things. If you’re able to identify the cases that are a little less intense for the moment, a little bit more fun, or have have those things going on, trying to spread those out through the week. Don’t stack like a good day. Make sure that you’re managing your caseload. Sometimes that can be hard, especially if you’re driving places, because you need to put people in the same, you know, the same area. You have to have them on the same day, that kind of stuff. But I think that there there is some latitude that you may have within your own caseload to try to figure out, how do I give myself a little bit of a break after the hardest session? How do I take some time there? Maybe that’s when you schedule documentation time or consultation time. The things that potentially will help to give you a little bit of breather, a little bit of space. If you go from one chaotic, high risk situation to another, for some folks, that’s going to be great. I’m just I’m staying on, I’m staying in the I’m in the mode. For other folks, it’ll be way too much, and they’ll need to to assess that and take care of that. I think even for the most part, I know that there’s agencies that aren’t this way, but there can be some consultation, whether it’s with a colleague, a supervisor, or someone who’s on call, that kind of stuff that can help to just regulate your system a little bit, remind you of your grounding in your clinical work. You’re grounding in safety. You’re grounding in whatever it is. I think, if you’re consistently having to talk to someone who does say, like, what do you do? Doing this wrong, you’re doing this wrong, or just figure it out, or I don’t have time for you, those types of things. I think those situations are pretty bad, and hopefully you can find your way to a different situation or find a different person that you can consult with. But I know for myself, especially when I’ve had a particularly challenging session, I need to at least debrief with a colleague, if not find actual supervision and consultation to talk through what I did well, what I did wrong, what I can plan for next. And so staying isolated or afraid with those fears of inadequacy, or you know that you’re incompetent, and not sharing those things, it it festers, and you keep having more doubts, and then you get more anxious, and then you don’t do as well. And so being able to bring that to the surface and actually have those conversations. I really like the way that DBT enforces that, and has that that consultation team, and has those coaching calls, and all of the things that I think are built into being able to manage these cases. If you don’t have that structure, remind yourself, like I do, need to have some of that support and access it in any way that you can.
Curt Widhalm 14:09
And a lot of what we’re talking about so far is just trauma informed practices.
Katie Vernoy 14:13
Yes.
Curt Widhalm 14:14
And any good trauma informed practices are going to acknowledge at first and foremost, that vicarious trauma, burnout, that kind of stuff can happen to anybody who’s in those roles. And part of what we’re both talking about here is building in the structure, into your schedule, or into your team, or into just your practice. You know, if it’s an individual thing, like you’re talking about where, okay, after difficult clients, here’s what I’m going to do, do all of that stuff as pre planned thinking.
Katie Vernoy 14:48
Yeah.
Curt Widhalm 14:49
You know, I find myself talking with a lot of my clients that having these plans makes it to where, when you are in a really stressed out situation, you don’t have to deal with both being stressed out and having to come up with the plan.
Katie Vernoy 15:02
Yes.
Curt Widhalm 15:03
So let’s at least get some of these plans in place. I don’t know that I would be having the type of practice that I do if I didn’t have a team around me. And you know, this is, I promise everybody, this is not just a sales pitch and like, go and have a great DBT practice. But one of the other things that I really like about DBT consultation team meetings is that they’re structured to be very egalitarian, that even as the group practice owner, the supervisor to many of the people at my team. Everybody rotates through leadership roles. Everybody, including myself, is expected to talk about these are the difficulties that I’m having. And everybody has the opportunity to step up and say, what is it that you need from the team in order to support you with this this week. And there’s really a lot of being able to build a cohesive team that may start with kind of the top down structure from me as the practice owner. But what it does is it makes it to where it’s not just trauma informed ideas, but the practice is actually put in place, and by extension of that, one of the things that we check in on is, how are you leaving work at work? How are you engaging in self care? There’s more camaraderie built around Hey, are you still going on your hikes on the weekends? Because that’s something that you said really helps to refresh you. So it’s also a way of, kind of being held accountable for some of your self care practices.
Katie Vernoy 16:57
When you’re talking about a plan, I think there’s, and this is how I talked about this with a lot of my clients. There’s the proactive and the reactive, right? There’s the proactive. I’m going to go on a hike on the weekend, I’m going to have these types of things. And I’ve heard that as accumulating positives, or putting together a lot of positive experiences so that you have those in your in your tank. You’re gathering resources, you’re you’re more able to come to work without all of this hanging over your head. And so I think the the proactive coping when you don’t need to cope yet is is really, I think, wonderful. And I think all therapists should do it, regardless if their caseload is intense or not. I think some of the the reactive stuff or I guess maybe, maybe this distinction isn’t helpful in this way, but being able to self soothe and having specific self soothing practices that you can do in your office after sessions that are really challenging. Being able to do both proactive and reactive mindfulness or other types of grounding exercises that get you back into a space. Practicing distress tolerance and understanding that these clients are potentially in really negative places in their life, and you’re on this journey with them, and there’s not a lot that’s changing very quickly. And we did a whole episode on when therapy isn’t progressing, and so we’ll link to that in the show notes, too. But it’s being able to understand that someone else’s crisis is not your crisis, your client’s emotions are not your emotions, and being able to really sit and allow that differentiation to be present for you. And I think the the one that’s definitely a DBT thing: before you jump into any of these crises or any of these things, making sure that you’re in wise mind.
Curt Widhalm 18:52
One of the practical ways is, you’re talking about mindfulness and wise mind sorts of things, is recognizing that when you are working with these clients, and even when you’re quote air quotes “around this working with them when you’re not with them” in other words, putting it really to the side, is focusing on meeting the clients where they’re at, not where they’re supposed to be.
Katie Vernoy 19:21
Yes.
Curt Widhalm 19:22
And that really comes as a benefit of taking that time to recognize: what am I actually facing right now with this particular client? Not what’s going to be happening next week, five weeks from now, 10 years from now, with them, but what are we really dealing with? Because sometimes we can treatment plan our ways into some sort of perfect way that this client is supposed to respond to things. But a lot of times when we’re working with people, it’s what is really happening right now. What is really going on? Because if we’re not working on the same wavelength as the clients, that can lead to a lot of frustration and a lot of impractical sorts of advice, and it can pull on our insecurities as far as well,I’m not doing anything that’s actually helping. I’m trying to give all of these evidence based treatments, or I’m trying to give things that have worked, but it’s not working right now. So this must be a failure on my part. But really, I think in all of the clients that I work with, that when crisis situations do come up, what I have found to be most successful is I just take the time to really be able to listen to what’s happening right now. What are, what are the needs for right now? And again, another benefit of DBT is the like between sessions coaching calls have a very structured way to to be able to talk about things. But it’s not doing a lot of extra work beyond what is actually needed in between sessions. It’s: here’s something that can help you right now, and this will help you get to our next actual session time. And being able to have some of that structure in place helps to make it to where the structure helps to take care of things, it gives us the permission to be human and responsive, and then it also helps us to be human and responsive for ourselves.
Katie Vernoy 21:37
Yeah, yeah. When you were talking, I was thinking about a phrase that we would say in community mental health a lot, and it was really reassuring for me, because it pulled me out of the protector role. It pulled me out of the hero, the savior role that I think sometimes especially new clinicians, and I’m fully claiming it for myself too, that we would have, right. That we’re going to be the one that makes them all better, that it’s our responsibility. And I think being able to pull away from that is really helpful, so that the saying was, your client has survived and done everything that they needed to do to get to this moment. Your help is just the frosting on top. And I don’t remember exactly if that’s how it was said, frosting sounds weird in this context, but it was something where recognizing we are a benefit. I mean, obviously we want to do no harm. So, there’s a whole other conversation about ways that we could be harmful in these situations, but assuming that we’re pulling from strong clinical structures and strong mechanisms of change and working with clients, whatever we do is just an added benefit to the resources and the strengths that the client already has. And so separating myself from this need to fix it, and just becoming this, you know, partner on the journey, or this consultant to add some extra tools, or whatever it is, took pressure off of me, and it really separated me from the results of what happened in a way that I think was healthy versus, you know, whatever happens doesn’t matter. I think it’s it’s something where it was really helpful to remind myself, this isn’t mine, and if I have done everything that I can do, that’s all I can do. I can’t make this situation different than it is.
… 23:41
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Curt Widhalm 23:44
As you’re talking I’m thinking about, you know, there’s been times, especially earlier in my career, where I looked at the people who’ve been practicing for a very long time, and I had wondered, are those just people who’ve learned how to survive in the system of working in mental health, or are there things that they’re actually doing to be able to manage all of this kind of stuff? You know, are we, are we looking at a survivorship bias out of people like you and me at this point where it’s, oh yeah, Curt and Katie are great at this. But maybe it’s just because, you know, they have that special sauce from the beginning to be able to…
Katie Vernoy 24:24
Got it.
Curt Widhalm 24:25
…work with this. So, I do want to tell everybody that, yeah, earlier in my career, I did struggle with some of this stuff. I remember…
Katie Vernoy 24:34
Oh, a lot, I did so much.
Curt Widhalm 24:36
I remember, you know, the first handful of clients that I had in my traineeship where I couldn’t shake what had happened in a session, and it wasn’t even necessarily crisis related stuff, but it was just learning how to deal with my job is working in people’s really big emotions and really big mental illness, mental health, kinds of crises that, you know, I’ve heard from my wonderful co host many times over the years, that part of this is also recognizing that you can’t turn everything into a crisis where you’re constantly in that kind of fight or flight response mode, and you’ve given plenty of examples on the podcast over the years around this is not an actual crisis. This is maybe a culmination of poor choices that’s leading to some consequences, but this is not something that’s going to result in death or violence, it might result in some things that we don’t really like, but I can’t respond at a crisis level on every single thing to everybody.
Katie Vernoy 25:54
Yeah, that I have a list of kind of some of the clinical things that are important to do, and I think one of them is: just because it’s a crisis to you, it’s not a crisis to me. And that really speaks to prioritization. What are the things that most need my attention, that I have capacity for? And so to expand out what you were talking about, Curt, there’s suicidality, homicidality. There’s serious issues that could end up in child abuse or other types of really serious violence, or…
Curt Widhalm 26:28
Domestic violence.
Katie Vernoy 26:29
…domestic violence, those types of things. And what I found a lot was someone coming to me and saying, I’m gonna be homeless in two days and and I’m sure you know long time listeners of the podcast have heard this story before, but someone being out of a home in a couple of days is not typically, and I’ll say that, I’ll put the caveat there. It’s not typically something that just happened that day. It’s something that’s been building over time and being able to identify, how do you, how do you manage with what’s there, and how do you make sure that you’re not responding as though that’s a crisis, and really holding space, because not only you not responding like a crisis will help you, it will also help the client to recognize, Oh, I’ll be okay. We can just calmly manage this. Now, they also might get frustrated with you because they you’re not experiencing the same urgency as they are, but I think it is something where another one of my kind of practical slash clinical suggestions is desensitizing yourself without losing your empathy, and that’s not easy to do. There were definitely times when I was completely desensitized, and I think I was also vicariously traumatized and completely shut off. But I think that there is an element of when you keep facing a lot of different types of crisis, different levels of suicidality that are not hospitalizable or not, recommended to be hospitalizable, I think you you start to get to that place of, we’ll call it distress tolerance, where you can navigate some of these things without it really spiking your adrenaline and putting you into fight or flight.
Curt Widhalm 28:17
One thing that I think happens also a lot, especially early in your career, is comparing where you’re at in your career and your skill set with people who’ve been doing this for a lot longer. And in that can kind of end of come that imposter syndrome, sort of feeling that then I see some people really panic on and then try and go and learn all of the skills right away, and recognizing that these are things that are skills that you can’t rush. You, you know, this is maybe a thing from Guy culture, but, you know, there’s all of the, like, dads and grandpas who’ve got what they call old man strength that, you know, just from like, years of like working in a machine shop, that just over and over repetition, that you can’t get that just by going to the gym and working out a lot more. You’ve got to do the things to get old man strength that you make old man strength.
Katie Vernoy 29:13
I’ve never heard of that one before. That’s pretty interesting.
Curt Widhalm 29:19
But part of being able to manage this earlier in your career is not filling all of your time with therapy related stuff. So…
Katie Vernoy 29:29
Oh, yeah.
Curt Widhalm 29:30
You know, I get the desire to learn new things, but you don’t need to spend all of your waking time studying new therapy things, going to new trainings, listening to all of the podcasts. You know, yeah, we thank you for listening to ours, but one of the things that you can do to make yourself most resilient is have a life outside of therapy.
Katie Vernoy 29:54
Yeah, for sure.
Curt Widhalm 29:55
And actively do it. Make it non negotiable to do things that differ from work and just existing at home. And I really wonder, as our field transitions into more and more remote work, more and more, here’s the opportunity to just work from home with these kinds of clients…
Katie Vernoy 30:21
Yeah.
Curt Widhalm 30:22
…that do take a lot of time and energy, and then, like we’ve talked about several times that we experienced during the pandemic, where it’s all right, I log out, and then I’m still in my space, and I can just go and dramatically flop down on my couch or on my bed and doom scroll until it’s time to fall asleep and get up tomorrow.
Katie Vernoy 30:41
Yeah, yeah. I’ll link to, I think we did an episode on how to manage it working from home during the pandemic. I’ll link that to the in the show notes as well. In researching for this episode, you know, we’re talking a lot about lived experience, but there are, there are some articles that I found. One was on managing anxiety. One was on managing fear of incompetence. And what I really took from that is really strong boundaries. Who is responsible for growth? Who is responsible for the work being done in the treatment, making sure you’re dividing that, that you’re holding that within the session. I also see boundaries, what you’re talking about, leaving work at work to the best of your ability. And if you’re not able to leave work at work, because I’ve had times in my life when I really couldn’t, and that was because of things going on my life where I didn’t have as many spoons or resources to be able to process and manage what was happening in sessions, reaching out to colleagues, reaching out for consultation. You know, more of the same that we’ve talked about. I think the other thing that that you mentioned before the podcast, that I think we should definitely talk about here is effective risk assessment and safety planning. Because I think in a lot of ways, when I have the most trouble leaving work at work, and I’m worrying about clients after sessions, or I’m thinking about them between sessions, it’s because I’m not sure what they’re going to do over the over the week, how they’re going to take care of themselves, what they’re going to be thinking, what, what’s going to happen if it’s their crisis or their suicidality spikes when we’re not having a session. And so we have a whole, we actually have two episodes, plus additional episodes. We have a whole section on to managing suicidality, but we do have two episodes. Both are CE, I believe that Curt you led on managing suicidality, so I’ll link to those in the show notes as well. But I think just to make sure that it also is housed within this shorter episode, if we can talk about briefly, effective risk assessment and safety planning.
Curt Widhalm 33:04
One of the things that I see that puts people at risk for burnout or running into these kinds of problems is they make themselves too large of a part of the safety plan.
Katie Vernoy 33:17
Yes.
Curt Widhalm 33:17
A safety plan should include your information as the therapist. It should include some of the things that you’re working on in sessions, as far as identifying triggers, identifying coping skills that work. But sometimes I see therapists who say I will follow up with you and do a safety check in, in 24 hours, 48 hours, that is very much clinician led, and then inevitably, when the client doesn’t answer the phone, the it adds a lot of extra stress to the clinician. So, part of being able to build out safety plans, is making sense of what the client has, as far as options. And you are one amongst many, not the sole piece of it. And it’s taking off that, that hero piece of thing, it’s being able to say, if I don’t hear from you, I will check in and I will follow up with somebody on your safety list, your emergency contact if I don’t hear from you within a certain amount of time, rather than needing to call every 15 minutes and then building up in your mind, the worst possible situations that could have happened.
Katie Vernoy 34:40
The more resources we’re able to identify and help the client access within a safety plan, within the work that we’re doing with them, the stronger they are in the long term. They cannot rely on you forever. You’re one single human, and potentially they can’t even rely on if you have a team. Or a treatment team, there are professionals who have lives, who go on vacation, who have their own situations that come up, and so creating more of a support network, of a safety network within their lives is good treatment, and it means that you know that your clients are going to be okay. They’re going to take care of themselves, and maybe they’re not, maybe that’s not 100% maybe they’re not going to 100% be okay. We’ll we have an episode scheduled or an interview scheduled about losing clients to suicide. But if you know you’ve done everything you can to build safety and structure around them, to support them in living if they choose to live. I think that helps to feel more confident. It gives you permission to not be on and thinking about them, 24/7, and it’s it’s stronger for them. Now, what I’ve done, and I’ve done this even in my private practice, I don’t have a high intensity caseload at this point. I just can’t manage it. But I do have some clients who have high needs, and with those clients, I get release forms for family members. I make sure that I’m talking with other people on the treatment team, that I’m expanding their treatment team. I’m doing the things that I did in community mental health in private practice, to make sure that I’m not the only one with eyes on and I’m not they’re, the client’s not the only one that’s able to let me know what’s going on when those needs are present.
Curt Widhalm 36:26
You can find our show notes over at mtsgpodcast.com follow us on our social media, join our Facebook group, the Modern Therapist Group, to continue on this discussion and share even more if you’ve got ideas that are beyond what Katie and I are talking about here, and until next time I’m Curt Widhalm with Katie Vernoy.
… 36:46
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