How to Fire Your Clients (Ethically) Part 1.5

Episode 226: How to Fire Your Clients (Ethically) Part 1.5

Curt and Katie chat about different therapist-client mismatches and how to manage them. We explore how to balance dealing with discomfort in therapy and seeking consultation with knowing when and how to refer out clients. We also talk about how to incorporate ideas of redefining and decolonizing therapy.

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.

In this episode we talk about:

  • How to manage situations when the client having a clinical need that the therapist does not feel capable to treat.
  • Different kinds of therapist-client mismatches.
  • Cultural considerations in therapist-client matching and incorporating ideas of redefining and decolonizing therapy.
  • How to refer out clients when there is a mismatch and what to do if the client doesn’t want to be referred out.
  • What to do when you have different ideologies than your clients.
  • The benefit of sitting with discomfort when you disagree with your client and knowing when to seek consultation.
  • How to support clients when they aren’t aware that a different therapeutic style (e.g., direct vs. indirect) may be beneficial to them.
  • The importance of reviewing treatment plans with client (even when not required).
  • Revisiting how to address therapy interfering behaviors and how to appropriately terminate with clients when necessary.
  • Barriers in referring clients out.

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Resources mentioned:

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Relevant Episodes:

How to Fire Your Clients (Ethically)

Make Your Paperwork Meaningful

Therapy is a Political Act

The Balance Between Boundaries and Humanity

Is Therapy an Opiate of the Masses?

Ending Therapy

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Who we are:

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, 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 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. 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

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

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Full Transcript (autogenerated):

Curt Widhalm  00:00

This episode is sponsored by SimplePractice.

Katie Vernoy  00:02

Running a private practice is rewarding, but it can also be demanding SimplePractice changes that this practice management solution helps you focus on what’s most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing.

Curt Widhalm  00:18

Stick around for a special offer at the end of this episode.

Katie Vernoy  00:23

This podcast is also sponsored by RevKey.

Curt Widhalm  00:26

RevKey is a Google Ads digital ads management and consulting firm that works primarily with therapists digital advertising is all they do, and they know their stuff. When you work with RevKey they help the right patients find you ensuring a higher return on your investment in digital advertising. RevKey offers flexible month to month plans and never locks customers into long term contracts.

Katie Vernoy  00:49

Listen at the end of the episode for more information on RevKey.

Announcer  00:53

You’re listening to the Modern Therapist 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  01:08

Welcome back modern therapists This is the Modern Therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about all things therapists and picking up on last week’s episode responding to user reviews, we felt the food getting a little more nuanced and a couple of things. But this review sparked a couple of ideas, check out last week’s episode about therapy interfering behaviors. We also wanted to dive into a little bit more of the firing clients maybe terminating prematurely before clients end up getting to their goals, we might want to call this episode firing your clients ethically, Part 1.5. Like it’s cuz this does help us dive into a little bit more of some situations where this comes up. We’ll talk about this from a clinical approach. We’ll talk about this as far as broadly, some of the ways that I’ve heard ethics committees talk about bad therapy when clients have felt abandoned by therapists, this kind of stuff. So Katie, and I wanted to talk about what are some times where we’ve heard therapists, quote, unquote, firing their clients looking to terminate prematurely referring out, etc. So Katie, what is first on our list today,

Katie Vernoy  02:37

the most frequent one that I’ve seen that I’ve experienced is this idea of a client having a clinical need that either pops up or was on assessed, you know, wasn’t appropriately assessed at the beginning, that I don’t feel capable to handle. And I see this a lot, where folks will say, well, this person has psychosis or they have an eating disorder, or they have substance abuse, or they have something and I’m not an expert in it. And so I am going to refer them out. And there have been times when I’ve chosen to refer out and there have been times when I have kept the clients and, and created a treatment team around myself so that there was expertise present. But I see that a lot. I think people get very worried, and sometimes with good reason that if they keep a client for whom they don’t have the appropriate clinical expertise, that they will be hurting the client. And so they then terminate the client, which can mean that the client feels abandoned because they have, especially if they’ve already developed a relationship with you, or if they had difficulty finding a therapist in the first place. And there’s not great referrals. So I think that’s potentially where we start is when a therapist feels like this is not my expertise. But they’ve already shown up in your office, either for one session or for 10 sessions. And this is a new clinical issue that pops

Curt Widhalm  03:57

  1. So Katie and I, before recording today, we were talking about a couple of different areas where this has come up in our careers. And part of managing some of these particular situations is having honest discussions with clients. This might be something where it’s a lot easier when it’s in those first couple of sessions of, Hey, we don’t have a real strong therapeutic relationship. But I don’t have the skills to be able to help with the goals that you’re coming in here with and especially if there may be more high risk or specialized sort of treatments you brought up about eating disorders before the show was recording here. These get a little bit trickier when you’re much deeper into relationships with clubs. And for instance, eating disorders that show up in clients after a couple of years of treatment where you have a very strong relationship with a client and it might be outside of your wheelhouse. I’ve had a couple of clients that I’ve worked with for a very long time that have eventually started exploring transgender identities and things that are not necessarily within the specifics of my specialties. But feeling the confidence in a therapeutic relationship and knowing what it’s like working with me over the long term to begin to explore some of these new identities. And I think, in the way that Katie and I have talked about this is a lot of times, it’s not necessarily firing those clients, but it’s helping to be able to develop a treatment team of specialists around who’s working with those clients to be able to help the clients reach their goals, while also still having the emotional space and the trust in the relationship that they know that they’re going to be taken care of.

Katie Vernoy  05:57

For me, I see it as a very attachment based style of therapy that I do, because I think I do longer term therapy, it’s very relationship based. And so if I can’t be the expert in the room with my clients, I act as a trusted person in their life who’s going to figure it out. And I’m going to get the right people around them. And I’m going to advocate for them. Some of this comes from my history of doing more on the kind of social work and of pulling together treatment teams and resources and advocating for my clients. But there are a number of times throughout my career where something has come into my client’s life, we have a very strong relationship, and I start doing research, I start gathering people around them. And the work that I do may be impacted by that there may be things that I bring in that is relevant to that particular treatment issue. But it may also be just me talking with them about like, how’s it going with a specialist? How are you taking care of yourself? What do I need to know to support you during this time? You know, it’s it’s something where it has to be within the relationship because a brand new client having to tell you what they need, doesn’t feel appropriate, but a client that’s been with you for years and has this new issue that they’re facing, I think it would be pretty bad. If you were to say, Okay, I’m out, because I don’t know about this. So you’re on your own, because people are not just these new treatment issues are not just diagnoses.

Curt Widhalm  07:27

And what you’re describing There is also getting your own consultation and learning and developing some new skill sets alongside of that, it’s not always going to be possible to out of the blue be able to develop a new best practices sort of treatment for these kinds of clients. And that’s where handling these difficulties. I think we’ve discussed this in enough episodes before and just kind of a general enough knowledge within the community that we can move on to our next thing on the list here.

Katie Vernoy  07:59

So one more, I think clients often opt out. But I think sometimes for especially those therapist pleasing clients therapist might have to do it is a therapist like relationship mismatch, that there’s something in the relationship that just seems to be getting in the way of the treatment being successful.

Curt Widhalm  08:20

And so sometimes this can be personality wise, this can be things where the agreement on what the treatment plan is, isn’t the same. It might be things that a client is particularly hoping can be addressed in therapy that the therapist doesn’t or won’t work on. And maybe to give an idea of something like this is if a black client is showing up to therapy with issues of depression and wants to talk about some of the systemic causes, especially in the news here in the last couple of years and issues related to that as being part of the causes towards the particular depressive symptoms of this client. With the therapist only wanting to focus on things like medication adherence and behavioral activation techniques that don’t necessarily take into account what the client is asking for in those therapeutic sessions. This has the potential of being in one of those areas where clients asking for something a therapist isn’t providing. As it’s described, this isn’t really bad therapy. It’s technically sound by using evidence based practices here. But I’d be hesitant to call this good therapy by any means because the client is expressing a desire to be exploring something with the therapist is completely sidestepping.

Katie Vernoy  09:51

I think when we look at it that way, this is where folks come talking about redefining therapy or decolonizing therapy. I think there are arguments, that’s pretty bad therapy, when a client clearly is bringing in things that they would like to address, and the therapist is refusing to talk about them, and not seeking any insight from the client on their methods of healing. And so we’ll link to a couple episodes in the show notes that kind of talk more specifically about how you can talk more about those types of issues if those that’s what your clients seeking out, but yes, I don’t think it’s unethical or illegal therapy. But

Curt Widhalm  10:28

I do. And that’s, that’s the wording that that I should use here is that not that particular example. But some of the ethics committee discussions that I see from time to time fall into categories like this, where a client is asking for something very, very specific that the therapist is not addressing, that doesn’t go against an ethics code, it doesn’t go against a legal statute that falls under this category of just a really bad client therapist match. And I agree that with redefining therapy, reimagining therapy, that decolonizing therapy, by those definitions, that is bad therapy. Yeah. For me, legal and ethical standpoint, there are no legal or ethical codes that define it as such. And so sometimes we’ll see client complaints about this that, you know, from a decolonizing, or a reimagining standpoint, would find frustration with that therapist not being investigated not being seen as a, somebody contributing to bad therapy, it’s because the rules of law, the rules of ethics don’t have anything to investigate those against and therefore there’s no punishment to be given, if there’s no rule against it.

Katie Vernoy  12:01

My hope is that if someone had that type of a complaint, rather than putting up a huge defensive structure, that they would actually look at what that mismatch was, because to me, I feel like there are clients who need that seeing that being known to be able to make any progress in therapy. And I think sometimes those clients will opt out and recognize that this therapist is not seeing me not potentially even doing some micro aggressions or macro aggressions like it could be something where the mismatches big and I think, bordering on unethical, although I don’t know that I have a code. So I won’t I won’t go that far. But I think that the problem is that some clients, especially clients who have been, who have identities that have been traditionally marginalized, I think they may not know that anyone would be any different. And so my hope is that if a therapist is getting any kind of feedback, or having that push back, that they would make that referral to someone who could have those conversations, I just don’t feel convinced that that’s going to be the case, I feel like that could be a missed, you know, kind of blank spot in their education and their self awareness.

Curt Widhalm  13:14

At best, it’s in that missed blank spot. You know, there are therapists that we have to admit that are out there who will actively go against and argue against that. And those cases, would be very bad therapy. And this is looking at some of those situations too. And this falls across ideological spectrums, here. But when you get into imposing values onto clients, for not believing in whatever it is that you believe, that is bad therapy, especially to the clients perspective, now, I think we’re way off of where this episode’s focus is supposed to be, as far as when those situations come up from the therapist side of things, you know, give you the credit as a listener here, that you’re not imposing your values on the clients here, but when those clients do bring up opposite ideas of how you practice, the show here, we’re big advocates of putting your values out there of kinds of work that you do so that way clients can self select in, but sometimes you’re gonna end up with clients who don’t match up with those things, stances on vaccine mandates, mascot mandates, these kinds of things that a lot of people are gonna have a lot of different ideas about, that this might be a mismatch. It’s not something that can necessarily be ignored, but it’s not necessarily something that’s the place of therapeutic focus. Or is it?

Katie Vernoy  14:49

I mean, I think it’s client by client and therapist by therapist, I think the to get us back into how to ethically fire your clients part 1.5 or whatever. We’re going to call I think the assessment of is this ideological difference, this mismatch sufficient that you believe you cannot do effective therapy with this client, and then referring them out appropriately, I think is important, but I chose so

Curt Widhalm  15:14

in your mind, how does that referral work? Like, Hey, I think you’re an idiot for this thing that doesn’t have anything to do with you coming in, like, how do you see those referral conversations going?

Katie Vernoy  15:30

I am not referring someone out because they have an ideological difference. But if they’re wanting to talk about things that I have absolutely no experience about, you know, or I don’t have a space to you know, I don’t feel comfortable in that space. And it’s not something that I want to subject them to, as I find my footing, I might say, Hey, I’m noticing that these are the types of things that you’re wanting to talk about. And it’s outside my my area of expertise. So I want to connect you with somebody for whom that is an area of expertise. And

Curt Widhalm  16:01

if that client says, Now I like you enough, we can we can teach you

Katie Vernoy  16:06

taking that question. I mean, that is that that is harder, because I don’t want to abandon my client. I don’t want to be in a place where I’m allowing my own, you know, ideological things to get in the way. But if it’s truly an ideological difference, whether it’s about political ideology, or something along the lines of vaccinations or different things, you know, the things that I may have a strong opinion about, but my clients either have a strong other opinion, or I think the one most recently, it’s been kind of vaccine hesitation, I most of my clients are vaccinated, some are not. And for me, I think what I end up doing is I follow the lead of the client, and I work to identify where their mind is, and try to understand them. And that doesn’t require an ideological knowledge. Just trying to understand their perspective and look at it doesn’t require an ideological knowledge. And I try to determine, do I need to know more about this in order to work with them? Or is is it central? Or is it not central?

Curt Widhalm  17:10

So for those clients that continue to bring things up, because occasionally I’ll get clients on the US ideological stance that are just kind of my rights to not get vaccinated? clients? They will, I don’t know, get emotionally momentum going in a direction that even an exploring where you’re going here, that they’ll start to maybe rope you in with like, you know what I’m talking about, right? Don’t you agree that people’s rights are important? That, you know, are these half sort of things? Do you step in at those times, knowing that you’re sitting there being like, I don’t agree with literally anything that you’re saying right

Katie Vernoy  17:54

now. I think what I’ve done at different points, sometimes I’ll go to psychoeducation. And say, I’m hearing you and I hear that you’re saying this, one thing that I’m reading is is this. And so sometimes I’ll go to a Hey, let me just add a little bit little tidbit not say like, Oh, well, I think you’re totally wrong, but go to like a tidbit of, you know, I actually did that or, or even say, Well, I don’t know, I actually, you know, that’s not something that I’ve been looking into, could you share with me some of the things that you’re reading, because then I get a better experience of what rabbit holes are going down?

Curt Widhalm  18:33

I’m not, I’m not giving those YouTube links that get sent to me, you know, these 30 minutes, here’s where all of the vaccines things are wrong. I’m not clicking on those.

Katie Vernoy  18:45

But I think they’re they’re there. There’s knowledge that potentially you can gain about where someone’s head’s at, when you actually ask them, how they got there, and not looking at trying to switch it. But I think there are times when just understanding and listening and then providing a little bit of information kind of from outside their information bubble can have an impact. But sometimes it just becomes very clear that there’s not common ground. How about for you? How do you manage it when clients are having these gigantic conversations with lots of emotion about things that you think are absolutely wrong?

Curt Widhalm  19:23

I do a lot of reflecting back even when there’s direct questions back to me. What does this mean for you? How is this impacting your day to day life? What can you do with this it’s very narrative approach in a lot of ways, and I have had some successes where clients are like, Thank you for listening to me, maybe you can help me get some perspective on some other ways of looking at this that is just kind of this being able to validate the process rather than the content of what’s discussed. And I’m afraid that a lot of therapists would get sucked into the content part of these arguments and feel Like this is something that I can’t help you with. And therefore, I need to go back to what we mentioned earlier in the episode and refer out to somebody who can validate the content of what you’re talking about here. Like we mentioned in last week’s episode, this is being able to have a really good idea of what your limits are, what kind of impact that the clients are having on you being able to sit with it. And that’s, that’s a part that, especially developing therapists I see struggle with a lot because this pulls up a lot of that imposter syndrome stuff is just because you’re having anxious or bad feelings of what a client is saying, separate from our other fire of clients ethically episode doesn’t mean that you’re not necessarily providing good therapy in those situations. Just because we want therapy to be easy and us to heal everyone doesn’t mean that we’re not going to run into some uncomfortable situations with clients. I was sharing with one of my other Professor friends here recently about some of the role plays that I bring into the especially like practicum classes when people haven’t started seeing clients yet, just like getting them prepared for stuff. And of course, I’m going to pick situations that make the therapist kind of uncomfortable, and it’s surprising how few of these I’ve ever had to make up completely to kind of put, you know, developing therapists on the spot. And when I was sharing some of these with my professor friends, they were like, what kind of a practice do you have? These are pretty like everyday sort of things. These aren’t even like the egregious ones. I say all that to say that sitting through a lot of stuff that makes us uncomfortable, can have a very deep impact for clients that we might feel mismatched with. But it comes back to attuning yourself to the relationship. Now, at that point, and again to the thing from this episode that we seem to have veered really far off from is when we get to those points, and it’s still not working out? Is it time for a premature therapeutic sort of termination? Can I help a client in that situation? Yes. Can everybody okay, I would like to think everybody has the capability to know. But if you feel that it is interfering with yourself so much before you get to the point of referring out clients for you feel that the mismatch is so great, ethically, what you’re going to want to do is have some really in depth consultations, that some clinical supervision from some people that are not going to just be part of a Facebook group that you’re only able to explain, you know, in a few sentences, what’s going on. And the chorus of commenters is going to, you know, give you seven or eight words as far as what you should do, but pay for a good consultation around how to manage it, and document that consultation. Not in the client chart, though, not in the client chart, but protect yourself in your process notes that you’ve explored the ways that this impact could be happening with the client. So that way, it’s not just a rash decision, that this is part of the extra workout side of the session that makes you as a better therapist that can lead to trying to provide space for a client to grow. If the results of that consultation are Yeah, you should probably refer this person out, you’ve got some better community understanding and thought process that goes into it. But if there’s space for you to work on and address through some of these issues with clients, depending on whatever specific content it is, with whatever it is that they’re bringing up. premature termination at that point, falls more into bad therapy than it does to providing a good space for them.

Katie Vernoy  24:18

Making that assessment I think, can be tough, and I want to get to that. But I want to talk about one more mismatch that I think is actually not as interesting as what we’ve been talking about. But I think it is an important one to put in there. And then maybe we can talk about how to make the assessment because I think making the assessment and then having really good consultation, I think can be very important. But the other mismatch really is style or personality. You know, whether you’re a directive therapist, a non directive, therapist, those types of things, I think that those, they actually make a big difference. And I’ve had clients where they’ve been able to give me the feedback and I can shift and be less more or less directive. But I think there’s some of us that are just more or less directive. Again, oftentimes when clients are empowered, they opt out themselves. So you’re not doing this premature termination. But I think it is important to talk about it just a little bit.

Curt Widhalm  25:12

Absolutely. And as somebody who does far more to the directive side of things, I tend to advertise to my community, the people who come to work with me, they know that I tend to be more directive more honest in the way that I put myself out there, then maybe some of their other therapeutic experiences, clients who want that, and the values that we put forward here, our work is put your values out there, let clients self select into this kind of stuff.

Katie Vernoy  25:45

But sometimes clients don’t know they operate in because they think it’s a good match. But then you can see them either pushing back against you being directive or shutting down. And I think I think the assessment becomes the clinicians responsibility if the client isn’t understanding that that’s what the problem is.

Curt Widhalm  26:06

And so those directive therapists out there in this situation would likely have very little problem directing that conversation to that particular problem.

Katie Vernoy  26:15

The opposite, though, I’ve seen where the non directive therapists kind of stay in therapy with some of these clients forever, and maybe this is you and I bias because we’re both more directive. But I’ve had clients that didn’t realize that they wanted more than they were getting, and I think non directive therapy can be hugely beneficial for some folks. Absolutely. But for for clients that want more, if they don’t know that that’s the case, how do we recommend that non directive therapists try to figure that out?

Curt Widhalm  26:45

I’m gonna be totally biased towards the directive end of things. It’s creating the space for that discussion, and really saying, personality wise, that’s just not who I am. I can’t provide what you’re looking for in this situation. That is a really good conversation to have with people, because it’s either going to lead into Yeah, but I still like you, as the therapist. Yeah. But what you’re asking for is not something that I can really do or be like, you’re asking a tiger to change it stripes like, yeah, at that point, it’s being able to then have a proper termination, even if it’s incomplete towards therapy goals in order to help those clients get matched with somebody who is going to be able to provide what they want.

Katie Vernoy  27:38

I think the knowledge that’s required for that conversation, maybe some that either the clients asking for more, the therapist is recognizing that the style isn’t matching up. I think sometimes that’s not evident. I think people typically can kind of flow together. And if the style is a mismatch, sometimes that’s not identified. But I think what can be identifiable? is lack of progress on treatment goals, or stagnation on treatment goals, or the Hey, how are you doing very little going on in the therapy session, that I think therapists, as a matter, of course, should assess progress on treatment goals, and be able to identify that there are a few different things and they want to assess if therapy doesn’t seem to be moving forward.

Curt Widhalm  28:23

And some of the ways that you can manage that is making sure that you go back and revisit your treatment plan with your clients every so often. And I know that that’s a, I was gonna say, a lot more popular in DMH work, but I don’t know that popular is the right word that

Katie Vernoy  28:39

consistent usually requires. Wire. Yeah, that’s probably best.

Curt Widhalm  28:46

But for independent practice, doctors, practitioners who aren’t, you know, as adherent to those kinds of contracts or rules that require you to go back to those treatment plans, do it anyway. So that way, these kinds of things can emerge sooner and have conversations with your clients about, hey, we’re not making any progress towards this goal. What’s going on with this? That does allow for the are we doing things right? Is this something that you would get this better out of treatment with somebody else that makes it more of a joint decision, rather than just the therapist being the all knowing or all scared of having to have that conversation with a client, that honest relationship, there’s typically really helpful.

Katie Vernoy  29:41

And when you were talking about that, I was remembering a conversation we had really early on in the podcast with Dr. Melissa Hall. I think it’s making your documentation meaningful or meaningful documentation, something like that. But she actually really talks about the clinical loop and how making that a regular part of your process helps you close And I play but it also opens this conversation for folks who aren’t quite sure what’s not working. Because I think when you’re documenting and paying attention, I think that can be very helpful. So we’ve talked about a lot of different things, I think there’s, you know, we could go more into a client not making clinical progress as a reason to potentially prematurely terminate.

Curt Widhalm  30:22

I do want to bring up though that man, sometimes building off of last week’s conversation around some of these therapy interfering behaviors, there may be times when even examining it through that lens, when you’ve consistently had these conversations with clients that you’ve sought the outside consultation, you’ve documented that the clients continue to break more egregious boundaries, but maybe not to the threatening level of the ones that were discussed in our first episode on firing clients ethically. And these are things where it might be breaking boundaries outside of sessions showing up to your office and hanging out way too long disrupting behaviors in the waiting room that you know, maybe couples who start their arguments in the waiting room that are interfering, the session that you’re having and stuff like that, yeah, where those types of behaviors are things that are impacting other people in your practice, that weren’t really straightforward boundary conversations that if they continue to happen, are things that you continue to bring them up if those conversations that were used suggested last week in the podcast about how this impacts things, and there is a an active refusal to follow those are acknowledge that those are even problematic behaviors that are impacting you, and especially other clients, that can be a cause that you should very much document quite well, as far as you’re welcome to services, not in this way. And if these are things that are coming up, here are appropriate referrals that, you know, we’ve talked about in termination episodes before being able to provide, these are behaviors that you’re demonstrating pair impacting me, we have tried to work on them, they are continuing to impact me in a way where I can no longer serve you. I have sought out consultation, I am working on this. And it is agreed that I am going to cause you more harm. Because of the feelings that are developing, then I can benefit you from this point. That is inappropriate referral. And that is inappropriate termination. They’re

Katie Vernoy  32:49

the things that come to mind for me, if I don’t have the capacity, and that could be strong clinical expertise. But it also could be time I had a client that I had to refer out because they needed more than I had time to take care of Sure. If they if the relationship is not one, that there would be an element of abandonment, the feeling of abandonment, abandonment is different than the abandonment of just saying today was your last session, audios. The treatment Alliance and we talked about this a lot in both of these episodes. But if the treatment Alliance is strong, there may be things that could be overcome that in other situations, it would be recommended to refer out. But I come back to something that I think is going to be very rampant right now, especially for certain types of specialties and certain types of things is the availability of more suitable resources. And so maybe as our last point, because we are getting pretty long here. But as our last point talking about, I’ve made the assessment, I’ve done the consultation, I’ve had the conversation with the client, I am unable to keep the client ethically, legally, logistically, whatever it is, and I’m having a hard time finding suitable resources to refer them to. At that point, some people keep clients. And I think that there are pros and cons there. But what is our responsibility? If there are just no therapists that are capable of helping this client?

Curt Widhalm  34:26

I think with the accessibility of telehealth now that this is much less of a problem than it has historically been that with providers in every jurisdiction now able to provide telehealth easily that this is going to be where, especially in the private practice end of things, those referrals are more easily found. Hired, indeed higher severity clients, those being sought out through things like DMH you’re going to have agency policies that you’re going to have to follow in those situations but To give maybe an anticlimactic answer, I don’t think that this is as big of a problem here in 2021, as it has historically been described, there, lots of referrals out there, there are clients and therapists who can match across distances now. And that’s, you know, one of the things that being more digitally accessible helps to alleviate some of these issues when it does come to providing care for these kinds of clients.

Katie Vernoy  35:30

So basically, the answer was, I’m not going to answer you, okay, because it’s not that big of a problem.

Curt Widhalm  35:37

Pretty much.

Katie Vernoy  35:39

So I’m going to actually just put us put my spin on it, because I do think it actually is still a problem. But I think the problem is not more, is there any available resource? It’s, is there an acceptable resource to the client? Because oftentimes, it does mean having a therapist who is telehealth and they want to be in person or someone who is not maybe as close of a personality fit but has a specialty and doesn’t take their insurance. I mean, there there are some issues here. And I think it’s something where, and maybe you can correct me if I’m wrong, in good faith, providing as many as close good enough referrals to this client as you can and trying to do what you can to do some linkage is sufficient. Yeah. Okay.

Curt Widhalm  36:28

You should let us know what you think of this episodes, especially in our Facebook group, the modern therapist, group or on any of our social media. You can also leave us a rating and review and we’ll include our show notes over at MTSGpodcast.com. Also, there is still like, hours left for you to be able to get your virtual therapy, reimagined 2021 tickets. We are going entirely virtual again this year, we had hoped to have some people come out and join us in Los Angeles, but enter in the meme of my fall plans and delta variant. Yes, but there’s still time you can get those tickets over at therapy reimagined conference calm. And until next time, I’m Curt Widhalm with Katie Vernoy. SimplePractice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use SimplePractice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform.

Katie Vernoy  37:37

Get your first two months of SimplePractice for the price of one when you sign up for an account today. This is collusive offer is valid for new customers only. Please note that we are a paid affiliate for a SimplePractice so we’ll have a little bit of money in our pocket. If you sign up at this link. Simplepractice.com/therapy reimagined. And that’s where you can learn more.

Curt Widhalm  37:57

This episode is also sponsored by RevKey.

Katie Vernoy  38:01

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Curt Widhalm  38:25

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Katie Vernoy  38:42

You can find more at RevKey.com and make sure to mention that you’re a Modern Therapist Survival Guide listener

Announcer  38:48

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