Should We Stop Badmouthing Evidence Based Practice? An interview with Jessica Tappana, LCSW
Curt and Katie interview Jessica Tappana, LCSW about evidence-based practices (EBPs). We talk about what EBPs actually are and how to implement them in clinically sound and ethical ways. We look at what therapists usually get wrong about EBPs and what they can do to improve their practice.
Click here to scroll to the podcast transcript.Transcript
An Interview with Jessica Tappana, LCSW
Jessica Tappana is a Licensed Clinical Social Worker in the State of Missouri with a Masters in Social Work from the University of New England. She has a private practice with offices in both Columbia and Lee’s Summit, Missouri and also a business that helps therapists in private practice show up higher in search engine results. She believes deeply in the power of psychotherapy to transform lives and is constantly looking for ways to improve her own clinical work and to empower the clinicians in her group practice with their best possible work. The daughter of an intervention researcher, Jessica grew up familiar understanding the value of research and the importance of using interventions that have been shown to be the most effective for specific populations. However, a social worker both by education and by heart she also sees the many barriers for applications and has spent her career looking for practical ways to offer high quality therapy that not only uses these evidence-based interventions but does so in a way that is practical and empowering for the clients served.
In this podcast episode, we talk about how Evidence Based Practices work in the real world
Jessica is a long-time listener of the show and a good friend of ours and has been talking with us about how we have spent too much time bad-mouthing EBPs. We decided it would be good to hash out the ideas around “manualized treatment” and how you can actually bring yourself as a clinician into the work, even when using these interventions that are backed by science.
What are Evidence-Based Practices?
“I hear people talk about evidence-based practice as if what it means is just reading a book…To me, it’s about a lot more than that. First, my bias is my mom [who] worked in schools of medicine on these huge grants…She would find these excellent interventions..[Then after spending] literally millions of dollars proving how helpful this intervention is…the minute the grant goes away, people stop using it, and I got to hear her frustration about that.” – Jessica Tappana, LCSW
- Using well-researched interventions
- Using the expertise of the clinician
- Understanding the needs of the clients
What should therapists know about evidence-based practice?
“If I’m going to teach DBT skills…I have to believe in it and understand how it works and understand the pitfalls and the discomforts with it.” – Jessica Tappana, LCSW
- There is room to implement EBP without full adherence
- Contrasting “eclectic” from “meeting a client where they are” and pulling from other evidence-based interventions
- The ways that EBPs are trained and studied (due to funding sources) lead to strict adherence
- How you teach or implement the EBP can be unique to the clinicians
- Contrasting fidelity of the model with adherence to model
- You can bring yourself as a therapist into the room AND provide evidence-based interventions
- Training and supervision is more challenging when you are not seeking strict adherence
- It’s important to have time to practice therapy outside of sessions with clients
What data or assessments should therapists use with Evidence Based Practices?
- Feedback informed care (e.g., FIT)
- Assessments of depression or anxiety consistently to see progress
- Screening tools and measurement to track progress
- It is important for clinicians to believe in and use the data collection
Resources for Modern Therapists mentioned in this Podcast Episode:
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Jessica’s websites:
Relevant Episodes of MTSG Podcast:
Revisiting SEO and AI – Ethics and best practices: An Interview with Danica Wolf
We Answer the Question: Is EMDR a Pyramid Scheme?
Which Theoretical Orientation Should You Choose?
Therapists Are Not Robots: How We Can Show Humanity in the Room
Reigniting Therapy, An Interview with Daryl Chow, MA, PhD (Psych)
Topic: Deliberate Practice
Topic: Supervision
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:
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Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
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, and this is the podcast for therapists about things that we do in our practices, the way that we approach our work. And one of the things that we may be guilty of around here is bad mouthing evidence based practices. And you know, we talk about cog in the machine kind of things like workbook therapy. Where does the clinician come in? I’m reluctantly admitting we may overestimate just how bad evidence based practices are. And here to help us with that conversation is our good friend, group practice owner Jessica Tappana, and she’s here to help demystify and make it where it’s like, no, there is room for all of the wonderful things that Curt and Katie talk about and doing evidence based practice. So thank you for joining us today.
Jessica Tappana 0:12
Thank you for letting me join I, for like two years have been listening to you guys bad mouth evidence based practice. I’ve been like, Guys, don’t mean what you’re saying. So.
Katie Vernoy 1:27
We’re so happy to have you here. It’s so wonderful to have good friends on the podcast, and we’ve been wanting to get you on for a while. We just finally made it. You had to, like, travel the whole world and then come back before you had time to to come on the podcast. But we’re going to ask you the question we ask everyone who comes onto the podcast, who are you and what are you putting out into the world?
Jessica Tappana 1:46
Absolutely, I am. My name is Jessica Tapana. I’m a licensed clinical social worker in the state of Missouri. I’m a group practice owner. I have a group practice in Columbia, Missouri that focuses on offering evidence based practice primarily for trauma and anxiety, and have had that now for seven years. And additionally, I have a second business called Simplified SEO Consulting, where we help other therapists get in front of their ideal clients and get matched with the clients that they work the best with. So we can all do our best work by seeing the clients that we feel we can really help.
Katie Vernoy 2:23
And we had Danica, you’re is she Chief Operating Officer, or something like some fanciness, we had Danica on already, so we’ll link to the episode with Danica talking about SEO and AI and all the good stuff in our show notes over at mtsgpodcast com.
Curt Widhalm 2:37
As you know, we start a lot of our podcasts with question, what do therapists get wrong about whatever the topic of the day is, and this comes not from a place of shaming anybody, but just to help clarify misconceptions, help people maybe not make the same mistakes. So what do other therapists usually get wrong? Not us, but others, maybe maybe us too. What do we get wrong about evidence based practices?
Jessica Tappana 3:05
To me, what I hear people get wrong time and time and time again, and it just is, we just assume that what evidence based practice means is taking the human element out of therapy and becoming a robot. And I hear people talk about evidence based practice as if what it means is just reading a book, you know, to a client, and, you know, put a monkey there that can read and it’s going to be able to do therapy. To me, it’s about a lot more than that. First, my bias is my mom is a interventionist as a researcher, and so I grew up with mother who was an MSW, but worked in schools of medicine on these huge grants. And I got to hear her frustration. She would find these excellent interventions that would help alleviate stress. Her area of expertise was hospice caregivers. And so she would tell me, you know, we’ve spent literally millions of dollars proving how helpful this intervention is. And then the minute the grant goes away, people stop using it, and I got to hear her frustration about that. Then I come and become and enter into the workforce myself, and I’m hearing therapists on the other side talking about all the problems that we have with implementing evidence based practice and particularly implementing these interventions in a way that’s adherent to the methods. And I’m sitting here like, Guys, there’s a happy medium. When you’ve heard the researchers and you’ve heard the clinicians, I feel like often the points that we’re making aren’t contradict. When I started providing for NASW some trainings on evidence based practice, I went looking for the definition of evidence based practice, trying to find that happy medium. And what I found is every field that talks about evidence based practice talks about the same three elements. They call it something different. They use a little bit different wording, but basically what they say is it’s using well researched interventions. So it is using something like DBT, EMDR, Gottman, whatever it is, and it’s the combination of where that meets the expertise of the individual clinician and where the client’s needs are, where they’re where we’re considering their culture, their preferences, all of that. And I have not found any definitions of evidence based practice. Someone’s going to listen to this correct me and send me a definition, so I’m ready for it, but I’ve not found any definitions to date in, like, really respectable journals, really respectable like the APA or, you know, those sorts of things, or even the Nursing Association, the doctors. So you know that that contradict that, that we need all three of those elements if we’re to deliver evidence based practice. And if I am just going to a client and saying, every single one of you need me to read this cognitive processing therapy manual with not making anything to meet you where you are. That’s not evidence based practice, but that’s what we often as clinicians think it is.
Katie Vernoy 5:51
Where do you think these ideas around evidence based practice is like this manualized, you know, give a monkey a book that if they can read it, they can do this therapy. And I think at this point, it’s more like put it into an AI bot, and it’ll be able to do this therapy. I think it’s more accurate to what we’re really worried about right now. Where do you think the ideas became so off base, so wrong from your perspective about what evidence based practice is?
Jessica Tappana 6:17
You know, when I was in in school, we talked a lot about taking an eclectic approach. When I, it cracks me up all the time. Aspire counseling website is all about evidence based practice, and I still get clinicians who will apply for a job. And what approach do you take? I take an eclectic approach. I draw a little bit from here and there and there, and so we, I think, as a field, prided ourselves on this idea that we can take a little bit from a bunch of different theories and create this artwork, almost of a beautiful therapy session, and we’ve seen so much magic in that. We know from the research that the single biggest thing that we have any control whatsoever on is is the therapeutic relationship, that just having a good therapeutic relationship is going to make a positive impact. So therapists see all of these gains that they’re making with clients, and then they hear somebody say, but you can make more gains if you’re using DBT, if you’re using EMDR, if you’re using you know, the first evidence based practice was cognitive behavior therapy. We hear that, and it almost feels like they’re saying there’s something wrong with what we were doing to start with. And so of course, we’re like, but there’s magic in being eclectic. I do get annoyed because some of the well researched interventions do make it sound like you have to be very exclusive and only hold to that. But I think a lot of times evidence based practice can still be I’m doing, you know, when I do cognitive processing therapy with my clients for trauma, for instance, I still also send the do some DBT skills, because I was a DBT clinician first, and so I don’t think it’s mutually exclusive. And you’re still and I’m still providing evidence based treatment, but I’m meeting a client where they are that if they need this other thing I’m going to pull from over here. That doesn’t contradict the fact that my primary treatment modality is this well researched intervention. It just means I’m doing good clinical work of meeting my client, where they are.
Curt Widhalm 8:06
The misconceptions, or kind of the the mental shortcuts that we make about EBPs is that they’re cold. That they’re just kind of very like, matter of fact, here, do this, here, do this. And what you’re speaking to, and even, you know, calling back to Katie’s, like, Oh, this isn’t just AI kind of doing this is the warmth of the relationship that does that is part of how we’re taught EBP is responsible for this. Like, there’s a lot of just, kind of, like, break down, kind of the human element at first to learn these skills and then bring the human element back in that allows you to do what you just described with all right, I’m doing cognitive processing, but I’m also going to pull something from over here, DBT, because this also will help you. Is it because of the way that we’re taught this that we’re kind of left with this foul taste?
Jessica Tappana 8:59
I think it’s the funding sources. Because when you’re looking at research to validate a new treatment, they want to know that everybody’s getting the same treatment. And in reality, in therapy, it’s really hard for us to give everybody the same treatment. And so you know, when we’re if you’ve ever worked on a grant before, which I know many of us have, when you’re working on a grant, it is very scripted. You have to do just this, this, this, this, because that’s what the funder expects us to do. And I think that that then becomes how we think of that treatment. When in fact, and often the fundings or the grants, or the not grants, but the any research that we’re doing also excludes a lot of the population. And I, and I’ve heard this at so many different trainings for different EBPs, where they say, okay, like, here are the results, and then you look at all the exclusion criteria, and you’re like, okay, yeah, you got great results, but you excluded most humans. And I’m doing therapy with humans, folks. Like, I’m not doing. In therapy with your ideal person that only ever went through one trauma. They had a perfect life until they had one trauma, their ACE score was, like zero. And by the way, they’re like, just this very narrow age range, and they’re obviously white. I mean, like it, no, I’m doing, I’m doing therapy with humans. They have a whole bunch of other factors, and had huge ACE scores, and have gone through, you know, had complex trauma, and then a single incident trauma, and on top of the, on top of all their childhood stuff. To me, I think that that’s where it comes in, is when they’re doing the research and they’re validating it, and they’re like, You must do it exactly this way. Then it comes out. And people think, oh, that’s how you do evidence based practice.
Katie Vernoy 10:39
I guess the question I have then is, are we stopping the research too soon? Are we too narrow in the research? And so we need to get more into this place of having the evidence base support more of a, I’ll not say eclectic, I’ll say integrated approach, or a meet the client where they are approach. I mean, how do we actually move beyond this such limited scope of research do you think?
Jessica Tappana 11:07
First of all, I think some of them are. I know when I’ve attended professional conferences in the last couple of years, I am hearing more of the presenters say, and here and our exclusion criteria was less, or the good news is, and so I think that we’re going to be moving that way. You know, we started as a field trying so hard to prove ourselves that they had to be that rigid. And I think that there is a movement more towards including, but I think that the researchers are responsible, quite frankly, for making sure that they’re doing that. But then on the ground, folks, what we’ve got to do is we’ve got to explain, okay, so it is important when you’re doing, for instance, DBT, to use all four components, right? It’s really important that you teach skills and that you’re making sure that you’re following certain formats, that you’re having a skills group that’s long enough to get something out of. But there needs to be a lot of guidance about how you teach that skill can vary greatly. You go look at five different DBT groups with different co-leaders and how they all teach it, because they’re going to draw from their own personality, they’re going to bring themselves, and they’re going to make it relevant to their clients. I don’t think any of those groups are not doing DBT, so we need to be explaining what it means to do these evidence based practice and where the human element is. You can teach a DBT skill and not just pull the example straight from the book, but you also can, you know, use this great metaphor that you’ve thought of, or this example you’ve seen, and that’s still DBT, and that’s okay. And I think teaching that is really hard and giving that clarity, especially when you’re often implementing them in larger agencies where there’s higher turnover and really new clinicians who, who you’re worried aren’t going to do it to fidelity. But there are ways to do it to fidelity. It’s providing good supervision. If anyone needs to know how to do that, you guys have some excellent podcasts on providing good supervision.
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Curt Widhalm 12:57
Well, and what you’re talking about is a couple of things: number one is being able to more accurately describe not just what is therapy, but what is therapy like with you. And you’re illustrating that really well, because the DBT that we offer in our practice is probably going to look very different than the DBT that you offer. And the second piece of this is something that I really work with on my staff, is it’s not just teaching the skills, but it’s also living the skills and being able to demonstrate that that brings that human component right back into having this as a basis for it.
Jessica Tappana 13:38
Exactly I used to describe to people that if you call and you want to do, I’ll use the example of DBT. Since we’ve started down that route, if you want to do DBT, I have these two, I had more than two, but I would use two of my clinicians as an example. You know, you can go with this, with this clinician or this clinician, they’re both going to do DBT, or they’re both going to do they both could do Cognitive Processing Therapy. They had some of the same modalities that they were using. But if you’re in this session over here, you’re going to have a whole lot of laughter. I’m sorry, we’re just going to hear it’s going to be such laughter that we can hear him laughing from the lobby, and he’s going to use a lot of humor, and it’s going to be infused in there. And if you’re over here, this is a former high school teacher who’s gonna be much, who’s gonna they all are gonna expect you to keep a diary card, but this one’s gonna basically approach it like a classroom setting, almost. And she’s fantastic. But their personalities were so opposite that sitting in an individual therapy session with them, we always knew was gonna be very different, even though they were doing the same modality, even though they sat on the same consultation team and would staff cases together. How it would feel to sit in a session with the two of them was different. And that was okay and wonderful, and they were, yeah, but one of those clinicians has now moved on, or I guess they technically both have to their own practices, but they were my perfect example of two totally opposite personalities who both were doing DBT to Fidelity, both getting excellent results. We could see from the data that their clients were getting better, but they weren’t just being a robot. They were being they they brought themselves to the session. And so for assigning clients, a huge like, the amount of training we put into our client care team is huge, because when they’re assigning clients, they need to not just say, Oh, you have a lot of suicidality, you’re going with DBT, or Oh, you have trauma you need to go with one of these. But they need to also be able to describe who those therapists are and how they how they approach therapy, how they show up in the therapy room.
Katie Vernoy 15:35
It’s interesting, because as you’re talking and I’m I’m the only I know DBT skills and that kind of stuff. But I’ve never done adherent DBT, so I’m the only one in the room not having done adherent DBT. But what you’re really describing is, is actually distilling down a manual, so to speak, and saying, these are the important principles. This is what you’re needing to hit. This is what this is the information that needs to be shared. And so adherent DBT is not the manual. It’s these principles and and skills that need to be taught and those types of things. And I think that’s that, to me, feels very, very approachable, as far as a clinician who has a lot of experience. Like, if I can learn something and kind of infuse myself into it and understand it, and just say, Okay, I gotta hit these points, but how I hit them is up to me. That feels very doable. But I think going back to what you’ve said, Jessica, is that’s hard to teach. And so do you have a sense of how, when someone is learning or teaching an evidence based practice, how you can get to that distillation of this is, this is the principal. This is the core. And this is, this is how you can bring yourself in.
Jessica Tappana 16:44
Yeah, in our practice, our two most manualized treatments are probably we do both exposure and response prevention for OCD, and we do cognitive processing therapy. And so they’re great ones to start our newer clinicians on. Our interns are provisionally licensed clinicians, and in Missouri interns means still in school. But I know we all have different language for it, but our less experienced clinicians do like starting with some of those. I keep looking over the side, because right next to me, I have the manual for cognitive processing therapy, and it’s great because it is very here’s what you do in session one, session two, session three, but how we teach it at our practice is using a lot of open ended questions, asking our clinicians, you know, how would you describe this? Okay, read this now, close the book and describe it to me without looking. And then the I’m looking and I’m like, Well, you hit these points, but make it yours. Make it why why do you believe it? A lot of times we use scales, and so we’ll show when we’re talking about evidence based practice, I think that having that belief in it is really important. And so we’ll show the some of the data for our clients who have gone through that treatment, help build that like sense of confidence in it, and then ask them to describe that to how they would introduce a client to it. It is more of an art, and I think it’s harder to supervise someone this way than it is to just be like, Okay, you went to a training for for ERP. Go deliver it and like, we’ll staff cases once a month specific to ERP. Like that would be way easier, but to do it right, we have for each of our primary evidence based practices, and my group isn’t huge. We’re, I think, 12 clinicians at the moment, maybe 13, but for each evidence based practice, we have a Google chat group going of everybody that does that particular evidence based practice, so you can hop in there and staff cases with our younger are newer clinicians. They really need to be paying attention to that and going to the optional monthly consultations, because it is more of an art than a than just reading a manual. And they need to go beyond just one training. They need to hear different examples here, different ways of doing it, and be able to staff. Okay, this client doesn’t quite meet the picture perfect thing, or this client has this request or this cultural thing that we need to consider. How’s that look? It’s we tell them, it’s like you can grab one of us, anytime. You can grab three four of us. We’re constantly coming together and saying in encasing these but it is harder, and I think from a practical standpoint, doing that in the larger your setting, in some ways, the more difficult it’s going to be to figure out how to how to be able to have that sort of culture of lots of staffing the cases, and lots of discussing how to individualize it, because it’s not easy.
Curt Widhalm 19:28
What you’re talking about is making people practice it in order to be able to do it. Like there’s there’s a whole evidence base around like, if you practice things, you’re going to do better at doing them. And you know, kind of brings the whole idea of what we do as a profession of like, it’s a therapy practice, which means that we should practice it outside of sessions. Otherwise you’re just doing therapy and subjecting clients to poorly practiced therapy, I guess?
Jessica Tappana 19:59
Absolutely, we have to, you you have to believe in it. You have to live it. You have to know how to use the skills. I think, you know, the first couple years I was teaching mindfulness, I still wasn’t sure if I was doing mindfulness correctly myself, because my brain needed it so bad. I was like, am I, am I getting this right? And so, yeah, I think having people live it, having people do the treatments that are going to resonate with them, or at least they can get to a point where it resonates. You know, when I’m doing EMDR and talking about the container exercise, I will literally show clients the container that my container is based off of, because I have one, I practice this. And well not every client, but when appropriate, I’ll do that, you know, when we’re discussing it, because I think that having the clinician buy in, and having the clinicians not just buy in, but like you said, you know, if I’m going to teach DBT skills, I better know how to use, dearman. If I’m going to do this it, I have to believe in it and understand how it works and and understand the pitfalls and the discomforts with it. I think to do the very best work.
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Katie Vernoy 21:03
You’ve talked about the data and being able to show, especially newer clinicians who are learning kind of what has happened in your practice. And we’ve talked about feedback, informed treatment and that kind of stuff. So briefly, if you can talk about kind of what is the data that you’re gathering and how does that fit into how you set up your evidence based practices in your practice.
Jessica Tappana 21:27
Data makes people very nervous. I like data a lot. Talking about feedback, informed care, one of my favorite things that all my clients do is the ARM-5, so I can see, you know, the impact of the therapeutic relationship. And my favorite thing I tell all new clinicians in my practice, I’m like, when it goes down just one point, that’s like, the best thing, because that’s them being honest, because they’re not going to read us too little, but they actually don’t think we’re as confident as we used to be, and so knowing that we can go in and change. So in our practice, what it looks like, though, is, because Data does make clinicians nervous, I have minimized my requirements around it, other than you have to be measuring something associated with what you’re working on with your client, and at least once a month, I need you using some measuring. Now, some measures and some types of therapy we’re going to use every week. You know, if I’m doing certain trauma therapies, my clients are taking the PCL-5 every single week so that I can see the progress. That’s part of doing it adherently. And but I try to give my clinicians the control to see data as a tool and not as like some punitive thing. I think that in some environments it’s become like this punitive thing. Like, if you don’t get the right numbers, that’s somehow a problem, where you’ve somehow failed. When, in fact, it’s not about that, to me. To me taking, you know, taking that those measures, whether it’s the PCL-5 or the GAD-7, or the PHQ-9 or the ARM-5, is to be able to go back and tell my clients, you know, show my clients the data. I we use a system where then I can share screen with clients. Or if they’re sitting in the session with me, I can turn it, because they’re like, all they can see is, here they’ve worked so hard, and they still, they still feel crummy, and they see that. And so then I’ll show them the data, and I’ll be like, Look, this is the progress this shows you make. How does that feel to you? Do you feel that? And a lot of times they’ll that’s when they’ll start triggering. Oh, yeah, you know, I did used to be that depressed, and I am less depressed now. And so for us, it is about thinking about what data is going to be most useful to that client and to the clinician, more so than than me being super prescribed about it. Because I would love to tell all of my clinicians exactly which tools to use for what, but I think that my therapists are using the data more because I give them a lot of freedom. And at this point, when I first said you had to start using some sort of screening tools and measurement to be able to track client progress, I thought I was going to lose half my staff. They were so they fought it hard, and now all of them are like, I couldn’t practice without this. And I’m like, good. That’s great.
Curt Widhalm 24:00
What do you find that helps? Because I think that there’s a parallel between using things that work like ERPs and using things that work like eliciting client feedbacks through this stuff. What do you think it is that really helps clinicians in those capacities to adopt it? Is it just as simple as like do it and find that it actually works and get over yourself.
Jessica Tappana 24:25
I I think it depends. It depends. We can all debate different ways to do this. For me, I try to get their buy in. But at the end of the day, when I made the decision that they were all going to start using some sort of measurement tool, that was that, that I had to force on them. I had to just say, That’s it. I’m not going to require you what you do, but like you’re just doing it, and I’ll give you control where I can. But I think that a lot of it, too, is we have this fear of being judged. It’s a fundamental human fear, right? We’re worried that we’re doing something wrong. We’re worried that we’re going to be judged. I think when we’re talking about evidence, about asking somebody to practice, evidence based practice, they’re afraid they’re going to get wrong, and if they go to consultation, or you review a video and see they got wrong, they’re going to be in trouble. And so I think it goes back to being able to create a culture of vulnerability, and one where you know we’re not we will have clients that don’t make progress. We will have times where you know we’re in a session and we’re not adherent, and we’re quite frankly super human and totally screwed up, and that in in being okay with that. But it’s hard, because we just have that natural fear of doing it wrong. We have that natural that natural tendency to be self conscious, and that fear of if we’re going to get punished or, worse yet fired if we’re not adherent, or if we’re not having clients show that they make progress. But that very fear can cause the problems that lead to those things to happen.
Katie Vernoy 25:52
How do you set up that that culture? To me, I’m hearing a lot of growth mindset and that kind of stuff. But, but what are the tools, or the tricks, or the strategies that you use to try to set up that culture of allowing humanity into implementing evidence based practices.
Jessica Tappana 26:13
From the time I interview, I describe my view of, I describe evidence based practice as being not just offering well researched intervention, but also you bring yourself to the table and you meet clients where you are. So from day one, we’re talking about that. We’re talking about the role of humility in therapy. I actually, I actually ask in interviews about their greatest failures as a professional, because I want to know they have the humility to tell me what that was. And if they give me some like, write off answer, I’m like, Really, that’s all you’ve ever done. Like, lucky you. Because I think that I want to set up from day one that we’re going to all be human, and we’re all going to be learning, and that evidence based practice isn’t going to be neat and tidy and easy to implement, but it is going to be messy. And and then, and then, as far as the culture aspect, once they come on, it’s it’s giving the support. It’s talking about it. It’s people demonstrating that vulnerability. Once you have a few people bought in, it’s a lot easier to get everybody else bought in, because they see that somebody else admits that they were wrong and nobody’s getting in trouble for it. Where, you know, I’ll show where I went wrong on on a regular basis, I’ll be like, yeah, look at this data from my client. Look, it went down there. It was great. It was the best thing that ever happened when that data went down, because we changed, you know, we changed up what we were doing this way, or I found out this about the client, and I encourage the other people in in formal or informal leadership positions within our practice to do the same.
Curt Widhalm 27:43
By the time that you’re interviewing people, they’ve presumably been through their internships or practicums, whatever it’s called, in listeners jurisdictions here. It seems like this is a novel thing that many interviewees are experiencing with group practice owners like yourself, like mine, some of the other group practice owners that we interview. Where it’s like, there’s coming out of grad school, that it’s kind of like, oh, evidence based practice means that if I don’t do CBT with 95% accuracy and results, then it’s a failure of myself as a human being. And it seems like such a novel thing in interview processes like yours, where it’s like, no, like, we can do everything, right? Are we failing students in like, presenting this in ways of like, here’s how, how you do this stuff. Is this kind of more of a systemic problem that we’re facing, and you’ve just kind of cracked the code into having a successful group practice by reintroducing humanity into therapy.
Jessica Tappana 28:46
I I think that would be a great question for all of those that do teach in universities. Because I think that there are reason, you know, I personally, have never wanted, had never had any desire, to go teach at the university level. And I think a lot of it does come down to the problems that I see with the way people are being educated, but I love that. That’s one of the reasons that I love actually. You know, we do bring people on when they’re in the that final internship in school and our practice. And so far, 100% of the students that we’ve brought on have then been hired after graduation, but I love getting in there while they’re still in school and being like, here’s our approach. Go talk about it in class, in your thing, and come back and tell me if they have anything they can say to contradict me. Because I have yet for them to come back and say and in any of the students that we’ve worked with come back and say, No, my teacher said that there is no way that you should, you know, do that with whatever, and and so I would love to see the schools bring more more into humanity. I think that our institutions, our universities, have such a difficult job of getting enough information in there and staying stuffy enough, is the term I would use, to have validity in the eyes of society, but also having that humanity piece in there. I wouldn’t want to create university curriculum. I think I’d be horrible at it.
Katie Vernoy 30:10
But you’re kind of a rabble rouser, like you’re you’re saying, like, hey, interns, come over to this, this little practicum over here, and I’m going to teach you all this stuff, and you’re going to go and infect your your university, with all of my rabble rousing ways.
Jessica Tappana 30:30
Yeah, that’s my role is to be the outside instigator.
Curt Widhalm 30:34
Alternate rebellion, living those DBT skills.
Jessica Tappana 30:39
I loved it. I had an intern last year who was, or a practicum student last year, who was splitting their time between us and another site. And they did the same treatment, they did cognitive processing therapies at both, and I loved hearing about the other one and how it was much more manualized. And then being like in here, here it is manualized. There is there are literal, like scripts. It’s very it. But have you thought about doing this? And I loved reviewing the video and giving the feedback of, well, where’s you? Where are you in this? You’re a human. You have all of these really cool intersecting identities that make you who you are. This particular clinician was working with clients that needed to see themselves in therapists. And I was like, Where do you show up? How are you reaching your clients? And I just loved that they were getting both approaches, that they were getting the same exact treatment in two different locations. And being able to come back to me and say, here’s how it compares. And can I take this over to, you know, one time they wanted to borrow a book to take with them to their other site, and I’m like, yeah, absolutely take that. You know, go, go, spread good, good treatment everywhere you go.
Curt Widhalm 31:48
Where can people find out more about you and your practice and your business?
Jessica Tappana 31:54
Absolutely. So my private practice website is aspirecounselingmo.com and then my SEO business is simplifiedseoconsulting.com.
Curt Widhalm 32:05
We’ll include links to Jessica’s stuff in our show notes over at mtsgpodcast.com. Follow us on our social media. Join our Facebook group, The Modern Therapist Group, to continue on the conversation and until next time, I’m Curt Widhalm with Katie Vernoy and Jessica Tappana.
… 32:20
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