Smarter than SMART: How therapists can improve goal-setting with clients
Curt and Katie chat about setting goals. We look at why goals are important to therapists, SMART goals (what they are, what works and what doesn’t), and how to move beyond SMART goals to more robust goal setting and behavior design.
This is a continuing education podcourse.
Click here to scroll to the podcast transcript.
Click here to scroll to the podcast transcript.
In this podcast episode we talk about how to strengthen your goal-setting skills
Many therapists learn SMART Goals and objectives as the primary tools for creating treatment plans. Oftentimes, goal setting can be a check box for insurance or a frustrating activity that doesn’t seem to support clinical progress. We dig deeper into how to make SMART goals better (SMARTer goals?), and we uncover and address the limitations of SMART goals. The current research on how to move past SMART goals to more effective and strategic planning for change also helps to make our clients dig deeper into the process of achieving their goals. We also explore additional goal-setting models to inform and create a more robust goal setting strategy…and we do it all with a demonstration on how to put it into action!
Why is goal-setting important to therapists?
- Therapeutic benefit
- Ethical responsibility
- Ability to achieve goals
What are SMART Goals? Do they work?
- A goal-setting style that leads to concrete behavioral goals
- Specific, Measurable, Attainable, Relevant, Timebound
- There are challenges that do not lead to goal attainment
- The benefits of effort or progress goals versus outcome goals
- May need to add steps to create a more robust plan
How can you improve SMART goals?
“Even though it’s a lot easier for clinicians to have goals that will span a number of treatment plan periods, it’s actually not effective for our clients.” – Katie Vernoy, LMFT
- Using the Grip on Life model
- Understanding the challenge and making sure that the SMART goal addressed the challenge
- Digging deeper into the elements of SMART goals
- Identifying the barriers to following through with goals set
- Finding life skills that help to reach the goal
- Exploring values, planning, attention
- Looking at what is actually more motivating
- Is motivation sufficient to make the goal happen?
“[Make] sure that you’re testing your own assumptions, because we want to meet the client where they are, in their timeframe of making the change. Because if we push them too hard, it becomes not realistic, or it doesn’t become attuned to them.” – Katie Vernoy, LMFT
What is the key difference between setting goals and behavior design?
- Tiny Habits by BJ Fogg
- Motivation is fickle
- Finding the smallest behavior change that can move you toward the goal
- Create a habit, put it into something you’re already doing, and celebrate the accomplishment
Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:
Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client’s insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don’t need to give up your rate. They charge a standard 3% payment processing fee!
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Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide
Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!
Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.
You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/courses/smarter-than-smart-how-therapists-can-improve-goal-setting-with-clients
Continuing Education Approvals:
When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information
CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Tiny Habits: The small changes that change everything by BJ Fogg, PhD
References mentioned in this continuing education podcast:
Bertelsen, P. & Ozer, S. (2021). Grip on life as a possible antecedent for self-control beliefs interacts with well-being and perceived stress. Scandinavian Journal of Psychology, 62, 185–192.
Fogg, B. J. (2020). Tiny habits: the small changes that change everything. Boston, Houghton Mifflin Harcourt.
Gano-Overway, Lori & Sackett, Sarah. (2021). Let’s Get Smart and Set Goals to ASPIRE. Journal of Sport Psychology in Action. 1-15. 10.1080/21520704.2021.2007192.
Geurtzen, N., Keijsers, G. P. J., Karremans, J. C., Tiemens, B. G., & Hutschemaekers, G. J. M. (2020). Patients’ perceived lack of goal clarity in psychological treatments: Scale development and negative correlates. Clinical Psychology & Psychotherapy, 27(6), 915–924. https://doi.org/10.1002/cpp.2479
Müller, A. A., & Kotte, S. (2020). Of SMART, GROW and goals gone wild – A systematic literature review on the relevance of goal activities in workplace coaching. International Coaching Psychology Review, 15(2), 69–97.
Parish, T. S. (2020). IMPROVING OUR CHOICES THROUGH EFFECTIVE GOAL SETTING and PLAN-MAKING. International Journal of Choice Theory & Reality Therapy, 15(1), 41–44.
Preben Bertelsen, Simon Ozer, Peter Faber, Anne Sofie Jacobsen & Toke Lund-Laursen (2020) High school students’ grip on life and education, Nordic Psychology, 72:4, 265-291, DOI: 10.1080/19012276.2019.1690557
Starreveld, A. (2021). MAGIC: A Proposed Model Based on Common Factors. Integrative Psychological & Behavioral Science, 55(3), 582–592. https://doi.org/10.1007/s12124-020-09599-0
Weintraub, J., Cassell, D., & DePatie, T. P. (2021). Nudging flow through “SMART” goal setting to decrease stress, increase engagement, and increase performance at work. Journal of Occupational & Organizational Psychology, 94(2), 230–258. https://doi.org/10.1111/joop.12347
Zarate, M., Miltenberger, R., & Valbuena, D. (2019). Evaluating the effectiveness of goal setting and textual feedback for increasing moderate‐intensity physical activity in adults. Behavioral Interventions, 34(4), 553–563. https://doi.org/10.1002/bin.1679
*The full reference list can be found in the course on our learning platform.
Relevant Episodes of MTSG Podcast:
Thriving Over Surviving – Growing a Practice Without Burnout: An interview with Megan Gunnell, LMSW
Why You Shouldn’t Just Do It All Yourself: An interview with Bibi Goldstein
Therapists Are Not Robots: How we can show humanity in the room
Whole Person Therapist Episodes
Therapy for Executives and Emerging Leaders
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):
Curt Widhalm 0:00
This episode of the Modern Therapist’s Survival Guide is brought to you by Thrizer.
Katie Vernoy 0:03
Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is you don’t have to give up your rates they charge a standard 3% processing fee.
Curt Widhalm 0:24
Listen at the end of the episode for more information on a special offer from Thrizer.
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 0:45
Hey, modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com.
Katie Vernoy 1:17
Once again, hop over to moderntherapistscommunity.com for one CE once you’ve listened.
Curt Widhalm 1:22
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 where we talk about the things that go on with therapists and the things that we do, the things that we can do better with our clients. And this is another one of our CE eligible episodes. And working title of this is Katie thinks that she’s smarter than you. And she is.
Katie Vernoy 1:51
I almost at a spit take.
Curt Widhalm 1:55
Probably not the title of the episode that’s gonna get published. But…
Katie Vernoy 1:59
Curt Widhalm 2:02
…in setting this up, we tend to take turns kind of leading the content of our CE episodes here, Katie’s the one taking charge of this episode. But really honing in on goals and goals for clients and how to get them to have better goals. The play on SMART goals is really what I was leading the episode with her and trying to be smarter than SMART. And that is where Katie is taking us off today. So follow the directions for how to get your CE credits. Those are available at the beginning and the end of the episode. So follow those directions. But Katie, just how smart are you?
Katie Vernoy 2:43
I don’t know. Some days, I feel pretty smart. And other days, I just don’t. But but I think that’s a good place to start is that we oftentimes at least I don’t know, maybe your training was different. But, but I learned SMART goals. And that’s kind of where it stopped. And I feel like a lot of the learning after that was something that I really had to pick up on my own or I had to, you know, follow within a model or something a clinical model versus kind of thinking about goals in a, in kind of a standalone way. And so the research I did for this will will link to that research or or the references in the show notes. But, but it’s something where I was, I was really coming to be aware that a lot of the goal setting information I was getting in previous iterations was really a lot more from the coaching and consulting arena. And I think therapists goals oftentimes align with whatever evidence based practice it is, or the SMART goals. And so I think it can feel like goal setting is a checkbox for folks. And so I wanted to revisit the power of goal setting, so that we could actually make sure that we’re doing a good job at it, because it’s actually pretty important.
Curt Widhalm 3:55
I was gonna add to this is more than just a checkbox. This is actually an oft ignored ethical standards, that ethics code, say, have a treatment plan, have goals. That’s essentially what a treatment plan is. So I agree that there’s a lot of setting goals that does seem to be you know, going to the Jongsma planners and just picking out evidence based practice goals that to fill out a treatment plan. And we wonder why clients don’t actually end up achieving them. And there might be some sort of vague teaching of like, well use a SMART approach to getting these goals. But you’re pulling some stuff and I’ve come to the the realization or embracing that there are some aspects of the coaching and consulting world that we can probably adopt as therapists to do better or these are things that came from the therapy world that coaches and consultants seem to be doing better than us in the larger discourse of things.
Katie Vernoy 4:59
Very good points that I think we can focus in on the relationship. I know I’ve focused in the relationships the most important. But if we aren’t setting goals, and our clients aren’t clear on the goals, there was an article Geurtzen et all in 2020, where, if there’s a lack of goal clarity, there’s poor therapeutic alliance, so it hurts the relationship. If you and your client are not clear on the goals, or if the clients not clear on the goal, it can increase symptoms, and it can increase the need for sessions which, even though theoretically, it means they stay in treatment longer, it doesn’t necessarily mean they stay in treatment longer, because the relationship is not as good. And so the impact of having really clear goals that you set with your client is really the the stuff of therapy. And when we, when we step away from really robust goal setting, I think we end up with kind of that directionless, meaningless process instead of a directed, meaningful, purposeful process. Some other quick studies just to talk about kind of the benefits give us the reasons why we should pay attention to this besides our ethical responsibility. If you have goals, even with like text feedback, it’ll increase attainment. So having an intention that I want to feel better, doesn’t actually make people feel better, defining it, setting a goal and having some sort of feedback loop involved actually gets us to where we’re going. We can’t just make it happen. And that was the Zarate et all in 2019. The other thing, and we’ve talked about flow quite a bit on the podcast, and different optimal performance systems of self care kind of stuff, is that Weintraub et all in 2021 did an article around or did a research study around setting daily, and it was SMART goals, actually, but daily SMART goals created the experience of flow at work. Now there was specifics to it. These goals needed to be around mastery, resource acquisition or understanding. So there’s there’s some nuance to it, it’s not just like any SMART goal works. But increasing flow, having better therapy, having direction, meaning and purpose. Actually meeting goals because you’ve set them. That seems like a win, even if it kind of seems like a pain in the behind to to make our treatment plans and set these goals, when it just seems like Oh, but there’s so much to talk about. Why do we have to do it? But we need to. It actually is, as you say Curt, an ethical responsibility. And it actually helps. So let’s start at the beginning. And you have kindly agreed to be a guinea pig in this. But let’s let’s just start with SMART goals, what we’ve learned. So what is SMART stands for?
Curt Widhalm 7:48
I remember being taught this as Specific, Measurable, Attainable, Realistic, and Time oriented.
Katie Vernoy 7:57
Okay. And that’s, that’s what I saw in a lot of the literature, I think that attainable and realistic. I’ve heard attainable and relevant or attuned and realistic, and there’s little nuances in there. I think they’re just trying to make it say SMART. But I think that’s pretty clear: Specific, you actually have something that you’re specifically not just like, I feel better, but I’m gonna get up, get out of bed in the morning. Measurable, you know, some sort of of number, I’m gonna get out of bed in the morning, five times a week versus two times a week. It’s Attainable. I can I can get out of bed, it’s something that I’m able to do. It’s Relevant. Getting out of bed seems to be something that will help me feel better. Because if I stay in bed, I feel pretty depressed. And Time bound, I’m going to increase the number of times I get out of bed within the next three months. So those were the kinds of goals I was setting in Community Mental Health. Seems to make sense. And this is the basics. We’re not staying here, folks, bear with us. We’re gonna go beyond it. But but for the purposes of our little experience here, let’s start with a SMART goal for you, Curt. So what what are you working on? What is something that you would like to meet in the near future? What’s a good SMART goal for you?
Curt Widhalm 9:12
As a group practice owner, I am finding myself needing to devote more of my time to managerial stuff, running the practice, those kinds of things. And part of what prevents me from doing that is a enormously high personal caseload of clients that I see myself. So in the spirit of SMART goals, I would like to decrease my caseload to 15 clients per week by the end of 2023.
Katie Vernoy 9:41
So that’s pretty clear.
Curt Widhalm 9:43
Katie Vernoy 9:44
Yes, very clear decrease caseload to 15 by the end of 2023. Okay. So what’s the problem with that? Like what are, what would you think are some problems with general SMART goals or goal setting in general?
Curt Widhalm 9:57
Well, it I’m going to start with the positives because I’m a positive positive guy. I’m also really good at writing concrete behavioral stuff. This one’s, this one’s very measurable, you do it or don’t. It is specific. There is a time bound aspect to it. It seems to be attainable. It could be realistic.
Katie Vernoy 10:21
It could be.
Curt Widhalm 10:22
It could be. It’s maybe not taking into account all of the wonderful me factors that have, you know, I can make all sorts of wonderful SMART goals, and they could be things that I intend to do, but doesn’t really get into…
Katie Vernoy 10:27
What you’re gonna actually do?
Curt Widhalm 10:42
What I’m gonna actually what I’m gonna actually do or have proven to. Because, I mean, what I’m doing right now, seems, seems to be working just fine. So it’s, it’s almost too behavioral. It’s almost, you know, un, I don’t know what the word for it is unwavering. Like there’s no flexibility to it.
Katie Vernoy 11:01
Yeah, yeah. See, a 2020 article Müller and Kotte, I think it’s how you say it? They say that smart goals are overly linear and not dynamic enough. So they don’t actually kind of play along with with the me factors, for example.
Curt Widhalm 11:17
Katie Vernoy 11:18
This is also an outcome goal. You either do it or you don’t, right? There’s 15, you get down to 15 clients…
Curt Widhalm 11:24
Katie Vernoy 11:24
…or you don’t. And there’s another model called ASPIRE, we’ll put the reference in the show notes. It was more about sports psychology. But this is Gano-Overway and Sackett in 2021. They were saying, actually, that outcome goals seem to be less effective than performance, learning or process goals. So effort goals, or progress versus some static outcome are actually more effective. So having a a end of the year goal that’s very static, it could be a place to start, but it’s not it’s not where we land, because it’s not the most effective type of goal. We want effort goals, we want learning goals, we don’t want you do it or you don’t.
Curt Widhalm 12:08
I will make efforts to be down to 15 clients.
Katie Vernoy 12:13
So hold that, because we have to figure out what are the efforts? We’ll the find the efforts…
Curt Widhalm 12:18
Katie Vernoy 12:18
…and we might find better SMART goal. The other thing that Gano-Overway and Sackett were talking about was also you want it to be realistic but challenging. And so do you really think you can decrease your caseload to 15 by the end of next year? And for listeners, this is knowing that Curt has a caseload of 29 to 30, because I know you well. And I know that you’ve been wanting to decrease your caseload from 29 or 30, for at least a year. So this is saying: I will somehow do it differently next year.
Curt Widhalm 12:48
Katie Vernoy 12:49
Is it really attainable?
Curt Widhalm 12:50
I mean, if we brought in all of the magical space dust and fairies that could make this happen, I’m sure that it could be.
Katie Vernoy 12:59
So this is not realistic, and may be too challenging, or maybe in its current form doesn’t seem quite realistic, except with space dust.
Curt Widhalm 13:07
I’ve had some recent conversations with some people that have made me realize that setting an outcome goal, in this way is not necessarily speaking to the process of why I want it to be there. And…
Katie Vernoy 13:26
Curt Widhalm 13:26
…and I’m certain that over the course of the rest of this episode, that the knowledge that you’re going to bestow upon me…
Katie Vernoy 13:26
I’m gonna, I’m gonna lay it down.
Curt Widhalm 13:27
…you’re gonna help me get to that. But…
Katie Vernoy 13:28
Curt Widhalm 13:30
…this, I mean, what you’re referring to is, this was my goal last year, and you know how easy it is to just change the number on the date of the time, that’s way easier than actually having to deal with this. So.
Katie Vernoy 13:54
Yeah, and even though it’s a lot easier for clinicians to have goals that will span a number of treatment plan periods, it’s actually not effective for our clients. And then the final kind of problem with SMART goal things or at least with goal setting in the way that you’ve described it here, Curt is a do plan or a positively framed plan. So do something is a much stronger goal than a don’t do something. And so we’ll want to get to that. I see you ready to speak to that, but we’ll get to that in just a minute. And then the other part and this is this is from a little paper from Parish in 2020: that if you can make it a habit, you know, something that’s repetitive and a habit, and we’ll certainly get to that much later with tiny habits from BJ Fogg at the end here, those are much, much better than a don’t do. So decrease your caseload to 15 is a don’t do. It’s a stop doing.
Curt Widhalm 14:55
But that is a that is a do do. That is, it…
Katie Vernoy 15:00
Tell me how decreasing your caseload is it do do.
Curt Widhalm 15:03
It is taking active steps to graduating clients. It is taking active steps to referring out clients that I’m…
Katie Vernoy 15:11
See, these are all things that are not written in that smart goal, though.
Curt Widhalm 15:14
Well, it’s, I mean, you didn’t have me write out like the specific steps to get to that SMART goal. I mean, because we’ve already identified that’s the outcome. It’s not the the steps to this, you know, this is, you know, I hear a don’t do goal is like, Don’t sneeze, like, you know, those are things.
Katie Vernoy 15:33
I’m hearing this is don’t take more clients or stop taking more clients. Not…
Curt Widhalm 15:37
That well. I mean, and I’ve written like I said, I’ve come from a background of ABA and writing very concrete goals like this, like, the difference between a don’t do goal and a do do goal. I mean, I’ll just speak sophomore about this. Let’s do do the doodoo. But I do do goal is referrals get sent out to my team rather than being put on my caseload. That is a do. It is not, don’t take the referrals for your caseload. It’s a matter of how you structure what the goal is, that turns it into a do goal. I still hear everything that I’m saying as these are do steps towards an outcome as defined in our SMART plan. If I do have a microphone, I should drop it right here because?
Katie Vernoy 16:29
Well, I think you’re getting to the part that I think is. He actually dropped the microphone. So I think what you’re getting to very intelligently, very smartly Curt, is the is the next steps. And this is the I think this is a problem, at least in the way that I saw SMART goals trained, when I was coming up is that you would get to something that was very, very concrete, very measurable. But you didn’t go to the next step on how do we actually get there, and you’re talking about that. So let’s go to the next stage here and take a little look on this to see how do we make this a bit better than just decrease my caseload to 15, which is what you’ve had as your goal for the last year, that you’re gonna reengage for the next year. We need to, we need to dig deeper. So there’s a group out of Norway Bertelsen and Ozer did a couple of different things, there’s a different group, again, will have the references in the show notes. But their model is around the concept of grip on life. And so it’s that general life skills are used to manage everyday tasks. There’s proactive goal setting. And in truth, one of the articles I was reading was they were setting this up for high school students. So this isn’t complex. This is something where it’s just a really logical process that you can go through to make sure that what you’re doing makes sense. And so you start with a challenge. You turn that into a spark goal, you choose the life skills you’re going to use, you find the next step and and think through kind of the motivation factors are basic five of life. You want the goal to be comprehensible, so you understand what the goal is and what it entails. You want it meaningful. And that it makes sense. And you want to make sure it’s, it’s manageable, you can imagine the outcome and how to get there. So I think because we’re going through this, I want to I want to make sure that we understand the challenge, because you said decrease your caseload to 15. What challenge is that solving? more concretely than you said in the beginning?
Curt Widhalm 18:30
So I, I say yes to a lot of things, a lot of people rely on me to do a lot of things. This is in my practice. This is in my side hustle here with our award winning podcast, and also in my personal life with family and friends. That there is a lot of things that bottleneck with me and are on my ever growing to do pile that just gets done based on whatever the concrete priority thing is that needs to happen just in time. I’m great at getting things done on time. But for some of these things that can just kind of sit in the background and stay at status quo forever. They become good promises from my ever warm and open, just positive personality of optimism that I’m gonna get everything done. But they just kind of sit there until there is some sort of deadline for them to actually get done. And I can make up deadlines like I have with this one. But there’s no real deadline to it. It’s just kind of, again, magic space dust that could make this.
Katie Vernoy 19:46
Well, and the way I’m hearing that is that the challenge is way too much stuff to do and not enough time to do it, is one element of it. So so that’s kind of what the decrease the caseload is for is to increase the time that you have to spend on some of these things. You’re also talking about the saying yes a lot. Is that part of the challenge that we’re addressing here is that you need to set firmer boundaries around your time? or say no to more things? Like what is what is that? What is the challenge there?
Curt Widhalm 20:15
I feel like I should say no, just so I can start working on this immediately.
Katie Vernoy 20:26
So we’ll say that’s a yes. Okay, so the limited time, saying yes to too many things, becoming the bottleneck. So what does that mean that you’re becoming the bottleneck?
Curt Widhalm 20:38
That people are waiting on me to get something done or organized or looked at for them to be able to complete what it is that they’re doing to be able to jointly, you know, move on to the next step of a project or an idea that if the saying goes, the buck stops here, the desk, you know, a little placard on my desk says everything stops here. Like.
Katie Vernoy 21:05
So the problem is that stuff that you’re wanting to get done: things, you know, whether it, maybe it’s for the practice, maybe it’s for the podcast, maybe it’s projects at home, whatever it is, there are things that you legitimately want to have happen, but because of your lack of time and ability to focus on it, especially if there’s, if it’s one of those things like nice to do not, I have to do it by next week or I’m in big trouble. Those things just kind of lay fallow, you’re not able to actually move them forward.
Curt Widhalm 21:35
Katie Vernoy 21:36
Okay. So so we’ve got the actual challenge and decreasing your caseload to 15. So cutting your caseload in half, could address that challenge. But there may be other things. And so we’ll want to assess that in just a minute. But let’s, let’s go through the SMART goal booster, which is part of this grip on life process that these folks made. And the first one is the specific the goal is clearly described, it’s framed positively. And there’s an awareness of how much the school addresses the challenge. So let’s jump into it, how much does decreasing your caseload by half address the challenge that you described?
Curt Widhalm 22:17
It doesn’t seem to address it specifically. And even just picking up on like, you know, I behaviorally wormed my way out of, you know, a do do goal, when really this is where what I’ve been focused on is decrease, but you’re saying here with specific that this needs to be a increase or framing positively. And ultimately what is behind this goal is, I want to free up more of my time to be able to do the things that are bottlenecking with me. And in order to do so one of the biggest places where my time is obligated is with some of my clients on my caseload.
Katie Vernoy 23:00
So, so framing it positively…
Curt Widhalm 23:05
I am positive that this is what happens.
Katie Vernoy 23:12
Well, we can we can go to increase, is it unstructured time increase?
Curt Widhalm 23:17
Increase productive time.
Katie Vernoy 23:20
Productive time, whereas client time is, is separate from that because it’s it’s providing services, and then productive time might be getting clinical documentation done, supervision, training, working on podcast content, like those are things where it’s, it’s focused effort towards other projects separate from performing clinical work. So increase the amount of time that you have to spend on that.
Curt Widhalm 23:47
Yeah, that’s what I meant all along.
Katie Vernoy 23:51
Okay, so let me write this down. So I can follow along here. So specific, kind of, I think we need a little bit more parameters. How much time do you want to be spending working? Like total time working in a week?
Curt Widhalm 24:05
I would like to cut it down to somewhere between 40 to 50 hours.
Katie Vernoy 24:10
Okay. So 40 to 50 hours, and you’re saying 15 of those hours would be client times? Right?
Curt Widhalm 24:18
Katie Vernoy 24:18
So so we’re looking at 25 to 35. Other hours?
Curt Widhalm 24:27
Katie Vernoy 24:28
Okay. How many hours do you have right now that you’re spending on productive or project time?
Curt Widhalm 24:37
Depending on the week, I would say 10 to 20.
Katie Vernoy 24:44
Okay, so the current is 10 to 20. So if we have you’re currently at a 30 caseload, 20 would be the 50 hours. Does that seem accurate? Are you working 50 hour weeks? Are you working more than that?
Curt Widhalm 24:57
I’m working more than that.
Katie Vernoy 24:58
Okay. So, you may already be at 25 hours of constructive time.
Curt Widhalm 25:05
Katie Vernoy 25:05
So, so increasing the productive or project time, you don’t need to you already are spending that much time.
Curt Widhalm 25:14
Yeah, you could say that.
Katie Vernoy 25:17
I mean, it’s it sounds like you’re not getting personal time.
Curt Widhalm 25:20
Yes, very much so.
Katie Vernoy 25:22
Okay. So part of this, and this is where this gets hard. And maybe the maybe time isn’t our best goal, because it seems like if we’re saying, like, you want to increase personal time, you would have to have a goal around, increasing time off of work, or more forcibly, holding the boundaries of work time to 40 to 50 hours. So behavioral goal master do to have a way to create that goal of holding a specific amount of work time, and personal time?
Curt Widhalm 26:01
I mean, I think, if I can talk through the process here and give our audience maybe a little bit of an insight into how this conversation might look in, in a therapy session here.
Katie Vernoy 26:13
Curt Widhalm 26:14
Is the amount of time that I’m doing on project time, or this kind of stuff, as you’re pointing out seems to be a fixed amount of time. What having my schedule as it is right now is that tends to happen anyway. And it happens to fit around wherever I’m seeing clients. Where I’m trying to get to is not having so many clients to fit this stuff around. And being able to dedicate the time that was previously taken up by clients to be able to get this stuff done, thus opening up other time in my schedule to be able to do home projects, family/relationship, sort of stuff, personal interests, those kinds of things.
Katie Vernoy 26:59
Yeah. So do we have? Are we able to get to a SMART goal there yet? Or do we need to kind of keep going before we…
Curt Widhalm 27:06
I think we need to keep going to look at this.
Katie Vernoy 27:09
Okay, because I think the reason I pointed that out is in our conversation. So this is assuming that you know, the client, but in our conversations, a lot of it goes back to well, it works. Because you are just eating into personal time to take care of the business stuff, the other projects, the other things because we didn’t even include the time that you’re spending teaching, which is another element, which obviously needs time to.
Curt Widhalm 27:36
Katie Vernoy 27:36
Okay. So going to your previous goal, decrease your caseload to 15. That is measurable. Can you see progress? And what is the progress? Do you have partial goals? And is there a meaningful developmental process? My response when I was thinking about the decrease the caseload to 15 is that I don’t see, it’s easy to measure, but the intermediate parts are a little bit harder. There’s not partial goals. So if we’re wanting to do more of a meaningful developmental process, when if we’re looking at eventually getting down to this ideal schedule, is there can you see a way to get there? Like, is there a measurable way to get there? Are there incremental goals that would be possible in this?
Curt Widhalm 28:20
So one of the thoughts that I had had is, as I have clients who graduate or stop therapy, get referred out, they move on whatever it’s being able to not fill their spaces, or to fill their spaces with clients who are maybe on the more extreme ends of my schedule, the ones who are very, very early on my schedule, the ones very late in the evening, and to be able to kind of condense down my days. So that way, I’m staying a little bit more in my flow states, rather than bouncing back and forth from doing all right, I’m gonna work on this task for an hour. And then I got two or three clients, and I’m going to work on this other task for an hour that’s constantly the shifting gears that will allow for me to actually more deeply get into some of these projects.
Katie Vernoy 29:06
Okay, so theoretically, I just had a thought, and I don’t know if this works for you, but I’ll throw it out there as a possibility. Is if we if we identify kind of an ideal schedule, we could, we could look at percentage alignment with the ideal schedule. And that could be you know, so like, you’re all over the map now. You’ve got clients that are spread out. So if your ideal schedule is compacted in, you’ve got more evening time free, maybe or you’ve got weekend, time, free, whatever it is, and you get closer and closer to the ideal schedule as you start doing these steps. Does that feel like something that has more of a developmental process? That you kind of over time, you know, probably there’s different steps you would take. Part of it is moving clients in as as people graduate. Potentially, it’s shifting, you know, some some scheduling to kind of create the space that you need in another spot. And so there could be incremental goals to get more in alignment with this ideal schedule. And we could get down to those. But the overarching thing for the year is, here’s my ideal schedule. I’m 20% in compliance, I want to be 80% in compliance by the end of the year.
Curt Widhalm 30:18
I mean, yes, all of this sounds great, but it still comes down to I am still only accountable to the person who got me into this mess in the first place.
Katie Vernoy 30:32
Very true. Okay, so well, we’ll keep working. The next one is, is this goal attuned and attainable? Is it too easy or too hard to reach? Is it meaningful? And do you have an idea on how you’ll reach it? You’ve talked about letting folks graduate and move on. Are you going to have half your caseload graduate by the end of next year?
Curt Widhalm 30:57
Not naturally, no.
Katie Vernoy 30:59
Okay. So this needs a little bit of effort, which I think requires some motivation, right?
Curt Widhalm 31:05
I think, you know, as part of this, and now recording this exact conversation twice for a podcast. I think as we had our pre recording conversation about this, now that we’re doing this, as part of the recording part of this is just being more accountable and concrete with things just by coming back and reviewing this, not just with the person who put me in this mess in the first place. But the deeper processing and understanding of why not. So this is meaningful, it’s meaningful to those in my life that I care and love for and also you, Katie.
Katie Vernoy 31:51
I’ll take it.
Curt Widhalm 31:55
It is meaningful. And I do have ideas on how to reach it. It’s yeah, this this does seem attuned, it’s something where part of the attunement comes to needing to not just privately hold on to this.
Katie Vernoy 32:16
Hmm. Mmm hmm. Okay. And that, that aligns with something later that we’re going to talk about too. But whether it’s atuned or attainable, realistic, relevant, I’m hearing or at least up to this point, part of the realistic or relevant is are conditions in place to meet the goal? And, you know, what are the obstacles to overcome them? And so, I think it makes sense to talk a little bit about that, because it sounds like to this point, the conditions have not been in place.
Curt Widhalm 32:44
Katie Vernoy 32:45
That there have been obstacles that that you’ve not been able to overcome. So let’s talk a little bit about that.
Curt Widhalm 32:50
And that is something that I’m already very much actively working on. I’ve hired a virtual assistant this year to take off some of the tasks that end up, you know, being the things that I have to get to at the end of the day, being able to train somebody on how my practice runs, being able to, you know, start to take intake phone calls, and have them be able to better match clientswith my staff, rather than me being guilted into, you know, whoever’s calling me and be like, but we really wanted to meet with you. And I’ll be like, you know, I’m such a caring guy, that you’re, you’re melting my defenses here. So being able to have some of the systems in place, some of the other staff members in place on my team to take care of some of the day to day operations stuff allows for me to do what I do really well, which is a lot of the big picture sort of things where some of the implementation of those is where the bottlenecks come in. And have the conditions been in place? Absolutely not. Have the implementation of changing the conditions been in place? Barely. But that has partially been bottlenecked by the amount of time that I am spending with clients that haven’t allowed for me to take that step back. And so this is actually something that I have taken more steps to prioritize in recent weeks to be able to better get to where I’ve vaguely been going and promising all along.
Katie Vernoy 34:27
Okay, okay. So there may be more there. But let’s, let’s keep keep going to the last step, which is time, are you going to start right away or in the near future? Is there a deadline? And can you imagine a timeline? You’re changing the two to a three on this goal on the decrease your caseload to 15. Is this something that you can start right away, that you actually start decreasing your caseload?
Curt Widhalm 34:50
I think so. I can probably I mean, I have a couple of clients that are very close to reaching their goals right now, anyway. So it’s something where, and I imagine that through the holidays, you know, traditionally, there’s been a few people who are like, you’ve set me up really well, I’ve got skills, I don’t need therapy anymore. And I’m, like, great. So I’m at a time where this could start falling into place. It’s not something that’s going to happen overnight.
Katie Vernoy 35:27
Curt Widhalm 35:28
Is this going on? Yeah. Is it going on as fast as it could? Absolutely not. Because part of what we haven’t talked about is also the anxiety of, I want to keep the same income from my practice. And this is something where being able to balance out the needs of myself and my income comes with probably expanding my clinical team as well, that needs to kind of go in lockstep with this.
Katie Vernoy 35:56
And I think the challenge with the financial piece is this this summit you have to reach. Where you have to recognize that you’re more likely to make more money in your practice, if you’re acting in the management leadership role, versus just grinding through 29 or 30 clients a week. And so how much of that do you believe? How much do you think that you can actually increase the income of your practice, if you step away from half of your caseload?
Curt Widhalm 36:27
I will have to get comfortable with taking a, the probability of taking a monetary step back in order to then be able to take a more comfortable step forward. And I think that that’ll extend beyond 2023. But it’s also sitting with just kind of that, you know, scarcity mindset anxiety, it would just be easier to solve the money problem by just seeing more clients.
Katie Vernoy 36:57
Sure. And I think that’s, that’s where you get stuck. Now, speaking to the bottleneck, is there anything sitting on your desk, any bottlenecks on your desk that theoretically, are lucrative?
Curt Widhalm 37:08
Theoretically, I can imagine a bunch of things being lucrative, but it for my practice, yeah, part of it is expanding out our DBT. We’re going to start doing comprehensive DBT. That’s built in to have more of a team oriented approach to it in the first place. We will hopefully have the things finalized for a wonderful CE platform that comes with our wonderful little side hustle here that will be able to expand our audience. Lucrative sort of things may change just based on personal factors of, you know, I have to except I’m not the only income of my households, and my partner has the ability to also, you know, continue to support the family in the way that she has. And so I don’t necessarily need to jump to lucrative. I need to be comfortable with stability.
Katie Vernoy 38:10
Okay. Because I think the pieces here that I’m hearing are is that there’s the the quick, easy answer is I see a client, I get money. And what you’re trying to shift here is from how do I stay financially stable? The easiest way is just see clients.
Curt Widhalm 38:28
Katie Vernoy 38:30
To how do I make a more sustainable career? And how do I make in truth, probably more money? If I can get to a place where I’m growing. And, and, and maybe it’s not even more money, maybe it’s the same amount of money, but working fewer hours, right? It’s getting using your skills to launch programs, to get things in place, that you can charge money for them. But if they sit on your desk, you’re not charging money for them. And so it’s it’s looking at how do you get to the place of my brain and my planning is more lucrative. It just takes a little bit more time than seeing one client in the next hour.
Curt Widhalm 39:12
Right. Right. Very much economics. Yeah.
Katie Vernoy 39:15
But if we’re looking at timed, it sounds like it’s going to start happening pretty soon. You kind of have a deadline at the end of next year. But even a timeline if we were going to kind of go even the more behavioral model. I mean, we’re you’re talking about dropping one to two clients a month and not replacing them. Is that timeline doable?
Curt Widhalm 39:37
That seems reasonable. It’s not like, Okay, I need to drop 15 clients, it’s more of oh, one a month. That seems reasonable as far as graduating, it’s being able to not feel like it’s taking on everything all at once.
Katie Vernoy 39:56
Yes. And I think the thing that that I’m hitting up against, and this is something that we’ll potentially reflect on at the end of the episode is, to me spending a year dropping your caseload to have the potential here feels really long. And so I’m fighting that bias of like…
Curt Widhalm 40:14
You’ve got, you’ve got ulterior your, your own goals.
Katie Vernoy 40:19
Motives I want you to I want you to stop being our bottleneck, of course. That’s why we had to do a pre record, we needed to work that crap out. But I think it’s that piece of for me, like my expectations were, if you want to do this, we’ll just do it. Like you’ve got associates, you’re gonna bring people on like in, you know, my internal monologue is, dude, you could do this in three months, that’s just dropping five clients a month. Like, where you could do it in five, that’s just dropping three clients a month, like for me, I’m thinking about it, like, Hey, you can actively go in and do all these things. So we’re I your therapist, I would not say any of that stuff. But I just want for folks in the background, kind of making sure that you’re testing your own assumptions, because we want to meet the client where they are in, in their timeframe of making the change. Because if we push them too hard, it becomes not realistic, or it doesn’t become attuned to them. Okay. So our goal in this little section was to get to a new SMART goal. Where are we sitting with that? Do we feel like we have a different goal besides decrease your caseload by 15 clients or to 15 clients?
Curt Widhalm 41:25
It’s increase the hours available to work on other projects, by decreasing caseload.
Katie Vernoy 41:38
In community mental health, I would be like an increase to decrease…
Curt Widhalm 41:42
An increase to decrease goal.
Katie Vernoy 41:44
Always, always pushed back, but we’ll allow it because I think we need to get into smaller ones. But increased hours available to work on projects…
Curt Widhalm 41:54
While maintaining income.
Katie Vernoy 41:56
…while maintaining income…
Curt Widhalm 41:56
And still be loved by everybody.
Katie Vernoy 42:00
I can’t promise that dude. So while maintaining income, and then in parentheses by decreasing my caseload. We’re gonna revisit that because I think decreasing your caseload may not be the only answer, but increase hours available to work on projects while maintaining income.
Curt Widhalm 42:20
Katie Vernoy 42:20
Or like non client projects. Because you also spend time, because you have some clients that that have a lot of needs, like there’s projects like calling hospitals or working with…
Curt Widhalm 42:35
Katie Vernoy 42:35
…treatment teams that are not direct client hours that add to the 29 or 30 hours of client time that you hit. Ok. So we’ve got our new SMART goal. And so the next step in this grip on life thing is the wheel of skills of life psychology. And this is the associated skills that we can shape, adequate, adequately shape our life activities and behavior to optimally achieve them. And so I’m going to talk through them. And then I think probably for our sake of time, let’s pick one area that you would want to talk through a little bit more. And maybe it’s even digging into stuff we’ve already talked about. So the first one is participation in creating your own life and communal life. And that includes relations, for example, do you need to create relationships to meet your goal? And maybe I’ll just talk this one through. You need to get another associate at least. Right?
Curt Widhalm 43:23
Katie Vernoy 43:23
Frames: do you need to add structure to meet your goal? And probably, we need to structure your schedule a bit differently. Community: do you need to participate in community to be able to reach this goal? And I don’t know if that one, I mean, you almost have to participate less people stop referring clients to you, but you don’t want them to not refer to your practice.
Curt Widhalm 43:41
No, if anything, I want to build a stronger community who refers to the other people that I hire.
Katie Vernoy 43:47
So and part of it you did with kind of your rebrand; is now the practice has a brand and so potentially, it’s the brand and you’re delegates, so to speak, need to be out in community more to be able to strengthen the ability of the other folks getting referrals, right?
Curt Widhalm 44:02
Katie Vernoy 44:02
Rather than us being the face? Okay. The second, the second kind of body of skills are realistic attunement. And this is in relationship to general life conditions. So the first one is attentiveness. Do you need to pay more attention?
Curt Widhalm 44:18
Katie Vernoy 44:21
I was just gonna say I’ll answer that one first. Yes. Yes, you need to pay more attention. But what do you think you need to pay more attention to?
Curt Widhalm 44:31
I mean, it’s easy to point to the external things of the business. But I think, you know, this is that deep therapeutic thoughts is I need to pay attention to the Why am I taking on more stuff? And what’s the drive and what’s that feeding for me that prevents me from getting to the things that I’m already doing?
Katie Vernoy 44:52
Sure. The second step here and in this realistic, realistic attunement section is planning. Do you have a specific plan?
Curt Widhalm 45:01
Katie Vernoy 45:02
Yeah. So well, we’ll get to that. Norms and values: what norms and values impact this? And you’ve talked about kind of the financial money-story mindset kind of stuff, what other norms and values do you think impact on this on your schedule issues, so to speak?
Curt Widhalm 45:21
I mean, you can point to any number of things I of, I have a reputation of being successful and having my crap together and doing things and being a stalwart of the therapists community. And I have a reputation to uphold. And I have things like being a male head of households that might have expectations of needing to be at least a major breadwinner, if not the breadwinner. I’m neither in my household. But of, you know, also needing to meet all of the professional just kind of here is a married father who has a business and has a side business and needs to be the consistent sort of thing. This is consistency for me at this point. It’s, it’s a crappy consistency, it’s one that it would be easy to just kind of keep plugging along and doing what I’m doing. And, you know, one day, reach a retirement age and be like, You know what, I’m done. Everybody, I’m closing down shop. So part of this is the norms of even just having to face doing a major change that feels partially just very guilty and selfish.
Katie Vernoy 46:49
Mmm. So decreasing the, your workload, theoretically…
Curt Widhalm 46:56
Katie Vernoy 46:57
…makes you feel guilty and selfish.
Curt Widhalm 47:00
Potentially. Yeah. I haven’t tried yet. So I imagine those are the feelings I’m gonna have.
Katie Vernoy 47:05
Well, I guess the question that leads to me is, you know, how do you feel as the bottleneck? Are there, are there feelings around being the bottleneck?
Curt Widhalm 47:15
Not to particular ones that have motivated me to really make any changes at this point.
Katie Vernoy 47:22
Okay. How about the amount of time spent with family? Are there feelings around when your workload invades family time?
Curt Widhalm 47:32
Yes. I want to increase family time and quality of family time. Yes.
Katie Vernoy 47:37
Okay. So that may be more motivating, which is part of another step, but, but it seems like that value of working hard, you know, kind of upholding your reputation, showing up for the people in your practice, doing the things like that. That’s motivating, which has led to this saying yes to a lot of stuff. And having a high caseload. The bottleneck stuff, it seems like that’s not motivating to you. That would be very motivating to me. But for you, it sounds like it’s going to happen when it happens. It’s not urgent, I’ll get to it.
Curt Widhalm 48:11
Katie Vernoy 48:12
Got it. But with the family stuff, it seems like that is actually more motivating. And so getting your caseload down, getting your total workout load down is actually more motivating. And so kind of rejiggering your your schedule so that you can fit more of the kind of diversity of things that you’re doing into a smaller work work time is motivating to be able to see more of your family, to spend more time with family.
Curt Widhalm 48:37
Katie Vernoy 48:38
Okay. And so I think we need to pay attention to that. Because if that’s more motivating, we want to increase that versus trying to work around something that doesn’t, doesn’t really get you moving. Which is that you’re the bottleneck. And people keep going like Curt, where is it? Where is it? What’s going on, Curt?
Curt Widhalm 48:55
Yeah, yeah, pretty much.
Katie Vernoy 48:57
You’re like, it’s all noise at this point. You’ve got like, how many 1000s of emails?
Curt Widhalm 49:03
Katie Vernoy 49:06
Yes. So if you’re sending Curt an email, if you actually get a response, it means he likes you a lot.
Curt Widhalm 49:14
It’s more of a lottery at this point, you’re one of today’s lucky five.
Katie Vernoy 49:20
All right, so that’s the realistic attunement. And then the last area of skills of life are this mentalization: understanding your own and others perspectives. And so those there’s four of those ones, awareness of your body and your five senses, and we, we didn’t really talk about that. So maybe that’s worth looking at. Understanding yourself, understanding others and understanding systems. So in the mentalization sphere, what do you think is relevant?
Curt Widhalm 49:44
I mean, I understand myself pretty well. I understand others pretty well. I understand the systems that we’ve created pretty well and I’ve found a very subconscious place of just operating to where everybody is low key just kind of annoyed with me. As opposed to, really, I’m in the Goldilocks zone of like, nothing is so problematic.
Katie Vernoy 50:10
Ah, so something would would have to shift for to really become for that element to become more important. Like you understand the situation, it’s just doesn’t motivate you to change it.
Curt Widhalm 50:23
It is a very slow burn to getting to addressing the right balance of keeping everything going and in place.
Katie Vernoy 50:32
Curt Widhalm 50:32
And, you know, this is something that I mentioned earlier, where actually having deeper conversations about what these shifts mean, with everybody around me, helps to keep me A: more on track and committed to doing it. But B: helps to redefine what all of these relationships and what all of these systems are. So that way, it’s not such a shock to do everything all at once.
Katie Vernoy 51:00
Okay. Okay. So when we look at this, when we look at the kind of the participation, one of the things you’re doing is keeping, keeping your community apprised of what’s going on.
Curt Widhalm 51:12
Katie Vernoy 51:13
You’re understanding the norms and values. It looks like having a specific plan is an area that we may want to work on.
Curt Widhalm 51:19
Katie Vernoy 51:19
And then as far as mentalization, it’s, it’s, you’re good at that. You’re you’re very aware of how this is you just recognize it’s kind of like having dysthymia, you haven’t hit depression. So you’re just kind of like, it’s just things kind of suck.
Curt Widhalm 51:33
Katie Vernoy 51:34
Okay. So if we’re looking at our new SMART goal, which is increase hours available to work on projects, while maintaining income, what is a good next step, a partial goal that we can, that we can a lot that potentially pulls from one of these, whether it’s skills needed, resources needed, or a skills or a resource deficit, like what is what is a partial step that we could take here?
Curt Widhalm 52:03
I mean, the first thing that pops to my mind is evaluating my caseload and seeing who is close to graduating, who’s maybe in need of a referral, who is likely to benefit from adjusting their schedule with me, any of those kinds of things. So part of it is being able to evaluate within my caseload where some of these changes can happen more realistically, sooner upfront.
Katie Vernoy 52:34
Okay. So when do you want to do that?
Curt Widhalm 52:36
It is natural that with updating everyone’s good faith estimates…
Katie Vernoy 52:42
Curt Widhalm 52:42
…that some of these conversations…
Katie Vernoy 52:43
Curt Widhalm 52:44
Yeah, will be happening fairly naturally, and will be coming up very, very soon.
Katie Vernoy 52:50
Okay, so in January with the updated Good Faith Estimate, will be a conversation with folks about progress, time to graduation, frequency of sessions, that kind of stuff. So there may be a big push towards the, you know, kind of creating more space, because you’ll have fewer clients, probably by the end of January. So maybe there’s or fewer client sessions, it could be that people go to every other week or once a month, so they drop a little bit. So you’re not saying 29 to 30 a week. So there may be some big progress right at the beginning of the year. And I like it, because it’s got a timeframe. It’s attached to something. And and it’s, it’s certainly something that I think is pretty doable. Because it’s already, it’s clinically relevant. It’s already it’s just adding a little bit, a mindset to the process that you are already potentially doing, right?
Curt Widhalm 53:39
Katie Vernoy 53:40
Okay. So the grip on life actually has an assessment that I like that kind of talks through, is this a good enough kind of partial goal or next step? And it’s called the basic five of life. So here we go. And that kind of is the next step motivating enough? So the first part is want to you want to set and reach this goal? Is there any reluctance? Should you modify your goal? And so if we’re looking at going through your whole caseload with these good faith estimates and doing these assessments and shifting, based on that assessment, do you want to do that?
Curt Widhalm 54:14
Katie Vernoy 54:15
Okay. Do you have the ability to do it? Sufficient knowledge and skill? Is there anything you lack? Is there anything difficult? Is there anything any skills or knowledge you should acquire, to be able to have these conversations with your clients and make the according, you know, the, the changes according to what you’ve talked about?
Curt Widhalm 54:31
Yeah, that’s yes.
Katie Vernoy 54:33
Way in your wheelhouse, right.
Curt Widhalm 54:34
Katie Vernoy 54:35
Like, that’s easy. Okay. Are there any external conditions that impact whether the goal happens?
Curt Widhalm 54:43
The ability to have some of my staff take on some of the roles that I’m continuing to do. The overall stability of my personal finances, this kind of stuff, my ability to hire and train new clinical staff to take on extra referrals. Yeah.
Katie Vernoy 55:01
So those external things are impact kind of the overarching goal. But as far as going through and assessing your whole caseload and having those things, are there, external factors on that? Is that also…
Curt Widhalm 55:12
No, no that…
Katie Vernoy 55:13
So that’s completely within your within your control?
Curt Widhalm 55:17
Katie Vernoy 55:18
But if we’re looking at the larger goal, what you described as external factors, money, you can you kind of have control over that. But hiring and systems, you can contribute to those changes.
Curt Widhalm 55:28
Katie Vernoy 55:29
Yeah. Okay. And then the fourth big five is: being met. Do you have get help/aknowledgement when you’re setting and reaching your goal? Do you have support networks? Or relationships? Do you get help? And what can you do to be supported or helped? So is there, is there support around doing this process of assessing your whole caseload and and kind of planning for folks to either decrease or close out if appropriate?
Curt Widhalm 55:53
I’ve mentioned several times in this episode of the benefits of having my trusted people, you, my practice, you know, partners, my, my wife. Yes, there’s…
Katie Vernoy 56:07
So you got those?
Curt Widhalm 56:07
I’ve got those.
Katie Vernoy 56:08
Okay. And then the doing one is kind of looking at the any concrete activities or pursuits that you’re already doing regarding setting and reaching this goal. And is there anything that prevents you or something that you could do differently from what you usually do? And so specific to assessing your caseload at the beginning of the year: what are you already doing? And is there anything that we prevent you or think anything that would have to do differently about the GFE process, for example?
Curt Widhalm 56:35
Not really, because that’s already gonna get done anyway. So yeah, that’s already,
Katie Vernoy 56:41
The only, the only thing is is actually doing that clinical assessment. It’s attached to it, or did you already do that last year, too?
Curt Widhalm 56:49
I mean, as a natural part of these GFE conversations last year, this is something that’s going to come up in these conversations with my clients anyway.
Katie Vernoy 57:00
Okay. And so that process is the only thing that’s really different is then implementing decrease or graduation plans.
Curt Widhalm 57:09
Katie Vernoy 57:09
Okay. Does that feel doable?
Curt Widhalm 57:12
Yes it does.
Katie Vernoy 57:12
Okay. Now, the these group, this group, Bertelsen and Ozer, in 2021, also was looking at this grip on life plan. And they, is a completely I don’t know that it’s unrelated. But it just, it was kind of an interesting thing that I read that I feel like I’m gonna just throw in here, because it’s really interesting is that they’re basically saying, like, if you’re motivated enough, you can do it. Like, if you can set this up properly, you can just do it. Right? And, and what they found is that a lot of therapists and a lot of folks say that, like self control is limited. You got to you know, it’s almost like a muscle, you gotta rest that kind of stuff. But but these two, these two folks were saying that if people believed that self control was unlimited, they were a better able to manage mental fatigue and pull resources and continue to to keep going to get their their goals met. And that was self control, meaning proactive agency, robustness to overcome obstacles and distractions, you don’t get distracted and forget to do your GFEs, for example, and resilience. If you forgot it in the first week, you do it in the second week, for example, you get back on track. So their model and the way they pursue it seems to be like, if you believe you can you can do it. Do you agree with that?
Curt Widhalm 58:32
No. I mean, and maybe the part that I get lost on this is I come from an idea where, you know, motivation is a finite resource, and I don’t rely on motivation. I’m somebody who comes more from having the discipline to follow through on goals, to put things into place, and to just meet what I need to do. If it’s my schedule, if it’s the commitments that I make, that they’re going to get done, they’re going to get largely done, especially externally, you know, situated sort of goals.
Katie Vernoy 59:13
I like that clarification, ‘mostly.’
Curt Widhalm 59:19
But, you know, I find, you know, many of our audience members know that I run marathons. That there’s a lot of days when my alarm goes off, or I have no motivation to go and get my workout done. But I have a fair amount of discipline to be able to get that workout done. And that’s really the way that I’ve framed things myself. And so this is a way different way of talking that I don’t subscribe to.
Katie Vernoy 59:50
Yeah, and I don’t know that I do either. I think that the interesting thing is that it’s the belief that self control is unlimited, versus the fact that self control is unlimited. So it’s really about mindset. And I think what I’m hearing you talk about, especially the marathon stuff, like you believe that you can do this.
Curt Widhalm 1:00:10
No, I believe that I’m not going to do it unless I do it. So.
Katie Vernoy 1:00:13
Yes, yeah. And so it’s something where when people get into well, you know, motivation is finite. And, and self control is a resource that runs out. I think, as a therapist, I have said those things to help people not be so hard on themselves. But I think what this study is saying is that we want to walk a line, because if people believe, Oh, well, if I’m tired, I should just opt out; they don’t get to that discipline, they don’t get to that implementation. And so I think it’s important for us to recognize it. But but but this lovingly wonderfully, gets to BJ Foggs work in tiny habits, because he subscribes to the same notion that you do, which is motivation is fickle.
Curt Widhalm 1:00:56
Katie Vernoy 1:00:56
And so you can do a lot. But if you’re just relying on, I can do it, it’s not going to work. And so I’d like to, in the last few minutes talk through this, and maybe we can figure out a tiny habit, I don’t know if we’ll find one related to this. But maybe we can talk through a tiny habit that will be something that you can employ to make sure that you’re consistently making progress towards your goals. So for BJ Fogg, his book he wrote in 2019/2020, again, all the links in the show notes are all the references in the show notes, but his his theory, and it’s drawn from so many different theories, like CBT, behavioral, like everything that you could think of, like, I went to his website, and there’s like, this gigantic list of like, everything you ever thought about and ever read, all flows into this, this thing. So this is his work, but it’s also very, very readily pulled from other places. So it’s gonna be familiar. But he says that behavior, behaviors happen when motivation and ability and a prompt come together. And so the motivation is, I want to do it, the ability is I can do it, and prompt is, and it’s time to do it. Something that something’s nudged me to do this thing. And so because motivation is fickle, and and so that first, that first element is so uncertain, we have to go to behavior design versus setting these goals, even if they’re very clear without any way to reach them, or without really clear pathways to reach them, habits that will be helpful to reach them. And he also reiterated motivation towards abstraction, I want to be happy, I want to have more time, that’s ineffective, you need to have practicalities and a very clear vision. And so his behavior design model, we’ll jump into it is get clear on the aspiration or outcome. And so your aspiration or outcome, as far as I understand, is having enough time at work to do all the things that you want to do, and have sufficient time at home to spend time with your family.
Curt Widhalm 1:01:00
Katie Vernoy 1:01:04
Okay. And so the next step, and this is something where we don’t have time to do it, but I think it’s a really good process. And maybe we can just dig into it for a minute or so is explore all the behavioral options, anything you can do to get that time better situated. Where work is more compact, and you’re getting everything done. You’re not the bottleneck, which obviously not motivated, but but something that it’s it’s worth considering.
Curt Widhalm 1:03:33
Katie Vernoy 1:03:34
And then you have sufficient time at home. So, so let’s go through, brainstorm, everything is possible.
Curt Widhalm 1:03:41
Katie Vernoy 1:03:41
What are some… what?
Curt Widhalm 1:03:43
Katie Vernoy 1:03:43
Human cloning. Okay, first one is human cloning. All right, what else do we got?
Curt Widhalm 1:03:47
Katie Vernoy 1:03:48
Okay, continue, I’m just writing them down. Because I know eventually you’re gonna run out of funny things. So let’s get to the real stuff. But here we go.
Curt Widhalm 1:03:58
Okay, not replacing the most extreme ends of my schedule.
Katie Vernoy 1:04:04
Not replacing extreme ends of schedule, okay.
Curt Widhalm 1:04:07
Removing things from my schedule that don’t make as much money, saying ‘no’ more.
Katie Vernoy 1:04:14
Well, what else are you spending time on? Besides seeing clients? What are the other things that you find yourself doing during the day?
Curt Widhalm 1:04:22
I teach, I work on our podcasts, I am training for a marathon, I cook, I spend time with my family and my kids.
Katie Vernoy 1:04:38
Okay, but if I were to actually like do a time study on you, what are you actually doing a lot of the time?
Curt Widhalm 1:04:44
Second screening on my phone.
Katie Vernoy 1:04:48
Okay, so, um, let’s use that one because that one’s actually a good tiny habit here. So second screening on phone. Okay, so potentially, and I know this isn’t motivating to you. So we’re gonna do a thought experiment on this one, because I don’t think you’re going to actually do it. But if you were to stop, to stop second screaming on your phone, yes. How much impact do you think it would have on the amount of time you you have in the day?
Curt Widhalm 1:05:19
Katie Vernoy 1:05:21
I would I would beg to differ. Someone who has to take 40 minutes to have a two minute conversation with you. I would, I would, I would beg to differ.
Curt Widhalm 1:05:34
I get productive things done sending emails responding to people while having these 40 minute conversations.
Katie Vernoy 1:05:44
So you’re just wasting my time?
Curt Widhalm 1:05:47
Yes, I’m only seeing how this is affecting you.
Katie Vernoy 1:05:50
All right. So maybe we can’t even do a thought experiment.
Curt Widhalm 1:05:52
Thought experiment. My doctor will be like, Why is your hand grips like there’s always a phone?
Katie Vernoy 1:06:05
So potentially in this thought experiment?
Curt Widhalm 1:06:07
Potentially, some of our meetings would be shorter, and I would be able to then have shorter meetings that allow for me to actually go and work and be productive on things.
Katie Vernoy 1:06:20
So what is your level of motivation to decrease your second screening or to instead, to frame it positively, be grounded and mindful and present, without other distractions? Like the second screen? How motivated are you to do that?
Curt Widhalm 1:06:38
I don’t know. I’m supposed to say the right thing.
Katie Vernoy 1:06:42
You’re not motivated at all. So what is your ability to do this? To to stop second screening?
Curt Widhalm 1:06:51
I mean, the ability is, is there? It’s…
Katie Vernoy 1:06:54
Well, what would you have to do to not second screen? Are you second screening right now?
Curt Widhalm 1:07:00
I am, because I’m trying to see how long it’s gonna take my Uber to get here to get to my office, because I have a hard out at two o’clock.
Katie Vernoy 1:07:07
Got it. Yes. But what would it take to what’s the ability that it would take to actually decrease your second screening or, or, or be able to stay more focused on the primary focus of whatever you’re doing?
Curt Widhalm 1:07:24
Part of it would be to have meeting partners who actually get to the frickin point sooner.
Katie Vernoy 1:07:30
I think I don’t get to the point, because you’re looking down and I’m like, Are we here yet? What’s going on? Okay, I’ll talk to somebody else. So.
Curt Widhalm 1:07:42
But that that goes back to community. That gets back to kind of the way that we interplay with each other? And yeah.
Katie Vernoy 1:07:48
Yes. So if, if I call you out on your second screen.
Curt Widhalm 1:07:52
Then I gotta call you out. And be no, I gotta be like, say something important? Keep my, my attention.
Katie Vernoy 1:07:58
All right. All right.
Curt Widhalm 1:07:59
I Wordles to work on.
Katie Vernoy 1:08:05
So if we’re looking at more mindful focus, single focusing, single tasking, what is the smallest behavior that you could do to start in that direction? What is the tiniest little thing to do?
Curt Widhalm 1:08:24
Honestly, the tiniest little thing that I can do is spend 5 to 10 minutes, the night before my day, and look at what are the tasks that I need to get done, and when am I most likely to get them done. And this goes back to our wonderful structural self care workshop that we had done. That is something that works best with my flow of needing to put the things out in my environment that makes the next day easier. And by and large. That takes five to 10 minutes, most days for me.
Katie Vernoy 1:09:06
Okay, so let’s actually do that as a real tiny habit. So what what you’re supposed to do is you’re supposed to find the tiniest habit. So this is a, a mini peek at the next day and planning that takes five to 10 minutes.
Curt Widhalm 1:09:19
Katie Vernoy 1:09:20
Okay. Do you know what to dothere? Like, do you have a plan? Like, does it make sense? Do we need to define it any further?
Curt Widhalm 1:09:26
No, I know what I’m doing with this.
Katie Vernoy 1:09:28
Okay, so then we need to find a good prompt. What BJ Fogg talks about with a good prompt is that action prompts are better than person prompts. So like having someone tell you or having you remember it, or context prompts, which is like having a little reminder pop up on your phone. So do you have a behavior that you could then follow this new new habit with; planning the next day?
Curt Widhalm 1:09:53
I respond really well to those prompts that come up on my phone and find…
Katie Vernoy 1:09:59
My texts, my unanswered texts would beg to differ.
Curt Widhalm 1:10:03
When my reminders come up on my phone, I’m really good at answering those.
Katie Vernoy 1:10:08
Curt Widhalm 1:10:09
Katie Vernoy 1:10:10
But is there a behavior that you typically do at the end of your day that this could attach to?
Curt Widhalm 1:10:15
So you’re talking about that Premack Principle of let’s pair a low frequency behavior with a high frequency behavior?
Katie Vernoy 1:10:22
Curt Widhalm 1:10:23
Honestly, for me in the way that most of my evenings go, I don’t necessarily see something that is an easy thing for me to just start pairing with that. Like, you know, I could say, I could do this while I brush my teeth, but I’m already you know, taking the dog outside and making sure that, you know, the kids are asleep and the doors are locked and that kind of stuff. So for me, honestly, something that already works in my environment is setting myself daily or weekly reminders to get something specific done. And so that…
Katie Vernoy 1:11:01
Well, let me help you really quick because I think the one of the things I didn’t add to this is to make this prompt, you want to match the physical location. So the physical location, the frequency, the theme, or purpose, and then find the trailing edge. And so doing it when you brush your teeth, yes, it’s the same frequency, but it’s not the same physical location. And it’s not the same theme or purpose. Now, I’m going to finish this up because we gotta go. But um in our systems of self care, or structural structural self care, whatever we call that. You talked about a closing out ritual for the end of your workday. So I’m going to assume that you actually practice that, and there’s some way that you close out your workday.
Curt Widhalm 1:11:46
Yes, there is.
Katie Vernoy 1:11:47
Okay. So what is the last step in closing out your workday?
Curt Widhalm 1:11:50
I put my laptop into my laptop bag, and I don’t take it back out.
Katie Vernoy 1:11:56
Okay, what is one step before that? What’s?
Curt Widhalm 1:12:00
I put the charging cord for my laptop in my laptop bag.
Katie Vernoy 1:12:04
Okay, two steps before that?
Curt Widhalm 1:12:07
I unplug it.
Katie Vernoy 1:12:09
Curt Widhalm 1:12:13
So, the last thing is that I do provide a as I make one last pass through anybody who has emails or something that needs to be responded to end of business day or end or my workday. And then I log out of my computer, I put it away, and I go home.
Katie Vernoy 1:12:29
Okay, so after you finish the emails before you log out of the computer, or maybe you log on to the computer, and then have a paper, I don’t know, if you want to have a paper with your list, or if you want to do that right after the emails. But before you put your laptop away between the emails and find the trailing edge there, the last thing that you do before you close out your computer, you do your five minutes of planning.
Curt Widhalm 1:12:50
Sure, yeah. But that seems very easy and doable.
Katie Vernoy 1:12:55
Okay. So you anchor it with, I’m already going through the last step, you you, you do the tiny behavior, which is your five minute check tomorrow. And then BJ Fogg says, do a celebration and so and put your laptop away. I’m done with the work day. So as we’re very long on time, and we need to get going, I think it’s something where it’s important for us to look at this process and get to what is the takeaway that you have here on this process?
Curt Widhalm 1:13:25
The takeaway is, I actually need to be mindful and come back to goals rather than just leaving them out in the distance. But to be able to put specifics towards these more amophous goals, be more accountable to the people around me by actually talking to them about it, relying on my community, coming back and evaluating how I’m doing towards these goals. And doing small steps along the way actually makes it seem more achievable.
Katie Vernoy 1:13:57
And I think that’s really, really important. Because I think, if you don’t create the small steps, if you don’t get to the habit point, you don’t celebrate, you don’t evaluate. And that’s a really important point you need to evaluate if these things are working, because if you find that you’re not doing this, this habit, gotta figure out why and assess. But I think if you don’t do those assessments, I think that you’re not going to end up getting to the goals that you want, or you might be on the wrong track. And you end up like, Hey, I’m doing a really good job of this habit, but it’s not getting me closer to my goal.
Curt Widhalm 1:14:23
Katie Vernoy 1:14:24
And so very briefly, there’s another article I’m gonna link to it’s on common factors and the magic that that change requires magic, it’st Starreveld 2021. It goes through some of the the bias and assumptions that are potentially playing into this as a clinician, and so I’m going to briefly talk about them and then we’ll close out. The first one is kind of this paradigmatic assumption, which is the beliefs the cultural, religious or other belief paradigms. Curt and I talked, talked about this with roles, Head of Household, financial things. It’s important that we know what paradigms are playing in on the goal so that we don’t get into the distinction that you and I had around, I would be very upset about being a bottleneck. That’s not as compelling to you. There’s other things that were more meaningful. Causal: where did the problem start? Who’s responsible for positive change? This goes into intrinsic and extrinsic motivation. But it’s important that we understand what our clients believe the cause of the problem is, and you got to: I don’t say no enough.
Curt Widhalm 1:15:31
Katie Vernoy 1:15:32
So that’s a whole that would be a whole therapy session in and of itself, at least one. And then prescriptive is kind of what do we think works? What I think works isn’t what you think works. And so I need to keep playing through and really getting to a place of who is the person I’m talking to? And how do I make sure that my assumptions are not playing into what the solution is? Because like I said earlier, I would just say like, Hey, go through your caseload, pick out the 15, you’re gonna keep and close out the rest. That happens in a month, right? You can do. That that’s possible. If you really want to make this change. You’re saying, I don’t want to do that. I want to do this other thing. And I think this is this is a stronger, stronger way to do it. So anyway, I’ll finish it up there. I think there’s obviously always more to talk about with goal setting, because it’s really one of the fundamentals of of how we do our work. But yeah, I think it’s something where if we take a little bit more time with it, I think our clients will be better served. And if we do this for ourselves, we’ll be better served.
Curt Widhalm 1:16:27
You can find our show notes over at mtsgpodcast.com. Follow us on our social media, join our Facebook group, the Modern Therapists Group, and you can support us and the pursuits that we do consider becoming a patron and enjoy things like the outtakes of our shows. And, or you can support us through things like Buy Me a Coffee, or get your CEs through us and listen to directions at the beginning and the end of the end of the episode for instructions on how to do that. And until next time, I’m Curt Widhalm, with Katie Vernoy.
Katie Vernoy 1:16:57
Thanks again to our sponsor, Thrizer.
Curt Widhalm 1:17:00
Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinicians should earn what they are worth. Every time you build a client through Thrizer an insurance claim is automatically generated and sent directly to the clients insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly and directly into their bank account. By eliminating reimbursement by cheque, confusion around benefits and obscurity with reimbursement status they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick and easy to get set up and it works great with EHR systems.
Katie Vernoy 1:17:41
Their team is super helpful and responsive and the founder is actually a longtime therapy client who grew frustrated with his reimbursement times. Thrizer let you become more accessible while remaining in complete control of your practice. Better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free. You will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.
Curt Widhalm 1:18:15
Once again, sign up at bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free.
Katie Vernoy 1:18:25
Just a quick reminder if you’d like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.
Curt Widhalm 1:18:40
Once again, that’s moderntherapistcommunity.com
Thank you for listening to the Modern Therapist’s Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter and please don’t forget to subscribe so you don’t miss any of our episodes.
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