What Actually is Therapy?
Curt and Katie chat about the confusing laws related to telehealth and other technologies that open up questions of how therapy is actually defined. We look at what is not therapy, what constitutes a therapy session, what differentiates therapy from coaching, and how therapists can navigate confusing laws related to texting, telehealth, and interstate communication with their clients.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we talk about what therapy is and what it is not
Curt identified some laws that don’t quite work because what is considered therapy is changing. What time does therapy happen if you are texting? Where is it located? And what actually is therapy and needs to be held under the laws of the profession AND the laws regulating telehealth and technology?
Why does Curt want to fix the telehealth laws?
- Rules surrounding knowing where your client is and safety depend on therapy happening concurrently.
- New types of therapy (like texting and asynchronous messaging) don’t have the same parameters to be able to identify what is supposed to be documented in therapy sessions.
What is therapy and what is not therapy?
- Therapy versus coaching
- Therapy versus coping skills training
- What is therapy versus what is therapeutic
- Does the presence of a therapist make something therapy?
- What about continuity of care or coping/coaching calls when someone is traveling?
- Things that are called therapy and are not: retail therapy, conversion therapy
- What is billable to insurance?
How do we differentiate what we do from non-therapists?
“What is it that makes us – as [therapists] licensees or as registrants, or people studying to be in this field – what is it that we actually do that separates us from the coaches and from everybody else?” – Curt Widhalm, LMFT
- Deeper emotional work within psychological principles
- Legal responsibilities of confidentiality
What is a therapy session?
“I am a therapist. My relationship with my clients- who I’m a therapist for – is as a therapist. Not everything that I provide to them is therapy, I don’t believe.” – Katie Vernoy, LMFT
- Therapy sessions versus coaching calls
- Therapists define what is a therapy session (according to CAMFT)
- We need to make sure that we clarify with clients what therapy is with each of us
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!
Our Linktree: https://linktr.ee/therapyreimagined
Relevant Episodes of MTSG Podcast:
Rage and Client Self-Harm: An interview with Angela Caldwell, LMFT
It’s the Lack of Thought That Counts: Ethical Decision-Making in Dual Relationships
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts include advertisements from the time of posting.
Curt Widhalm 00:00
This episode is brought to you by Thrizer.
Katie Vernoy 00:02
Thrizer is a new modern payment platform for private pay therapists. Unlike other credit card processors Thrizer automatically submits claims and deposits reimbursements for your clients with every appointment charge.
Curt Widhalm 00:15
Check out bit.ly/moderntherapists to learn more.
Announcer 00:20
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 00:35
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 things that go on with our practices, things go on with our clients, and answer the largest questions in life. And today is a seemingly philosophical debate and, you know, as the instigator that I am, I like to look at: Where do we have some gaps maybe in our laws and our ethics? And bear with me here, for a moment, this is going to meander a little bit, but it’s going to get into a really good philosophical debate that actually does have potential legal and ethical ramifications. So I’m gonna start with a little place in some California laws, I assume that some of the other states have maybe this same gap out there. California law requires that when we do telehealth with clients at each and every single session, we need to document where the client is located. Now, this comes with the idea that in the event of an emergency, we know where clients are, so that way we know how to best call in for higher levels of intervention or those kinds of things. The problem becomes, when things like asynchronous therapy exists. When, you know, we have newer forms of therapy that might benefit some clients even better. You know, writing, you know, emails or letters to each other. We’ve heard some people talking about how some of the online platforms have kind of this back and forth where it’s not necessarily at the same time. Clients fill out worksheets on their time, it allows for them to better formulate their thoughts, they don’t feel pressured by somebody just sitting right there waiting for them to respond. And we would generally call this asynchronous therapy. And at least as far as California is concerned, asynchronous therapy is acknowledged in our statutes. Now, the problem becomes, how do you document where a client is located? And when therapy exists, if you are participating in asynchronous therapy? Is it when I sent the email or the stuff to clients? Do I need to also have them be like, hey, whenever you open this just quickly type back, like where you’re located at that time? If this is even getting into things, like sending stuff to clients, and then they travel out of state and open it up out of state, are we now violating interstate licensing jurisdiction laws? So the question becomes, not only how do we do that, but the very philosophical question in and of itself. What is therapy?
Katie Vernoy 03:30
Yeah, I think some of what you’re talking about feels a little silly. Because I don’t know that like the asynchronous stuff, like, Do you really think that there’s going to be some sort of a llegal reckoning around that?
Curt Widhalm 03:42
Where the one in 1 million chance that this happens, I want to be on record that this was at least discussed. I mean because because we do get people every so often, who are like, Hey, I had this like one in a million things sort of happen. And maybe Curt and Katie have this episode, and they go back through our archives, and they find that episode. So hey, future person doing asynchronous therapy, you are welcome.
Katie Vernoy 04:14
Well, I think the question goes beyond the crazy telehealth laws, because I think it is important that we understand the telehealth laws that we understand what’s happening…
Curt Widhalm 04:23
And follow the law.
Katie Vernoy 04:25
…and follow the law. But if the law doesn’t speak to it, how do we address that?
Curt Widhalm 04:29
Then we fix the law.
Katie Vernoy 04:31
But we are not the people fixing the laws.
Curt Widhalm 04:35
That’s the point of this is we can now point to we’re in the archive of having discussed this. Mental health professionals are discussing that we need to fix gaps in the law. So that way, future people don’t get in trouble.
Katie Vernoy 04:49
All right, all right. We’re on record. But to me, it seems like you know, there’s quick phone calls that happen that are like, Hey, I just need a quick check in. I mean, you’re saying that the law suggests that every single time I communicate with my client that I’m supposed to say, Okay, before we get started, where are you?
Curt Widhalm 05:07
I mean, you probably should, because if this is a crisis situation where somebody needs that kind of in between session contact, part of your protocol should be like, alright, we kind of got to know what the situation is. So that way we best know how to handle what’s going on.
Katie Vernoy 05:26
Sure, sure. But I mean, like a quick like, Hey, I was thinking about what you said, and I wanted to have a quick phone call. And it’s two minutes.
Curt Widhalm 05:34
That’s the point of this conversation. Is I did, you know, annoy the attorneys at CAMFT on this. Because one of the beautiful things about CAMFT membership is being able to call up and talk to the attorneys. And I asked this question to them. And I think in general, when I call them with legal questions, they’re like, alright, we got to put our best and brightest on this. And because this is…
Katie Vernoy 06:01
And we’ll get back to you,
Curt Widhalm 06:03
That’s what happens. They’re like, we got to call you back. We don’t know.
Katie Vernoy 06:09
Did they get back to you? Are they still working on it?
Curt Widhalm 06:11
They did. And listen for the end of the episode, and I will give what their response is.
Katie Vernoy 06:16
All right. All right. So it’s our responsibility, okay, you’re gonna know the law, we’re supposed to know exactly where they are at all times. But it’s our responsibility to have a sense of how we can best keep them safe. And part of that is knowing where they are, when we’re doing therapy with them. And the point of our conversation is, when are we actually doing therapy with them?
Curt Widhalm 06:37
Yes.
Katie Vernoy 06:38
Okay.
Curt Widhalm 06:38
Because if, you know, some of our platforms allow for clients to reach out to us by, you know, text message, or through the platforms or this kind of stuff. If a client texts you like, I am having a panic attack, and you text them back. Breathe. Like if that is something that you would talked about in a session, what you’re doing in that particular moment is you are providing a evidence based psychological intervention for somebody in the midst of a mental health condition. That seems to be therapy.
Katie Vernoy 07:13
Okay. So the law says…
Curt Widhalm 07:17
The law doesn’t say anything. I’m setting out to create the definition to put into the law.
Katie Vernoy 07:22
To make it harder for all of us. Thanks. So, but according to the current law, it would the response shouldn’t be ‘breathe,’ it’s ‘where are you?’
Curt Widhalm 07:32
I mean, even that’s a mindfulness intervention of like, take notice of where you’re at. communicate that to me. Two birds, one stone.
Katie Vernoy 07:39
What is your current address? What is your current location? And then breathe?
Curt Widhalm 07:44
Yes.
Katie Vernoy 07:45
Like that is, that is your what you’re suggesting? Is is happening in…
Curt Widhalm 07:50
That’s, that’s what we…
Katie Vernoy 07:53
…the law as it stands.
Curt Widhalm 07:53
Yeah.
Katie Vernoy 07:55
Okay, well, I mean, I can see the intent. But I think it is hard. Because what if the client says, I’m so frustrated da da da da da… And you’re like, you know, ‘Remember what we talked about. See you in session next week.’ Is that therapy?
Curt Widhalm 08:11
I mean, that’s crappier version of therapy, other than ‘Remember that we talked about breathing? How about breathing now?’
Katie Vernoy 08:20
No, no, no, it’s not like the ‘I’m having a panic attack.’ Because that’s actually kind of a crisis. It’s more like, I’m so frustrated, and I didn’t I just, you know…
Curt Widhalm 08:27
Okay. So what you’re saying is that the severity of whatever’s going on with a client determines whether or not it’s therapy.
Katie Vernoy 08:34
Yeah, well, at some point it is like, ‘when’s our next session?’ And the answer is, you know, ‘Tuesday at two.’ Like, like, that’s not therapy.
Curt Widhalm 08:43
Sure. Okay. So let’s work towards finding a cooperative definition here.
Katie Vernoy 08:50
Well, I think if we get too in the weeds on this, this isn’t gonna be that interesting. But there is an interesting definition that apparently has been put together by the masses on Wikipedia. That doesn’t really help us that much, but I’m gonna read it anyway.
Curt Widhalm 09:02
Okay.
Katie Vernoy 09:03
‘Psychotherapy, also psychological therapy, talk therapy, or talking therapy is the use of psychological methods, particularly when based on regular personal interaction to help a person change behavior, increased happiness and overcome problems. Psychotherapy aims to improve an individual’s well being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions and to improve relationships and social skills.’ But it goes on but using psychological methods to help people is kind of what Wikipedia got to.
Curt Widhalm 09:36
So there is plenty of aspects out of the field of psychology that is used by people who are not therapists.
Katie Vernoy 09:46
Yes. Like you and I talked about this a lot before the episode. Like actually getting to a definition of what is therapy and what is not therapy? I mean, we have an episode on the line between therapy and coaching. We’ll probably talk a little bit more about that kind of distinction here. There’s also therapy versus coping skills. When I was working in community mental health, we had bachelors level folks that were doing coping skills stuff, and we billed a different rate through Medicaid and it had different qualifications. There are things that are therapeutic, that aren’t necessarily therapy. And so I think it’s something where getting to a definition to determine what qualifies here is tough.
Curt Widhalm 10:29
On that point, so I’m going to pick a couple of the words that you were saying here, there’s an article from Becker called ‘Wilderness Therapy: Ethical Considerations for Mental Health Professionals.’ And this is from 2009. And in Child and Youth Care Forum. And amongst a very good description, a lot of this applies to wilderness therapy here. But…
Katie Vernoy 10:54
Is this the type of therapy where they send kids off? Because they’re bad, quote, unquote?
Curt Widhalm 11:00
Some programs do that? Yes.
Katie Vernoy 11:02
All right. So I would argue not therapy, but… continue.
Curt Widhalm 11:05
Well, one of the points that Becker makes in this is that there are distinct differences between what is therapy and what is therapeutic. And that has to be something that is emphasized because there are lots of things that people do because they feel therapeutic, retail therapy, wine therapy.
Katie Vernoy 11:27
Going out into nature.
Curt Widhalm 11:28
Depending. Well, I mean, even and this is discussed in this particular article of wilderness therapy is going out into the wilderness or on a hike or camping or something where a mental health professional is using psychological principles to help clients better get into their emotions. And that is distinctly different than going on like a therapeutic hike.
Katie Vernoy 11:56
Sure.
Curt Widhalm 11:57
So okay, is it the presence of a therapist that makes something therapy? Not necessarily. Like I mean, there’s a lot of just times where I’m sitting there while the client is talking, where I don’t know that my presence has necessarily moved the needle for them.
Katie Vernoy 12:15
Sure. And I think there’s a lot of times when I’m in therapy with my clients, where there’s elements of it that are more skills based, and could be pretty similar to an executive coaching session. And I have clients who are executive coaching clients who I do similar skills, I just don’t do the part that’s therapy. And so the way I define therapy in that regard is it’s it’s when it really gets into more processing healing practices versus practical skills. And that’s how I distinguish it. But I think it’s, I think it’s hard because even people that are trying to distinguish between coaching and therapy, I think, have their own definition. Some it’s like, oh, therapy is past focused, and coaching is present focused or future focused. It’s like, and that’s that. I don’t agree with that.
Curt Widhalm 12:58
I don’t agree with that, either. Because what that is describing is, I’m going to shortcut a lot of just, you know, theoretical orientation debate here.
Katie Vernoy 13:07
Sure.
Curt Widhalm 13:07
A lot of that is describing the nature of therapy with that particular therapist.
Katie Vernoy 13:14
Yes, because it really is orientation based, right? Like…
Curt Widhalm 13:17
Right.
Katie Vernoy 13:18
If somebody’s considering therapy, very past focused, I mean, that feels a little bit more like an old school focus on you know, kind of psychodynamic or you know, those types of things where, as a coach, and as a therapist, I feel like I’m pretty balanced between past, present and future.
Curt Widhalm 13:35
Well, I mean and look at how many guests that we’ve had on you know, Angela Caldwell comes to mind of like, you know, talking about family therapy does not seem to necessarily be about making people feel better. I mean, she actively describes as like…
Katie Vernoy 13:47
Trying to make them feel worse.
Curt Widhalm 13:49
Fight therapy, we got to burn stuff down.
Katie Vernoy 13:51
Therapy Fight Club. We’ll link to that episode in the show notes. It’s really good.
Katie Vernoy 14:01
Just gonna pop in here real quick to tell you more about our sponsor Thrizer. A payment processing solution for private pay therapists.
Curt Widhalm 14:08
Every time you charge a client through Thrizer an insurance claim is automatically submitted to their insurance and processed for out of network benefits. Most Thrizer clients get reimbursed within one to two weeks seeing an average of 80% of the session costs reimbursed directly to their bank accounts.
Katie Vernoy 14:23
That is amazing. But even more amazing is that clients can have the option to choose to only pay their copay amount and a lead for Thrizer to wait for the reimbursement instead. The platform starts completely free for clients and you only pay a standard 3% Payment Processing Fee.
Curt Widhalm 14:40
Go to bit.ly/moderntherapists and use the code ‘moderntherapists’ to enjoy an entire month without credit card processing fees as you get up and running.
Curt Widhalm 14:54
So if that’s the nature of therapy, we still are working on getting towards What is therapy? The nature of therapy can happen in nature. It can happen not in nature. Therapeutic things can be things that happen with or without a mental health professional. But if we’re really honing in on like, What actually is therapy here?
Curt Widhalm 15:21
Yes.
Katie Vernoy 15:21
And why is that question important? I mean, you brought up the question around when do we have to document where a client is?
Katie Vernoy 15:24
But I think it’s also like when a client is traveling to another state…
Curt Widhalm 15:32
Yeah, absolutely.
Katie Vernoy 15:33
…and needs a quick coping call. And it’s coping strategies. You know, you’re a therapist, you’re maybe having a continuity of care or a coping session call. And it’s not, I’m not billing that as therapy. But it still is something that, you know, some people were like, Oh, well, you can’t even talk to your client, because they’re in another state, because de facto, you’re their therapist, and you’re providing them therapy. And so I think there’s that nuance. There’s also what can you bill insurance for? And it’s potentially also what some people are using to describe, they’re using the the name therapy, like conversion therapy, which I would say is torture, not therapy.
Curt Widhalm 16:07
Sure. Agreed on that one. So that is something that is not therapeutic, that has therapy…
Katie Vernoy 16:16
In the name and is not therapy either.
Curt Widhalm 16:19
Okay, let’s let’s go to your insurance example here. You know, this is even a matter of, you know, CPT codes. Of, you know, therapy according to the insurance companies, this is a sarcastic outsider’s view not to be taken, as you know, the word of all things for everyone. But therapy, according to insurance companies is how much time a therapist spends with somebody doing things. Unless, it’s too much and the wrong CPT code is used. And then it’s not that.
Katie Vernoy 16:52
And a lot of, I think regular insurance companies only have kind of the basic therapy with the client, and the different timeframes, collaterals with the client present, or collaterals without the client present. So you can either you can talk to a parent, you can talk to a family, or a couple or you can talk to the client. But it Medicaid codes have a lot more, which also include case management. And I’m assuming these are probably other insurance, but just know, very few insurance companies actually cover these codes, or consultation, or I think there was a team case consultation for a long time and got to change something else. And then also more of the skills building that is not therapy, as well. And so as a therapist, when I was billing insurance, or when I do out of network billing, it’s all therapy, whatever I’m doing with the client is therapy. And I think I can legitimately say that because it’s usually within the confines of a therapy session. And as we talked about on our nickel and dime, when I don’t necessarily charge for quick phone calls outside of session unless they’re long. And so for insurance purposes, as a therapist, everything I do is therapy.
Curt Widhalm 18:01
Okay, I’m gonna go back to a point from Becker here for a second, that: Is everything that you’re doing during that session actually therapy, though?
Katie Vernoy 18:12
Probably not. And there was actually some feedback within community mental health that the time spent, you know, talking about scheduling for the next week, we could not bill that minute.
Curt Widhalm 18:25
Sure.
Katie Vernoy 18:26
And like, we actually had to pay attention to those minutes. And I would argue the cadence and frequency of therapy is a therapeutic activity.
Curt Widhalm 18:34
And, you know, even a lot of this comes down into, you know, anybody who’s hanging on this long waiting for a common factors arguments, here’s, here’s that part of the episode. But yeah, how often do we hear it, you know, it’s about the relationship. And this is, you know, something where I had a termination session last month, were talking with a client who has been in and out of my practice over the course of years, and has reached a lot of their goals and brought in the client and I brought in parents and said, you know, what, I think we can step away from sessions for a while. You’ve reached all of the goals that you’ve needed to reach. Go and have your life. And here’s kind of the, if these things come up. These are particular times where you might want to consider reaching out for one or two sessions. And the ongoing discussion about that was, it was therapeutic for them to know just that there has been a consistent presence and availability, even if they aren’t actively working with me. Now, I would love to bill their insurance company for that continued ongoing therapeutic presence that I provide for them.
Katie Vernoy 19:43
Sure.
Curt Widhalm 19:44
But that’s obviously not therapy here.
Katie Vernoy 19:47
No, no. Well and I was just thinking of kind of when we’re talking about the relationship, and that common factor is that the relationship is one of the most important parts of therapy. I’ve had clients text me ‘I got the raise,’ ‘I got the promotion,’ and me texting back, ‘Awesome! Hooray!’ I mean, that’s praise.
Curt Widhalm 20:07
Sure.
Katie Vernoy 20:07
That’s the relationship. And according to the crazy telehealth laws, I need to say, ‘Where are you? Hooray!’
Curt Widhalm 20:19
‘What is your nearest emergency?’ Start time of text 11:08am and 14 seconds ends time of text 11:08 and 23 seconds. Yeah, even even a preset series of emojis that like you can just like send out to somebody. I mean, the point of getting ridiculous with this, though, is we have a lot of discourse in the field and a lot of arguments over What is the nature of therapy? And we hold on to that and maybe conflate that with What is therapy? You know, all things set aside, you know, this is something where we know what therapy is. Except for those conversion therapy folks, go fuck yourselves. But if we can define what therapy is, I think that it helps to move this discussion to something where, when it comes to maybe more helpful than, you know, the one in a million, you know, asynchronous therapy people, but especially in this interstate therapy definition of that is something that we do see people get in trouble for more regularly. And there have been lawsuits over you know, especially during the pandemic, of therapists working with clients who move to other jurisdictions of this being disruptive to what is therapy. But it’s really getting clear on What is it that makes us as licensees or as registrants, or people studying to be in this field? What is it that we actually do that separates us from the coaches and from everybody else? Okay: diagnose? But that’s a first session, sort of…
Katie Vernoy 22:12
And not all therapists are able to diagnose.
Curt Widhalm 22:14
Sure.
Katie Vernoy 22:14
It’s not necessarily a dividing line for all therapists.
Curt Widhalm 22:18
So other than agreeing to jump through a bunch of licensing boards, processes, what is it that we do that’s different than those people out there who are doing something therapeutic for people. And maybe another example of this, while you’re thinking of this is, look at how much content creation out there by therapists has the disclaimer audit of this does not condone therapy or not in a therapeutic relationship…
Katie Vernoy 22:44
This is not a substitute for therapy.
Curt Widhalm 22:45
Yeah.
Katie Vernoy 22:46
Yeah. For me, I feel like therapy is a process that the therapist and the client engage in, that is more about healing and processing and deeper psychological principles than what coaches are doing. And there’s more of a space in therapy forkind of a free range of expression and conversation in therapy, than there is in coaching. In my kind of experimentation around: Who am I as a therapist? And who am I as a coach? Whether it was, you know, kind of that initial conversation with clients around? Do I provide therapy to you? Or do I provide coaching to you? Which one is more appropriate? Or, in those rare cases where there’s a conversation, there may be a discussion around switching, if appropriate, and we have a whole episode on dual relationships. And I promise I went through the 17 steps. But you know, and typically didn’t switch. But in looking at what therapy is, therapy feels like this, this deeper process where it’s a little bit more free range, it’s a little bit more as far as like the conversation, it’s a little bit more processing and feeling and digging into psychological principles, whereas coaching feels much more directive. And, again, this may be to the same thing that you’re talking about, of it being therapist style, but coaching, you know, for example, if I have a therapy client who is an entrepreneur, and they’re doing something illegal, I just allow that to stand and talk with them and do all those things. As a coaching client, I’m going to call you out on that, because part of my responsibility is making sure that your business is going to be successful.
Curt Widhalm 24:33
Sure.
Katie Vernoy 24:33
Right? And so I’m more directive, it’s more knowledge based. Now, I flow sometimes between those two, but the therapy element, there’s so much more room I feel like to be expansive into the emotional process that I don’t feel like I have in coaching. Though, my fear is that some coaches go there and they don’t have the skills to help people uncover and deal with that kind of raw emotion. And so that’s the concern I have about coaches who aren’t therapists. But I think for me, that’s how I distinguish between the two. And so when someone’s at more of a place of skills and strategy, and that kind of stuff, I feel like they can get more coaching, and don’t need as much therapy, because the huge emotional process has kind of already happened. So to answer your question of like, what’s different that therapists do than what coaches do? For me, it’s, it almost feels like it’s, it’s hard to define, which seems to be the case for everybody. But it feels like it’s a more emotional process, it feels like it’s a deeper psychological process than what typically happens in coaching, at least for me.
Curt Widhalm 25:40
You know, part of the really broad definitions, and maybe why there is so much, you know, discourse between therapists about what I am calling the nature of therapy here and where different approaches, end up meeting clients with different needs is actually a good thing that it’s not so well defined. And it seems to be speaking to, all right, we want to help people. We want to use these behavioral principles. There’s a certain agreement of, you know, legally guaranteed things like confidentiality. There’s standards that were upheld to that things like coaches don’t necessarily have to follow. We can define what therapy is not.
Katie Vernoy 26:28
Yeah.
Curt Widhalm 26:28
And part of the struggle of this is being able to point to things like, Okay, here’s where the line where, here’s what therapy definitely is, it’s not necessarily exclusive of any sort of singular, one aspect or another. And this changes even from jurisdiction to jurisdiction. So we have clients, we tend to work on their emotional processes, we use things psychologically oriented, or based out of psychological principles to do that, we work on relationships, depending on the nature of your license, and who the client is that having our licenses and being a part of, you know, these professions allows for us to do in a more consistent way with a wide variety of people. That’s what it allows us to do. And I know that this is maybe pedantic. So now, are we needing to define what is a therapy session?
Katie Vernoy 26:29
I think that’s actually more accurate. Because to me, as we’ve been talking about it, I am a therapist. My relationship with my clients, who I’m a therapist for is, as a therapist. Not every thing that I provide to them is therapy, I don’t believe. And so it becomes what is a therapy session? I mean, it still doesn’t really help the folks that are doing asynchronous therapy sessions.
Curt Widhalm 27:53
Actually, this might help them even more, but…
Katie Vernoy 27:56
Sure, but I think there’s that element of, you know, as a therapist, if I were to charge differently for coaching sessions with therapy clients versus therapy sessions with therapy clients. You know, coaching sessions mean more like DBT coaching calls or things that are more specific, tighter timeline, that kind of stuff. Like, does that interact with these laws? Or does it just confuse things more?
Curt Widhalm 28:22
So for those of you who are waiting for the appeal to higher authority, in which the wonderful attorneys at CAMFT told me when they called me back, is: there’s nothing in statutes, and there have been no cases that have gone through the courts that have necessarily defined what is therapy. And in the absence of those things, what a therapy session is, is ultimately whatever the therapist defines it as.
Katie Vernoy 28:54
But in the nature of consumer protections, it might also be How the client or patient describes it as a therapy session.
Curt Widhalm 29:03
I love that and I was ready to just ‘boo’ whatever answer that you came up with. But I love that because if we encourage as far as you know, what’s on your websites, more importantly, what’s in your informed consent is being able to describe the nature of therapy with you. You should work towards defining what is a therapy session and what is not in your informed consent paperwork. And you know, you talked about DBT coaching calls. I think this is a great example of where what is defined as therapy and what is defined as a coaching call is very much set up within that structure.
Katie Vernoy 29:42
Yeah.
Katie Vernoy 29:43
Sure.
Curt Widhalm 29:43
Individual therapy sessions with your individual therapist. Coaching calls happen at these times in this format. And so the better that you can structure yourself like that, if you are those one in a million case, sort of people, this is where just a little bit of a forethought of defining like, okay, ‘When is it a therapy session.’ If you need a check in, in between sessions to better be able to apply the skills that we have… I’m taking straight out of DBT here.
Curt Widhalm 29:43
…reach out to me and these ways. We’ll talk about the principles that we put into place to help you generalize them to the environment. Those are coaching calls. And you know, whatever structure you got set up for, however you’re billing, those things also be clear and upfront about that. And that seems to be a good place to maybe settle on, here’s what therapy is with you.
Katie Vernoy 30:35
And yet, we still haven’t solved the problem of texts and asynchronous.
Katie Vernoy 30:40
But if all that you do are these asynchronous sessions, quote, unquote, or asynchronous messaging, I mean, I can almost see it as something where within a an asynchronous therapy app, it tags where you are when you write a text, and you have to have your GPS on. Like, that’s the only way I see this working. Because I think therapists having to ask before they respond to something, or having to figure out where their clients are in this asynchronous fashion. I mean, sure, if we’re sitting down, and we’re just texting back and forth. And it’s synchronous, but just written therapy. That’s one thing. But if it’s, I’m having a panic attack, and I don’t know what to do about it, you know, and you respond 30 to 50 minutes later, it may be, even if you say breathe, it may not really be therapeutic. And it’s just one of those things where it’s like, it’s, I still feel like, there is a problem here.
Curt Widhalm 30:40
Define it.
Curt Widhalm 31:45
Let’s take this to an even more absurd place. You know.
Katie Vernoy 31:48
All right.
Curt Widhalm 31:48
What if I am walking through TJ Maxx picking up decorative pillows for my office, and one of them has ‘breathe,’ you know, stitched onto it? And a client is also in the same store as me? Is that therapy?
Katie Vernoy 32:04
I think not. But you would know where they were. But to me, it seems like this is an interesting time to be a therapist, because there are all of these different places where we have to define what is and is not therapy. Whether it’s in content creation, if it’s, you know, quick coaching calls when clients are potentially not where you’re licensed. I mean, I think there’s different things that we’re not going to recommend or say don’t do, you have to make your own decisions on these things and, you know, ethical decision making but and legal decision makin. But I think it’s something where it is important for us to understand it because we have to defend our decision making on what we’re providing to our clients and when and how much documentation and scrutiny that we do based on some of these telehealth and other types of laws.
Curt Widhalm 32:52
We would love to hear your thoughts on this and help us maybe come to a better conclusion than where we have arrived. We’ll include a couple of links in our show notes over at mtsgpodcast.com of some of the stuff that we’ve been looking at. And you can also follow us on our social media, you can join our Facebook group, The Modern Therapists Group, and if you want to continue to support us and the work that we do, please consider becoming a patron. We do some wonderful things for our patrons every so often. Join us on Buy me a Coffee, and until next time, I’m Curt Widhalm with Katie Vernoy.
Katie Vernoy 33:33
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Curt Widhalm 33:40
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Katie Vernoy 33:46
Go to bit.ly/moderntherapists and use the code ‘moderntherapists’ for a full month without credit card fees.
Announcer 33:53
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