What Can Therapists Do When Clients Don’t Get Better?

Curt and Katie chat about what modern therapists can do when their clients don’t (or can’t) get better. We explore what “getting better” looks like in therapy, what can get in the way of clients improving, how we can support clients who are unable to reach traditional treatment goals, and how clinicians can take care of ourselves while doing this longer-term work.

Transcript

Click here to scroll to the podcast transcript.

In this podcast episode we talk about how therapists can happen when clients aren’t improving

At a recent talk, we got the question – what if my clients aren’t getting better? We decided it was time to look at how goals are set, what “getting better” actually looks like, and how therapists can cope with clients whose treatment goals are “not getting worse.”

What does “getting better” look like in therapy?

• Treatment goals are often set based on functionality, independence, and productivity
• Outcome measures can be used to track improvement on mood, anxiety, etc.
• Goals of “not getting worse” or prevention of future concerns are often hard to quantify or are unsatisfying for therapists (and potentially for their clients)

What can get in the way of clients improving in therapy?

• Situational concerns that are not changed
• Longer-standing diagnoses that don’t go away, but can be stabilized
• When improvement is defined as reaching goals, rather than avoiding relapse

How can therapists support clients who are unable to reach traditional treatment goals?

“Don’t be hesitant with diagnosis, because if somebody’s going to need this ongoing care, they’re going to also need a record of that diagnosis.” – Katie Vernoy, LMFT

• Collaborative treatment goal setting
• Identifying appropriate expectations
• Quality of Life goals
• Showing ongoing medical necessity and documenting appropriate need for ongoing care
• Higher acuity and relevant diagnoses documented

How can clinicians take care of ourselves when we have longer term clients who don’t show dramatic improvement?

“It’s really being able to redefine what success actually looks like.” – Curt Widhalm, LMFT

• Getting clear on client’s capacity for growth
• Be clear on your own skills and capacity as a therapist
• On-going conversations with the client to determine whether other help is needed
• Exploring quality of life goals
• Identifying incremental gains and reframing to build hope
• Deepening the therapeutic relationship, focusing on the attachment
• Redefining success and understanding the pieces that are still uncomfortable
• Making sure that therapists do not define their own success based on client outcomes
• Destigmatizing long-term weekly therapy as a coping strategy

 

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!

Quality of life measurement article:  Measuring quality of life in mental health: Are we asking the right questions?

 

Our Linktree: https://linktr.ee/therapyreimagined

 

Relevant Episodes of MTSG Podcast:

Smarter than SMART: How therapists can improve goal-setting with clients

It’s NOT a Chemical Imbalance,  An interview with Dr. Kristen Syme

How to Fire Your Clients (Ethically)

How to Fire Your Clients (Ethically) Part 1.5

What to do When Clients Get in Their Own Way

 

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:

Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:17
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about the things that we do in our professions, the things that happen with our clients, and the ways that we look at things and trying to dissect all of the messages that we get from each other and about our field and about the things that we’re supposed to do and how therapy is the magical, wonderful place where everybody gets better all of the time. And if they don’t, it’s because you are a terrible therapist.

Katie Vernoy 0:48
Yes.

Curt Widhalm 0:50
Or creating some nuance to that conversation is the topic of today’s podcast episode. And this is conversations that have been around for a while. But a renewed interest in this, for us, comes from a question that we had received at the end of a presentation that we had done at a conference recently, where we had talked about doing client outcomes and measurements, and somebody asked, What about those clients who just don’t get better. And we are putting in place all of the good practical steps of reviewing what we’re doing, coming back to client treatment goals and this kind of stuff. And there’s just clients who aren’t making improvements. How do we do that while taking care of ourselves? Because these clients can also be a very big emotional drain on us as therapists. So what do we do with clients who just don’t get better, even though everybody seems to be doing what they’re supposed to be doing?

Katie Vernoy 1:52
Well, I think the first thing that comes to mind for me is what is quote unquote, getting better. Because I think oftentimes how we define success, the goals that we set, sometimes that’s based on what clinicians want, what family members want, dare I say what capitalism wants. I think that there is an element to this that some of the goals, being set, maybe have neurotypical norms, maybe they have norms based on kind of what mental well being has been described as, you know, whether it’s in a western culture or those types of things. And so sometimes it’s just reassessing the goal, right? Sometimes it’s saying, what is it that the client wants or and the client could be an individual, or the client could be the individual and the folks around them. But are we defining the goals wrong? I think is a first place to start, because oftentimes, we have these expectations that whether it’s insurance companies, or you know, like I said, capitalism, where each person has to be a productive member of society and work and feed into the machine, which I don’t think is actually true.

Curt Widhalm 3:07
When we were recording our prep for this episode, you can see that if you’re one of our Patreon members, but I was like, you know, this just sounds like a lot of capitalism, like, I’m just like everybody, and it’s, you know, who sets the goals, the people who are paying for it, the third party, you know, managed care companies and this kind of stuff that they need to meet these thresholds. If they don’t do it, it’s you as the therapist that suck. So little shout out for the capitalistic ways of supporting us through Patreon. But I have long taken the approach that good therapeutic alliance boils down to you and the client agree on what the goals are, and you agree on how you’re going to get there, and you agree on how you’re going to evaluate it. In the vacuum where money is not a thing, this looks like, hey, client, what do we what are we here to actually achieve? Here’s how we can do that. Or here’s the steps in between where you’re at now and where you’re at there. You know, this could be a miracle question kinds of things. It could be the DBT life worth living kinds of things. It’s already baked into a lot of theories already. And as long as we’re both like coming back to that conversation, Hey, how are we doing towards getting to that goal? It gives us the ability to reevaluate and look at the work that we’re doing with clients. Now, I think that in a lot of settings, where people are not practicing completely independently, they aren’t allowed fully to be able to be like client you get to fully invest in being the one who determines how good your outcome is. We’ve got a bunch of assessments that may or may not deal with your problem. PHQ-9, so we’re just going to track your PHQ-9s. And as long as we lower those scores…

Katie Vernoy 5:12
And the GAD-7s.

Curt Widhalm 5:12
Yeah. I mean, those all have good utility sorts of things. But we need to change the numbers on those things in order to justify why you continue to come and see me.

Katie Vernoy 5:25
I think that’s an oversimplification. But it also is, you know, accurate in a lot of senses. I think for me, the folks where it’s really redefining the goals, and not just saying Is your PHQ-9 getting better? I think it’s also there are folks where they’re not getting better. But the goal is to not get worse.

Curt Widhalm 5:47
Yes.

Katie Vernoy 5:48
And to me, those are the clients where they need this ongoing support. And if it’s, Hey, they were in the hospital four times last year, and this year, they’re in the hospital zero times, but they still feel as distressed, that is improvement, right?

Curt Widhalm 6:06
Mm hm.

Katie Vernoy 6:06
That’s still, you know, decreasing risk, improving the ability to stay in this community, lower level of care, whatever. But what about when it’s prevention, where someone is coming to you, and you’re able to keep them out of the hospital from the beginning, but there’s constant safety planning, and there’s constant work to keep them, quote, unquote, stabilized.

Curt Widhalm 6:31
What you’re talking about is the dynamic piece of care. And we’re we first learned about it, I first really learned about evaluating things in this way, in some kind of formal ways, when we were doing our lobbying work for MFTs to be part of Medicare. And through that process, we were asked about the scoring of the bills. You know, and this is how much does this cost? And there’s static scoring, and there’s dynamic scoring. And static scoring is just like, here’s how much it costs to implement, period. Dynamic scoring is, here’s how much it costs, but here’s how much it saves in these other places. And that’s really what you’re talking about is, it’s taking this more dynamic approach of being able to say, Hey, I’m at risk of just saying Katie’s things, but in my words, here, so giving her proper credits from, you know, a minute and a half ago, this is saving money elsewhere. And it’s being able to track that kind of stuff that really helps you to put into perspective, here’s how effective things are. Another way that I’ve heard about this is from friend of the show, Ben Caldwell, who borrowing from some of the lectures that he’s done in tracking client outcomes, whether you’re an individual and talking with your clients specifically, or whether you work in an agency is being able to track just what Katie is saying, as, here’s where you were before, here’s how things fit. But he has relayed that somebody in the audience of one of his presentations, did data tracking for their agency over the course of a year and found that almost none of their clients were getting any better. And they had to go in and look at some additional data and some additional tracking. And what it showed is that a lot of their clients, when they got to this agency in the first place, were on such a big downward trajectory coming in, that this clinics job was about stabilizing clients. And that’s what actually ended up helping keep this clinics funding going is, here’s where clients are coming in. We’re not getting like people’s, you know, GAD-7s you know, down to like ideal scores, but they’re not getting worse. And so this is really where things stand out as it’s knowing what to look for, you know, some some clients, as much as all of the published research says, These things make people better. There are still a number of people because of systemic issues in our world that are just going to be stuck at certain places for periods of time.

Katie Vernoy 9:24
I think there’s also you know, and we can we can have an argument about quote unquote, it’s not a chemical imbalance. I’ll link to that episode in the show notes. But there’s also you know, mental health concerns or mental disorders, serious mental illness that seems to be pervasive and potentially treatment resistant, like bipolar or psychotic symptoms, or those types of things. Yes, there are things that are situational that can impact those things. But there are folks that have brains that work differently, or, or systems that work differently where this is a constant struggle. It’s not, hey, I’m going to get better, I might get stabilized. But once stabilized, I may be hanging on by a thread. And I think the thing that that helps me to think about it is, when we are working with these folks and keeping them out of the hospital, for example, or from having these big down swings, you know, we’re smoothing out their ups and downs, those types of things. There’s an article and a link to this in the show notes about quality of life measurement, where if we actually dig deeper, folks that are at that space where, you know, serious mental illness, it’s about a decrease in mental ill being versus an increase in mental well being. That looks like I’ve calmed my life down and I’m, I’m avoiding relapse. And avoiding relapse may be not trying to get that more meaningful job because it could risk relapse, or it’s not getting and testing out some of these new relationships, because that could lead to a relapse. And so sometimes, therapists can try to support folks in making those leaps and then you get some of that, that goal attainment that everybody is hoping that you will, but sometimes it becomes this thing of, okay, let’s see what your capacities actually are, and how ready you are for that. And is it worth it? Because if you’re constantly kind of like, I achieved the goal, I relapse, I lose the goal. You know, like, if you’re constantly going up and down, is that better than staying stable at the space where you’ve kind of landed. And I don’t know, and that’s gonna be different for each person. And this goes back to what you were saying earlier about, like, this is where we work on goals together. And sometimes that’s also really helping the client to get to self awareness about capacities and what they’re wanting to risk, or try for, versus allowing them to run free with whatever indoctrination they have around what their goal should be around independence, or productivity, or those types of things. It’s like, let’s have a collaborative conversation about all that’s possible. And reframing some of what they’re talking about into things that might fit more for who they are, and how they’re showing up. Obviously, respecting them and understanding them as well as you can. But but you can often get stuck in this place with you’ve got a client, who you’ve seen for years, who maybe is marginally better than when they first came in. But they’re mostly stable. And you’re stuck thinking, Am I helping them or not?

Curt Widhalm 12:47
And again, the best way to measure that is go back and ask them.

Katie Vernoy 12:50
Sure.

Curt Widhalm 12:51
Are you getting benefit out of this? And…

Katie Vernoy 12:54
They’re like, Yes, I’m not dead.

Curt Widhalm 12:58
And for some people, that is going to be a win. And I think that this is part of balancing expectations and hope and the reality of the environment that you work in. We’ve talked a number of times throughout the show’s history about like, you’re not going to get everything that you are told about the field out of any one particular job. The type of treatment that you might want to implement might not be practiced by the agency that you’re in. The abilities to do all of the things, charge your worth, and provide service everybody and all these kinds of things. It takes a real honest look at what your work environment is, what you’re actually capable of doing. Because sometimes the clients in these situations are like, alright, the way that we work, the skills that I have, the agency that we’re in, the number of sessions that were allowed, the environmental factors going on in your life, we might only get to 80% of this, but let’s get 100% of 80%.

… 14:07
(Advertisement Break)

Katie Vernoy 14:07
Yeah, I do want to address one of the things that you said, because I hear a lot folks say, well, insurance is not going to pay for it. And this could be situational for me versus across the board. But having worked in a Medicaid funded place, and then also having folks in long term treatment in a in a hybrid, you know, insurance, private paid practice. I found that as long as you can show ongoing medical necessity and part of that is the ability to show it’s not getting worse or the work that you’ve done, similar to what that that agency was able to show that that you know, if we look at where they were heading when they came to me versus where they are now and really be able to document medical necessity appropriately and have a sufficient diagnosis that suggests they will need need ongoing care, then insurance pays for it. They would much rather have them in weekly, bi weekly, once a month therapy with you than in the hospital, or some other liability. I think there’s that element of being able to document appropriately. If there is a review, I’ve had one review, in private practice saying like, hey, this client has an adjustment disorder, why they’re still coming to you two years later. I’m like, it’s an ongoing adjustment. And this is how I describe it. And this is what’s going on and, and the person on the phone was like, oh, so there’s getting better, but there’s still a little bit more work to do. And I said, Absolutely. And they approved ongoing treatment. And that was the only time that’s ever happened. And I think it’s cause I had an adjustment disorder, and somebody was going into year two with an adjustment disorder. But I think there’s that element of, especially in some of these places where there is higher acuity, higher level diagnoses, like schizoaffective disorder, bipolar, that kind of stuff. You don’t necessarily have limited sessions. And that’s not true with everything, because you know, money runs out, blah, blah, blah, blah, blah. But I think when you when you know that you have at least a chance of being able to do this longer term work, even on insurance, I think just be really very clear with your documentation. Don’t be hesitant with diagnosis, because if somebody’s going to need this ongoing care, they’re going to also need a record of that diagnosis, because that can help with other other benefits like Social Security disability, things like that, the longer they’ve had a diagnosis, the more support they can get in the long run once they finally get on to disability. But there’s that element of do the work to show that this is a client that needs support. And don’t beat yourself up. I mean, I think that’s the piece that I think a lot of folks have trouble with is that there’s that element of Is this client dependent on me? Is this is this not helpful? And, and it can just be a slog, I mean, the amount of work that can go into someone that chronically has risks to assess, chronically has really intense mental health concerns to navigate through can take a toll on clinicians. And so I don’t know, do we have anything else that we need to say about like how to kind of get treatment together? Because I think we can switch to like how, as clinicians, can we take care of ourselves, so we can do this work? Because I think this is important work. It just doesn’t have the big wins, that can feel really rewarding and meaningful, that that other clients may bring to you when they come into your practice. So how do you manage the kind of clinician factors when you’re working with folks that are less likely to make kind of these big improvements?

Curt Widhalm 17:50
Part of it’s really looking at what the client’s capacity for growth is. It’s really being honest with myself as far as what the expectations are going to be. And I’ve talked about this with my supervisees for years: Is there’s an inherent understanding of the attended supervise a lot of cases with kids. Like that, you know? And people push back like, What do you mean expectations? Like anybody’s capable of achieving anything. And I’m like, Alright, is this kid that you’re working with, are they likely to become President? Well, no, because of x, y, and z. Okay, then what are they capable of?

Katie Vernoy 18:35
Yeah.

Curt Widhalm 18:36
And, you know, if we’re talking a margin of error of taking it from being 70%, off down to 5or 10% off, I’m okay with being able to get into like, All right, we’re, we’re getting close enough on things and being able to collaboratively work with clients on like, Alright, let’s see, are your expectations to get to what you’re fully capable of? You know, the aspects of going into things with a realistic idea of here’s what we can accomplish here. Is admitting to yourself, here’s the skills that I really have, as far as a person in this kind of work of being able to help things out. It’s bringing some of the humanity aspects in that makes the therapy work. It’s a lot about building relationships. And it’s being able to utilize that in some of the conversations with the clients that we’re having. And sometimes, here’s the frustrations that I continue to this day to hear from clients of like, I’m really frustrated I’m not making more progress. I thought therapy was going to help more. Great, let’s talk about our expectations and what we’re actually capable of doing in this work together. Because sometimes the answers are going to come from places outside of me. You might need help that I just can’t provide. And so there’s really that true, like acknowledgement of what are we actually capable of doing here? We, we just don’t throw more therapy at something if therapy is not helping, or not helping that improvement aspect. But that doesn’t mean that it’s harming it either, that there could be all of that stuff that we talked about in the first part of the episode here.

Katie Vernoy 20:22
That assessment is really important. And and whether it’s am I not the right person for this client, and we have, you know, episodes on firing your clients and referring out and blah, blah, blah. So we can link to those in the show notes. I think there’s also is there an adjunct treatment that could be supportive or supportive services that could help? I think being able to get to a place that the client feels comfortable with how they’re living their life, I hate to even say progress, but like, that they have a good enough quality of life that they feel like what they’re doing is helpful. And to me, I really think about the clients where they’ve got crippling anxiety, and you know, there’s other things involved. And so some of the, the treatment strategies that we use don’t work. And so they, they end up basically, you know, kind of interacting in a different way, creating a life that’s a little bit different than someone who isn’t anxious about some of the things that are out in the world. And so I think there’s, there’s this element of how do we stay present with them? And how do we reframe and identify those incremental gains? Whether it’s creating an environment that’s more suitable to how I interact with the world. Whether it’s identifying more about who I am and accepting that so that I can then get the resources that I need, or I can understand myself differently enough so that maybe I start making progress because I’ve accommodated my own unique needs. I think about kind of neurodivergent folks, especially with more and more, especially female identified folks getting diagnosed, it’s like, I thought I was horribly anxious. And now, if I just make accommodations and actually flow with things, I’m much better off than trying to work against my neurodivergence. And so there’s that, that element of kind of deepening the relationship and finding those incremental shifts or, or accomplishments and pointing out: And you’re still doing better than before I saw you. You know, it’s looking at how can you frame some of that to build hope? But also, how can you foster acceptance with the client? So they’re not continually coming into this with: I’m just not getting better. It’s like, well, what does better mean? I mean, are you still aligned with these other goals that are, are more based on what society thinks everybody should be doing versus what might be healthiest for you. Or for most people, honestly, I think a hugely productivity achievement focused society is not great for most folks. There’s a balance that we have not strike at least in the United States. So I think there’s that that element of getting to a small enough space with the goals, with the accomplishments to be able to celebrate some of those little bit little wins, even if it’s, and you’ve not been cutting for six months, you know, or whatever it is. You know, maybe you don’t feel better about yourself, maybe you haven’t got the new job, or found the new relationship or done the big thing that you’ve been looking for. But you stopped cutting. You know, whatever it is, right.

Curt Widhalm 23:36
Right.

Katie Vernoy 23:36
And so I think there’s that element of, of being able to frame it properly. But that can be tiresome work, too. I mean, I think about as a clinician, there’s times when I’m thinking, Yeah, I’m, I’m having a hard time sitting with you in this space, because I feel that frustration too. For you, for myself, I’m questioning myself. And I think for me, when I get to that place, I dig more deeply into the relationship and connection. And that’s why I say I’m mostly an attachment based therapist, because oftentimes, when someone comes into my office, that’s, you know, we always say, oh, it’s the relationship that matters, whatever. But like for me, when I’m in this client’s corner, when I’m part of their life, when I’m personally connected with them, and I’m able to use the relationship to continue to foster positive quality of life, practicing relationship skills, whatever it is, then I feel like it’s more meaningful and valuable to me, as well. It feels more doable. This is somebody that I care about, and we’re in this together versus this is a problem I have to solve and there’s not a solution.

… 24:44
(Advertisement Break)

Curt Widhalm 24:46
You know, it’s funny, when I end up having families come into me and their expectations are, we are stating that our goal is we want to communicate better, reduce conflict, sorts of things. And, you’ll know, they’ll be fighting in sessions about things, and they’ll reach agreements on things. And then they’ll just keep arguing because their child still has emotions. Like they’ve reached an agreement. Like, yeah, and what it sounds like is it’s just kind of like that, you know, here’s our expectation of you, the kid has a disagreement about the way of achieving it. And so the kid’s, you know, trying to assert some independence, like, I want to do it my way, and the parents are like, Fine, you know, but if you don’t get it done, then there’s gonna be consequences. And the kids like, Fine, I’m going to show you, I’m going to do it my way, I’m going to do it this way. And I’m like, Alright, this is the point where you have an agreement. Like parents are gonna put a consequence in if the expectation isn’t matched, kid has a way of outlining it. But they’re still fighting because the kid is having emotions. And I point out, I’m like, you guys actually have communicated effectively here. Like, it’s, it’s that I’m thinking of the number of times that I have sessions like these, that it comes in with like, it is the recognition of, alright, sometimes our goals aren’t that everybody is just going to get along peacefully, forever. Like, it’s…

Katie Vernoy 26:16
Yeah.

Curt Widhalm 26:17
You know, the goal isn’t: we want zero conflict. It’s when conflict happens. And so it’s really being able to redefine what success actually looks like. And it’s being able to set those expectations of like, yeah, you know, you might not be like, drugged out and self harming all the time. And you found out that there’s still a lot of parts of life that just kind of suck.

Katie Vernoy 26:44
Yeah, yeah, I was just thinking about that. Because, like, for me, some of my clients, it’s more about increasing the window of tolerance. It’s about, it’s about the other steps, because they’re like, Well, I still am upset. And it’s like, well, you’re gonna be upset at times. Or like the situation still sucks, or, like you said, Life still sucks sometimes, like, it’s, it’s something where you’re doing better but you may actually be experiencing more emotions. So you’re feeling worse, right? And so now we have a new thing to work on. And they’re like, Ah, I don’t want to feel my emotions. Emotions are bad. And I think, especially in, you know, societies that that I am most familiar with, emotions are seen as bad. Which is awful, because then people can’t kids can’t disagree, they can’t have emotions that can be like, Ah, shucks, you know, this is so bad, you know, because everybody’s supposed to be peaceful and calm and confrontation shouldn’t have to happen. Or I don’t have to be able to, to, like, be sad for a day because something sad happened, or I remembered something sad. Having emotions, I think are things that people will, like the definition of happiness, or success sometimes doesn’t include having any adversity at all. And that’s just not reasonable. So that’s another I think, space to go into, as is increasing the window of tolerance, increasing capacity to cope, those types of things. And I think that can be very hard for folks, they just, they just want the magical thing to make them better.

Curt Widhalm 28:16
I want therapy to be magical. I want not only the problem solved, but I want all problems solved everywhere all of the time.

Katie Vernoy 28:25
Yes, yes, society needs to be fixed. I need to stop being marginalized. Work has to recognize that I’m amazing. And all anxiety should cease to exist, and then I will have succeeded in therapy.

Curt Widhalm 28:39
Some of the other things that help as far as the clinician end of thinks is not basing your value ever, as a therapist, as far as what’s client outcomes are.

Katie Vernoy 28:54
Yeah.

Curt Widhalm 28:54
That in this maybe it’s just a different way of packaging, having real expectations or realistic expectations for your clients. But you know, one of the things that a lot of places track as far as who’s actually effective therapists is like, how many clients graduate from therapy with you? How many of you, you know, how good are you at getting clients in, they feel that their treatment goals are done and you know, Oh, your caseload, you are just still carrying the same clients that you were 3-6-9 months ago. That…

Katie Vernoy 29:29
Or 3-6-9 years ago for me.

Curt Widhalm 29:34
Yeah, and so, you know, this gets into that, like, who’s defining success sorts of aspects. That some clients want that. The best way to find out who those clients are is to ask them.

Katie Vernoy 29:47
Yes.

Curt Widhalm 29:49
And, you know, it’s sometimes I end up with families that come in, they’re like, Hey, we expect that our kid’s gonna be working with you for the next 10 to 12 years until they graduate high school and probably even longer than that, because… And part of it’s just, you know, some of the specialized work that I end up doing that deals with autistic clients and that kind of stuff that like, that doesn’t mean we have seen each other weekly for 10 to 12 years. But, yeah, but it’s also kind of the constant, like, let’s redefine what successful goals are now. And, you know, success in that situation is like, like, I have a session recently where family came in, and the kids like, and I used the tool that you taught me last week, and I was teaching it to the other people in the treatment team. And like, I have less problems because we were using the tool. And I was like, this is success. You’re, you’re still going to run into a whole set of new problems as all of your peers around you reach the next developmental stage, and you’re going to have a new set of things to be able to navigate here. So, you know, some of this is also looking very incrementally at what’s going on, too.

Katie Vernoy 31:07
Sure. Yeah, I think I think that, that is very helpful. I think the other element of this is destigmatizing using therapy as a coping strategy. I do. I’ve been in therapy for I don’t know how long. It’s something where and I’m in weekly therapy, and I cancel here and there. So it’s not 100% weekly. But there’s that element of, for me, it is my weekly check in with myself where I can, I can have the attachment connection, I can, I can explore things, and I can then go out into the world. And I have one extra little bit of resilience and resourcefulness that I didn’t have before the session. I feel like that’s what my clients, a lot of my clients want too. And they’ve moved down to once a month or as needed, or every other week or whatever, where they get to a place where it’s like, this is part of my self care strategy. And I get that folks are like, well, this is treatment, it should have an end, and I get that. But I don’t know that all therapy needs to look that way. And maybe that makes me you know, a good business person and not a good therapist. But like, it’s a lot easier to keep a caseload full if you do these, this long term deep work where you get to know someone really, really well. You can, you know, I’ve got clients that I’ve seen since they were teenagers and, and be able to remember back to how they interacted, you know, 10 years ago, and be able to reflect back to them, you know, their developmental progress, or folks who have come a really long way. And this is obviously folks who are making progress. But some have come a really long way. And so doing long term work, I think, can be very, very powerful for folks, especially for folks who don’t have as many healthy relationships out in the world, and struggle to make those relationships. And so that you can be that that you can be there for them. And so so maybe that’s not what some folks call therapy, but for me, that work allows for deeply knowing your client and helping them to navigate the world and not get worse, and hopefully get a little bit better, too.

Curt Widhalm 33:23
We would love to hear from all of you about how you’re not helping your clients get better but are still successful with them. And you can do that either through our social media or in our Facebook group: The Modern Therapists Group. We’ll include some stuff in our show notes over at mtsgpodcast.com. And until next time, I’m Curt Widhalm with Katie Vernoy.

… 33:46
(Advertisement Break)

Announcer 33:46
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.