The Modern Therapist's Survival Guide with Curt Widhalm and Katie Vernoy

Bipolar Disorder - How Can Therapists Support Clients and Their Families?: An interview with Dr. David J. Miklowitz, PhD

Curt and Katie interview Dr. David Miklowitz about his work with people with Bipolar Disorder and their families. We look at what therapists can often get wrong when working with patients presenting with this disorder. We explore differential diagnosis, treatment options, lifestyle coping strategies, and family support. We also talk about how to walk the line between self-responsibility and accommodation.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we interview an expert on Bipolar Disorder

Many clinicians can miss or over-diagnose bipolar disorder. We wanted to make sure that our modern therapists have enough of the basics to identify if it is coming in their offices. We also talked with our guest about non-medication options to supporting bipolar clients and their family members.

What makes it hard to diagnose bipolar disorder?

·      Therapists need to get adequate information, which is often self-report or family history

·      There are a number of rule outs and comorbidities such as depression (unipolar), anxiety, trauma, personality disorders, substance use

·      If someone is inaccurately dx, it can lead to the wrong treatments, including the wrong medications

·      It is challenging to differentiate normal adolescent behavior from bipolar, so careful assessment is needed.

What can get in the way of treatment compliance for bipolar disorder?

·      Desire to be more creative or feel all of ones emotions can lead to lack of meds compliance

·      Perceptions about productivity during hypomania

·      Substance use and abuse can cause a lack of compliance or efficacy with medications, substances can also lead to exacerbation of symptoms

·      Medication side effects can be challenging, which requires active communication with psychiatrist to adjust dosages

What role can the family and loved ones play in supporting someone with bipolar?

·      Family-Focused Therapy (FFT) is a protocol that can be helpful

·      Family members can provide accommodation for client

·      There is a balance to be struck between family support, medication, and personal responsibility

·      Boundaries are very important

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

Is Your Informed Consent Based on Magical Thinking?

Curt and Katie chat about the strange, manipulative, or outright illegal and unethical policies that therapists put into their informed consent. We talk through court, payment, and jurisdictional policies (among others), exploring why these policies are so bad. We also give some advice on what to do instead. 

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about the ridiculous things therapists put in their informed consent

An old article from our friends over at CPH resurfaced talking about all the ways that therapists try to skirt laws or mandates with their informed consent. We thought some of this stuff sounded a bit like magical thinking. 

What goes into an informed consent?

·      Policies and procedures

·      Risks and benefits for treatment

·      Social media and court policies

·      More information here:

What are the biggest concerns with therapist informed consent?

·      Forcing clients to sign illegal policies is in fact illegal

·      Putting undue force onto a client is wrong

·      Court avoidance clauses are not realistic and may be illegal

·      There are limits to the fee structures you can have clients agree to

·      You have to complete your legal responsibilities, even if a client signs something that says you do not have to do so

·      You can’t have someone agree to waive jurisdiction when they travel or consent to calling your services something different

What do therapists need to do with their informed consent?

·      Make sure you don’t have any illegal or unethical practices in your informed consent

·      Don’t try to “game” the system to protect yourself from your legal and ethical responsibilities

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

Is Artificial Intelligence Bringing Bias into Mental Health Treatment?

Curt and Katie chat about the responsibility therapists hold when they use AI applications for their therapy practices. We explore where bias can show up and how AI compares to therapists in acting on biased information. This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about whether therapists or AI are more biased

With the inclusion of artificial intelligence tools into psychotherapy, there is more access to mental health treatment by a larger portion of the world. This course addresses the question “Do the same biases that exist in in-person delivered psychotherapy exist in AI delivered treatment?” at the awareness, support, and intervention levels of mental health treatment.

How is machine learning used in “AI” for therapists?

·       There are different types of AI used in mental health, machine learning, neural networks, and natural language processing

·       AI can be used for awareness, support, and/or intervention

·       There is a potential for bias within AI models

Where can bias come in when AI models are used in mental health?

·       Source material, like the DSM

·       Human error in the creation

·       Cultural humility and appropriateness

Are human therapists less biased than AI models in diagnosis and mental health intervention?

·       The short answer is no

·       A study shows that ChatGPT is significantly more accurate than physicians in diagnosing depression (95% or greater compared to 42%)

·       ChatGPT is less likely to provide biased recommendations for treatment (i.e., they will recommend therapy to people of all socioeconomic statuses)

·       There is still possibility for bias, so diverse datasets and open source models can be used to improve this

What is a potential future for mental health treatment that includes AI?

·       Curt described therapy practices being like Pilots and autonomous planes, with the ability to provide oversight, but much less intervention

·       Katie expressed concern about the lack of preparation that therapists have for these dramatic shifts in what our job looks like

Key takeaways from this podcast episode (as curated by Otter.ai)

·       Enhance the training and validation of AI algorithms with diverse datasets that consider intersectionality factors

·       Explore the integration of open-source AI systems to allow for more robust identification and addressing of biases and vulnerabilities

·       Develop educational standards and processes to prepare new therapists for the evolving role of AI in mental healthcare

·       Engage in advocacy and oversight efforts to ensure therapists have a voice in the development and implementation of AI-powered mental health tools

Receive Continuing Education for this Episode of the Modern Therapist’s Survival GuideContinuing Education Approvals:

Continuing Education Information including grievance and refund policies.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

Why Are So Many Adults Getting Diagnosed with ADHD and Autism?: An interview with Dr. Monica Blied

Curt and Katie interview Dr. Monica Blied about adults getting diagnosed later in life with Autism and/or ADHD. We look at why people (especially individual assigned female at birth) are getting diagnoses later in life. We also explore skills, strategies, and accommodations to support neurodivergent individuals in navigating life. We also talk about unmasking and helping adults talk with their family members about diagnosis.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we look the trend of adults getting diagnosed with ADHD and Autism

During a recent conference, Katie saw Dr. Blied talking about later in life ADHD and Autism diagnoses and loved what she had to say. We figured it was time to talk some more about neurodivergent adults.

Why is there an uptick in adults getting diagnosed with ADHD and Autism?

·      There is more information that is being shared on social media

·      Therapists and psychologists with ADHD and/or Autism are sharing information more freely

·      Increase in diagnoses in children, leading to other family members getting their own assessments

How can therapists support clients who believe they are neurodivergent, but may not meet the criteria?

·      Exploring what a neurodivergent identity means to the client

·      Provide psychoeducation on some differential diagnosis

·      Seek formal assessment for autism or ADHD

What strategies can therapists utilize in working with clients diagnosed as neurodivergent as an adult?

·      Confirm and validate experience, normalize

·      Somatic exercises to bring clients into their bodies (and out of their brain)

·      Executive functioning skills (e.g., using timers and the pomodoro technique)

·      Premack principles?

·      Use the principle of inertia (start with something small, to get in motion)

·      Understand available workplace accommodations (and where assessors and therapists can support in that process)

·      Learning how to tease out when skills, accommodations, or self-acceptance are needed

·      Support acceptance and unmasking

·      Help clients walk through the grief process that comes with diagnosis

·      Learn about autistic burnout and the 5 S’s from Dr. Joey Lawrence of Neudle Psychology

·      Provide support to clients to talk about diagnosis with their family members

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

AI Therapy is Already Here: An interview with Dr. Ben Caldwell

Curt and Katie interview Dr. Ben Caldwell about the state of Artificial Intelligence in therapy. We look at the “AI Therapists” that are already working as well as how they are being regulated (or not). We talk about how AI therapy chatbots are being received and likely next steps in innovation. We also explore what “human therapists” can do to protect their practices and address the influx of low cost, always available AI therapy.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we look at the latest developments in Artificial Intelligence in Mental Health

Our friend Dr. Ben Caldwell has been writing some articles on the current state of AI in therapy. We decided this information needed to come to the podcast, so we invited him back on the podcast.

What is the current state of AI in the therapy profession?

·      There are chatbots providing “therapy” or mental health support

·      Some apps are going the path of becoming registered as a medical device with the FDA, some are staying in the coaching space

Who is regulating AI therapy?

·      Licensing boards for “human therapists” may have no ability to regulate the use of the term therapy by apps, medical devices, or “AI therapists”

·      State legislators may be the avenue for regulation, but there may not be an appetite to do so

·      FDA can regulate apps that get registered as a medical device

Who wants AI therapy?

·      Clients or patients will seek out AI therapy as a very cost-effective and available option for mental health support, also AI therapists will not judge clients and will always remember what clients have said

·      Insurance providers will see AI therapy as a way to expand networks

·      Legislators will likely purchase AI therapy for state and county Medi-caid services as well as support expansion to address mental health shortages

·      Basically, everyone wants AI therapy except for human therapists

What are the concerns about AI therapy?

·      It is only approximating the relationship between therapist and client

·      An AI therapist doesn’t have morals and values, ethics

·      The apps are working only from manualized treatments

·      It may be only psychoeducation, without current ability for deeper work

What can therapists do to protect their practices now that AI therapy is here?

·      Make sure to vet any AI services or applications that you use

·      Shift to services that AI therapy doesn’t provide (like diagnosis, or more niche services with children, families, and couples)

·      Move to overseeing AI as an adjunct to therapy (i.e., “prescribe” a particular chatbot or AI therapist and check in with clients periodically or when the client is in crisis)

·      Work with AI therapy companies to train the AI therapists

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

Exploring the Danger, Trauma, and Grief for a Palestinian Therapist in the United States: An anonymous interview

As part of a double episode release, Curt and Katie share an anonymous interview with a Palestinian American therapist about their experience in our profession and in the United States both historically and since the attacks in Israel on October 7, 2023. We explore what therapists need to know about Palestine, Palestinian culture, and Palestinians in the diaspora. We also identify additional resources for Palestinian therapists in the diaspora.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we look at the challenges Palestinian American Therapists face in our communities and our profession

We reached out to Palestinian American colleagues to work to get the perspective of these individuals during the last year as well as historically. Due to safety concerns, our interviewee decided to be interviewed anonymously. Curt and Katie share written interview questions and answers on this episode.

What should therapists know about Palestine, Palestinian Culture, and Palestinians in the diaspora?

·      There is a rich and complex history for Palestinians, deeply tied to experiences of displacement, resilience, and a strong sense of community

·      One of the most significant events in Palestinian history is the Nakba (or catastrophe) which saw the forced displacement of hundreds of thousands of Palestinians from their homeland in 1948. This event has led to intergenerational trauma and collective grief.

·      There are generational differences in the Palestinian experience to be aware of

What has the experience been like over the past year, with heightened awareness of Palestine and the conflict in Gaza?

·      There has been a heightened sense of dread and the ability to remain invisible or avoid the topic has been taken away

·      Safety, even with therapy clients, has been questioned

·      Difficulty balancing denouncing the violence committed by Hamas, while also advocating for Palestinian human rights without being branded a terrorist sympathizer

What do therapists need to know about working with Palestinian clients in the diaspora at this time?

·      Clients may be reluctant to share feelings about the conflict due to the challenges in doing so without judgment or fear for their own safety

·      Therapists need to have an understanding of the conflict and the broader context, to help avoid relying on the emotional labor of the client to educate

·      Palestinians are not a monolith (there are religious, cultural and socioeconomic differences, as well as different reasons for emigration), so it is important to see and connect to the client in front of you

How can therapists in the diaspora navigate global tragedies in their homeland?

·      Seek and Accept Support: Don’t hesitate to reach out for support from colleagues or professional networks. It’s crucial to have spaces where you can share and process your experiences.

·      Engage in Personal Therapy: Utilize personal therapy more actively. Having a space to openly discuss and navigate your identity and feelings can be invaluable, especially when faced with such intense global events.

·      Choose Supportive Communities Wisely: Be discerning about the communities and support networks you engage with. Ensure they offer a safe and respectful space for sharing and discussion and be mindful of how public or anonymous these spaces are.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

Growing Antisemitism in the Therapy Profession: An interview with Halina Brooke, LPC

As part of a double episode release, Curt and Katie interview Halina Brooke, LPC, founder of the Jewish Therapist Collective, about experiences of antisemitism in our profession. We explore the foundations of antisemitism throughout the development and innovation in psychotherapy. We also talk about lived experiences of Jewish therapists of increasing antisemitism since the attacks in Israel on October 7, 2023.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we look at the increase in antisemitism in the therapist community

In a recent article from Jewish Insider, there are stories about increasing antisemitism in the therapy profession, including in online therapist Facebook groups. We decided to reach out to Jewish Therapist Collective founder, Halina Brooke, LPC, to talk us through what has been happening throughout her time as a therapist as well as the escalation of antisemitism in the past year.

Experiences of Antisemitism in the Therapy Profession

·      The Jewish Therapist Collective has received an increase in calls from clients who are seeking Jewish therapists after October 7, 2023 due to cultural incompetence from non-Jewish therapists

·      Jewish therapists have reported being sidelined or fired from their mental health workplaces due to being Jewish

·      Jewish therapy students report being told that their presence is triggering to non-Jewish therapists

·      Jewish therapists and counselor have reported losses of peer groups due to antisemitism, including affinity groups for intersectional identities

Antisemitic Incidents Within Therapist Facebook Groups

·      Posts targeting “Zionist” therapists have been used to identify Jewish therapists

·      There are lists of “Zionist Therapists” that include only Jewish therapists, potentially ones who have not made political statements about Zionism, that “antiracist” groups are suggesting should not receive any referrals due to their status as “Zionists”

·      These lists appear to solely be lists of Jewish therapists, without including Christian Zionists or others with Zionist beliefs

What do therapists need to know about Jewish Culture and Identity?

·      Multicultural education on Jewish identity in graduate school is insufficient

·      There is as much diversity within the Jewish community as there is between the Jewish and other communities

·      Halina discusses the historical context of Jewish identity and how often they are not seen as part of the dominant majority

·      It is important to seek consultation from Jewish colleagues due to the many nuances and differences

·      Even though many of the founders of psychotherapy are Jewish, there is a lack of inclusion of Jewish identity in multicultural courses

What support is available for Jewish Therapists?

·      The Jewish Therapist Collective provides community and training

·      Halina described the steps that she has taken to hide her Jewishness as well as to find support within the community

Learn more about these resources: jewishtherapists.org

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

Navigating Religious Trauma, Spiritual Abuse, and Lies About God: An interview with Dr. Jamie Marich

Curt and Katie interview Dr. Jamie Marich about her new book coming out in October 2024, You Lied to Me About God. We explore the impacts of religious abuse, Jamie’s personal story of spiritual trauma, and what therapists can miss when working with clients on these topics. We also dig into the idea that therapists can let their clients down when they don’t do their own internal work, address their bias, and show up effectively.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we look at the impacts of spiritual trauma on therapy clients

We invited our friend, Dr. Jamie Marich, back on the podcast to talk about her story (and her upcoming book) that deals with spiritual abuse, religious trauma, and the lies that have been told "in God's name" that lead to shame and isolation for many of our clients.  

What are the impacts of spiritual abuse and religious trauma?

·      Definition of shame as the lie someone told you about yourself

·      Spiritual abuse goes deeper because the lies are told in God’s name

·      There are big impacts of religious trauma on those in the LGBTQ+ community as well as those who are seeking deep spiritual connection

Looking at the concept of forgiveness within the context of religious and other trauma

·      How forgiveness can be helpful

·      How forgiveness is weaponized within the church and can be harmful

·      Forgiveness is not required, acceptance is a more appropriate goal

How can therapists make sure they are not adding to the harm for clients with religious trauma?

·      Do your own work, so you can approach clients where they are

·      Be authentic, don’t lie to your clients, but don’t bring it up unless asked

·      Seek consultation to enhance your understanding of the client’s situation

·      Cultural humility is key, and don’t rely solely on your clients to be the cultural informant

·      Do not impose your spirituality on your clients, but be open to discussing spirituality

·      Be aware of the power dynamics, so you don’t become the client’s new guru

·      Help clients to find their own answers rather than relying on external authority

Other ideas we touched on in this podcast episode

·      The importance of critical thinking

·      “Therapy cults” that promote adherence to a specific intervention model

·      The challenges of folks seeking compliance and righteousness, rather than taking a nuanced approach to topics and deciding for themselves

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

Do Therapists Lie to Their Clients?

Curt and Katie chat about whether therapists are dishonest and whether they should be. We received a request from a listener to talk about the idea that therapists lie to their clients. We look at what types of lies are common, whether lying is expected or acceptable, what to do instead, and how to decide whether you will lie or not in session.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk through how, when, and why therapists lie

We received a listener email requesting a discussion on therapist dishonesty and the impact on the therapeutic relationship.

What types of lies might a therapist tell?

·      Whoppers (fraud)

·      Fibs (untruths that support the clinical work or the therapeutic relationship)

·      Omission (concealing facts that impact the client)

·      Deflections (bending the truth for therapeutic effect)

·      Denial (rejecting reality, with positive and negative results)

 Is it good or bad for a therapist to lie?

·      Fraud is never okay, and is illegal and unethical

·      Fibs may be in the best interest of the client OR could be to protect the therapist (which is human, but not really okay)

·      Professionalism, exaggerating/minimizing emotional responses for therapeutic effect, and “social niceties” may be appropriate, but it is important to think about authenticity and whether it will negatively impact the client if they perceive the deception

·      If a client is asking for the therapist’s opinion of them, the context of the client’s treatment agreements and their needs, as well as the therapeutic relationship impact whether a therapists will be best served by honesty or deflecting or denying the truth

What can therapists do when they are tempted to lie to their clients?

·      Make the decision of whether to tell the truth based on the context of the relationship and treatment goals

·      Be more transparent with the client about therapist’s limitations, while also holding hope and accountability to address these limitations

·      Work collaboratively with the client to get to the information or treatment interventions that are needed, rather than working by and for yourself.

·      If you lie to your client and it backfires, work to make repairs (see our episode on “Should Therapists Admit Mistakes?)

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/

Welcome to Therapist Grad School!

Curt and Katie chat about what the career is like, what is important to know starting out in grad school. We look at what prospective therapists need to know as they enter school, including hard truths and tips for social support. We also talk about what changes are needed in the profession and how students and new therapists can navigate these challenges. We provide suggestions on how to best take advantage of the opportunities in graduate school. We also unveiled a new project for the podcast.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk through what the therapist career is like

We decided to talk through what it is like to be a therapist and how to best navigate your grad school education.

What do prospective therapists need to know as they enter grad school?

·      Grad school doesn’t cover all that you’ll need to know to be an effective therapist

·      Lived experience is valid and definitely informs your work

·      It is important to assess what you already know, what you need to unlearn, what interventions you can add to what you already know

·      Learning how to be a “safe therapist” is not the same as learning to be a “good therapist”

·      Theories and orientations are foundational, but you can’t know them all

·      Once you graduate, that’s when you actually start learning how to be a therapist

What can grad school students and new therapists expect regarding needed changes in the profession?

·      Changes may happen, but slowly

·      There can be times for advocacy to help increase the sustainability of the practice

·      You don’t need to worry about getting a job immediately, but you can start working with clients or in the field, if you would like or need to do so financially

·      There are a number of students who burnout before graduation, so pay attention to your capacity and self-care practices

What opportunities are important to take advantage of while you are in grad school for therapy?

·      Consider taking the hardest or more complex practicum sites to learn how to work with the most challenging populations

·      Volunteer to do roll plays and risk making mistakes in your classes

·      Make mistakes while you are a student and prelicensed individual to get the supervision and oversight, to learn from these mistakes

What are some hard truths about becoming a therapist?

·      The therapy profession is not for everyone

·      Not all students will make it through to graduation or to licensure (whether by choice or not)

·      Grad schools are not always transparent with how long it will take to get through the program, whether you will have support in getting a practicum site

·      The entry level jobs in the field may not pay very well (i.e., some are at or only slightly above minimum wage)

·      There is a risk of becoming disillusioned by the state of the world and the profession

What are the social elements of becoming a therapist?

·      If you’re only friends and socializing with therapists, your view of the world may become more limited

·      There can be echo chambers, especially around social justice topics within mental health

·      Having friends who are therapists, so you can have the validation and understanding of other therapists

·      Socialization can be too focused on alcohol-forward events. It is important to find other ways to socialize to avoid the risks of substance abuse and dependence, especially as therapists are held to a higher standard through licensure

·      Take responsibility for self-care/self-maintenance

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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

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/