Wicked Psychotherapists

Demystifying Therapy: Insights & Self-Care from the Trenches

• Erin Gray and Tanya Dos Santos • Season 2 • Episode 15

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In this episode of Wicked Psychotherapists, hosts Tanya Dos Santos and Erin Gray offer a candid look into the world of psychotherapy, addressing common myths about therapist income, the realities of private practice expenses, and the complexities of insurance and client rates. 

 They share personal experiences to highlight the often overlooked costs of running a private practice, including continuing education, taxes, malpractice insurance, and the unpredictable nature of client appointments. 

The discussion also touches on the ethical considerations of making therapy accessible, dealing with insurance audits, and the personal impact of offering sliding scale fees. 

Additionally, Tanya and Erin navigate the nuances of therapist-client boundaries, especially regarding after-hours communication, sharing client anecdotes to illustrate their points.  

The episode closes with an exploration of self-care practices for therapists, underscoring the importance of maintaining personal well-being to effectively support their clients.

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You are listening to Wicked Psychotherapists, a podcast where two psychotherapists show you that taking care of and learning about mental health doesn't have to be wicked hard.

tanya:

Hi, everyone. I'm Tanya Dos Santos. And I'm Erin Gray. I wanted to start out with and tell me how you feel about this with addressing the the question about income with therapists and have you heard anything was there other things that you commonly hear things that just maybe rub you the wrong way or what have you heard about income with therapists like what they make?

Erin:

I think people assume that a lot of therapists are almost on par with some of the other health care professionals. Where it's a fair wage and great income compared to my past life, like it's a lot better. Yeah, it

tanya:

is. I would have to say that I've definitely heard that on people. There's some myth out there that therapists like make bank and I'm not saying you can't or if you have a private practice that's thriving. But there are a lot of considerations how much schooling it takes to become a therapist if you take out loans or if you just paid for it along the way. It's a lot of education and continuing education. Yeah. Because we have to still get continuing CE credits as we call them all the time that usually are not paid for. We pretty much always have to pay for them. Pricey.

Erin:

Where it's different than a lot of fields where Their job might pay for it or they get reimbursed. Both you and I are in private practice. We're responsible for all of our continuum ed and our setup and our supplies and everything else we need to run our practice. We take that in account too. Of what you make because we are private practice. You still have to take out for Taxes and for this and that and so if you see that number Whatever the hourly amount is it's going to be lower

tanya:

Yeah, we have to pay our own quarterly taxes There's also other things that we have to have like malpractice insurance, CE credits, anything that you need for, if it's a telehealth therapy business, maybe not too much overhead in terms of having to buy furniture and things like that. If you have an in person office, there's furniture and other things that you would have for clients and rent. from that space. There's also the fact that you have to really struggle to, to get a decent, I think, rate through the insurance company. And it's set very randomly. It's not something that's very transparent. They tell you not to talk about it with other therapists, what your rate is. It's a messed up system. And a lot of times insurance companies can do what they call clawbacks, which is if they decide to audit you and they found your notes to be for any reason up to a certain amount of years depending on each insurance company. If they found them to be not appropriate for what they wanted, they can take that money back. That's not something that I think is a constant threat, but it's still the fact that something that you made a year ago, I think now they're doing like payment plans, or they won't pay you until. You have paid them back, but that's pretty frightening. And when it comes down to it, a lot of times in our code of ethics, we're told all throughout school to make therapy available to people to like, say, you can offer a sliding scale. You cannot, but. And our code of ethics, it is something to be able to help out people, right? To be able to offer them this service that can be a necessity. So there's that guilt already instilled in there for making money. And I've also heard from other people, how do you live with yourself charging this rate if people need this? As if, I think sometimes it's forgotten that this is how we're making our living and we're not, we're barely breaking even a lot of times. Right.

Erin:

Okay. Right, because if you do take in account of student loans, insurance, taxes, and other overhead, it's just like with any job. Fees and there's different things that we're responsible for, but yeah, it's, it is an uncomfortable subject. It's something as a private practice person we have to talk about with our clients where it's okay, here's my set rate if you're paying out a pocket and here's the copay if you're using insurance. So finances have to be spoken about.

tanya:

Yeah, absolutely. Absolutely. Like you said, it's, that's not what we take home. There's taxes, there's other considerations that we have. There's other things that we pay for and we don't have hourly guaranteed clients. People can cancel. We don't necessarily have enough clients at certain points. We don't have. People that maybe can come to therapy for a few weeks and we have to constantly fill in those gaps if you are in private practice, right? So it's not necessarily like this is eight hours a day of getting this rate. It's not that. I'm not saying some therapists don't have that because some therapists can't set that up, but it is a lot of work maintaining a caseload and a consistent caseload. A lot of luck, I think, sometimes with people getting sick, cancellations, and that kind of depends on their cancellation policy and all that. But usually it's 24 hours. Some people say 48 hours and sometimes people give a freebie that first time and are like, okay, we're all human.

Erin:

Yeah, I, I tend to, I always say it's probably not the best business practice, but I tend to do more of the freebies just because. I always worry like what happens if I get sick and then I have to cancel. I tend to, it's probably frowned upon by a lot of people, but I tend to do the, as long as you let me know, no, I'm okay. If you're not, if you're consistently a no show, then I have it in my consent forms that I will charge. A fee. So I do it by case basis. If they do let me know, if they call and let me know if they're sick or something happens, but if they don't show or they don't call, I will probably do the fee, like the no show fee. But otherwise, as long as I get noticed, because I know things happen. People get sick, I get sick, and I've had to cancel before as well.

tanya:

And that, even the way you said that is, it is totally reasonable. I think built in with that is your, this is a service, but we also, within the service, we're providers that have a high level of empathy. And so I think we can see that and we can know if the tables were turned and we're like, if I was sick, maybe I might have to cancel a little bit sooner or a little bit later. You wouldn't know. And sometimes that influences our business style. We can't be as hot and dry, or some people are. I would say I'm probably fairly similar in terms of, of people can't show up because the clients that I do have, they do let me know. They usually let me know ahead of time if they're able to, but it's pretty reasonable things. But yeah, and that, that's a hindrance to income as well. Just that very fact of the nature of. What it is we're doing and the fact that we do understand that, it's, it's something that, you know, that, and it's not like we don't have any like government assistance that's, Oh, okay. Oh, you, you had a missed client. Okay. So we'll give you some, it's just, we just don't make money, but we don't, because sometimes people have said in, in other jobs that I work in, they'll be like, Oh, you get paid anyway, if I don't show up. And when some instances, sure. When those kind of community mental health jobs where. You're getting paid a salary, but then you have productivity. So you have to make up anyways. And then other instances of snow, if you don't, if you don't, if you work in like a group practice or private practice, no, you just don't get paid. So there's no kind of supplementation. There's no government that's, there's no like organization that's, Oh, we'll pay you for that time.

Erin:

Yeah. Yeah. Like you're not usually eligible when you're a sole provider. For those PPP loans and stuff like that, because they're not going to bail you out if you're just not able to see the

tanya:

client. But even then, that's a, it's a loan. Yeah. It's a loan.

Erin:

It's not free money. It's not like

tanya:

any assistance. Yeah, um, and I don't know that people really get that. Which kind of brings me into the next topic, which I think we were talking about before. which is the amount of accessibility that we have as a clinician or provider. Being on call, being available to people. So what have you encountered with that in terms of people maybe texting you, messaging you, emailing you after hours, or how has that been for you? Yeah,

Erin:

so I, I think I probably a little unconventional in some instances, but Whenever I get a new client, I always tell them like, here's my cell phone, here's my email. You can call or text or email me in between, which is fine because something could happen or they could be like, hey, I just thought of this or want to make sure we have an appointment on Wednesday or whatever. Usually most people are pretty good about not over communicating in between session. I have had in the past, like where some people will use the texting as a therapy session. So for instance, we have a session on a Monday. They'll text me Monday through Monday, little things every day or recordings or, which that's different than just sending a meme or just sending, Hey, do we have an appointment next week? That right. Almost steps into, are they asking for therapy or are they trying to use the resources? That I'm giving them in other manners. So I'll usually try to redirect someone if they are doing that, where I'll be like, Hey, do you need another session sooner? Or just try to let them know, I don't mind you reaching out if it's an emergency or if you need something, but I can't text all the time every day to them. Also, I might be in session with other clients, right? So obviously I can't text while I'm with SES in session and. My hours I start seeing clients some days I start seeing clients at 8 a. m And then I usually end about three so Then I still have to do notes And I have other so i'm I don't really have a lot of I don't want to say I don't have time But it's not if every single client did that I would it would be very difficult to Do a full level of care for everybody if everybody was texting. Yeah,

tanya:

it's boundaries. I've come to realize, I know we were taught in school, you shouldn't have to give out your personal information, but sometimes in private practice, you have to, right? Because that's what you have. I have one of those like virtual phone numbers that I really explained to them. And I told them from the beginning, But this is a number that it does have texting capability, but I say I prefer like an email address, which is a separate email address and that it's not to be used for emergencies. If you have an emergency, these are the numbers that you call because I don't know if I'm going to be available. This is just for rescheduling. This is just for if you have a question or a clarification and that's it. And that's how I've evolved into that. Like I definitely have had points where it's felt like what's the line, what's the line here and you have to almost draw those boundaries. So when I started my private practice. I knew that I'm a very nervous, anxious person. I knew that I had to have those boundaries because we're people and we have to shut this off after a certain point. And your clients, you tell them this, it's something that they'll stick to. But I didn't know, I didn't know these people when I first got. Right. And so I was very much, okay, this is how it's going to be. This is for the emergency numbers. I have not had much other than through another job that I work at. I haven't had anything that's in this recently that has happened in terms of that. But in the past, yeah, there have been people that, would talk in terms of they would want to send memes and things like that. And you'd have to just be like, Oh, That's cool. Like we can talk about it maybe at our appointment. Like you said, redirect. The feeling is that you don't want to, you don't want to have somebody have an emergency and you didn't check. You have to make it clear that I'm not on call I'm not a crisis clinician.

Erin:

One thing I was just thinking when you're saying that I also try to let all my clients know, I don't sleep with my phone. I know a lot of people do. But I don't and I make sure they know that I am very purposeful that I put my phone in my kitchen and I charge it In my kitchen and I make sure my I tell my clients I usually tell most of my clients that like I if I go to bed at eight or whatever I Because I wake up at five i'm not 90 but I do I'm, i'm a five. I work out and i'm just crazy like that I like to wake up at five, but I always tell them like I go to bed early I but I charge my phone so i'm not going to It does it's not on my bedside. So if they're texting me or if there is an emergency i'm not going to hear it so Yeah, same thing. I give them like the different, like, here's the different hotlines. Like you can call, but for the emergence, for the after hours things.

tanya:

Yeah, because it's, that's definitely, it's definitely important to know because it's also important to know and I think to model that self care, right? That we also have times when we need to shut off. We're not available. It's not, The way that things are advertised in mental health of reach out if you need some help. That doesn't mean if you're just feeling sad for a little bit that we can, yeah, just should have somebody available constantly. And I'm not talking about like depression. I'm talking about if there's kind of difficulty with that, that may have to be something that waits until.

Erin:

Yeah.

tanya:

At the session, right? I guess it's the same with other professions. How would you feel if people were contacting you 24 7, you know, like, we're not subhuman, you know, we are people. We need that time. It's not fair.

Erin:

One thing I found that helps when I've noticed somebody is Reaching out a lot as an emergency. We'll do like a little check in to like at the next session, if it's not a crisis and let them know, Hey, you know what? Utilize the notes on your phone or something like that. So you can almost use that as texting me. And then when we have session. We could read it. You could read it to me and that, and that seems to work a lot for people because then they're still typing it or they're still getting it out, but they're not feeling like they have to text their therapist, everything it's still there that, so they let it out of their brain, but they didn't have to send it directly to their therapist.

tanya:

Yeah. And that's a great point. Maybe it is just that some people are saying I have to get this out and my therapist would like to know this. And yeah, there's certainly, I think that's a great tool to say, Hey, write this down or have this on the notes section so we can talk about it next time. Because it sounds like you're worried about forgetting it and this is maybe something that you're feeling a lot, but you can't access it during our session. So maybe you're really wanting to let me know that. And that's totally, yeah, that's a good redirectable skill. And that's, that definitely sounds like a really. Great idea. Yeah. And I think that it's, it's very different for different places. There's some places that are built for crisis. Like it literally is a crisis center. That's obviously different, but yeah, just, I guess that's a misconception that some people are not aware of. I, I haven't experienced it too much in my private practice because I was very, like I said, I was very, because of past experiences, I was very, okay, I have to set this up and structure this. Very, I mean, like, that's from learning from. Yeah. And that's

Erin:

really good though, because you have the boundaries, but You also have the experience of working in facilities, where you probably learn, like, I don't set boundaries. This is not gonna, this is not gonna be great.

tanya:

Yeah, I definitely like community mental health centers and things where it's, you get the whole gamut of mental health disorders and you're working on productivity, so you're working with numerous people, so you have to really learn how to be like, okay. This is what I can contain in this work time and then the rest of this, I have to feel good about it being there and to know that they have the resources for that. Right. Because otherwise, it, it just, I had it happen. I burned out a couple of times. It was really bad. Yeah. Yeah. What about, yeah. It's, it's frustrating.

Erin:

I, now I want to just ask you a question. So what do you do for self care as a therapist?

tanya:

What I try to do is reduce the amount of social media that I'm on. That's my first thing that I always go to. Okay. I also love yoga. I think that it's something that it really changes my physical and mental state. And I like the camaraderie of other people being there and just not having to worry about other people. Instead, it's just, I can focus on myself and just feel at peace. And I also like to, I love going out in nature and just being outside with my dog because she's just like a little kid. She likes to play in there and she enjoys it. And it's just. It just feels, it just feels good. It just feels rejuvenating for that. But yeah, it's self care is really important. What about you?

Erin:

My Peloton. It's like I'm, it's when I'm doing it, it's because it's very addictive and it helps me out a lot. And then a garden, Paige, the dog she's my buddy, my partner. And then we just installed, I sound like such a dork, but we installed, we. End up getting one of those basketball hoops, like the in ground ones. So we just installed that. Cause we used to have the cheapy one that you'd fill with water or sand. So I've been playing a little b ball every, that's really, it's so fun. Cause I had the other one, but I'd always, it always fall. And I was like, ah, I'm like, I am buying a new in ground basketball thing. And I just got one that was on sale, super sale. So it took my husband and three people to put it, three of his co workers to put it up, but I'm living every, I'm living every teenager dream right now. It's fun, but it's fun. But yeah, so I highly recommend it if you don't mind having a big basketball thing in your driveway. It's fun.

tanya:

I've heard that's really good for stress relief and just relax. Yeah. And then,

Erin:

yeah, it's, it's good. But yeah, but self care is so important. And that's because otherwise, as therapists and humans, we wouldn't be able to navigate any of our private practice if we didn't take care of ourselves.

tanya:

Yeah, absolutely. It's that kind of age old thinking of if you're on a plane and the air masks, they drop, you got to put yours on first before helping someone else. You have to have your cup filled before being able to fill others. Because. That's what we do. We, another misconception I've heard about therapy is people think we're just here to diagnose and psychoanalyze and I don't know about you, but I rarely, if ever think in that manner, we're here to help. Yeah. Right.

Erin:

I, I will usually ask, Hey, have you ever been to a doctor or have you ever been officially diagnosed when I meet somebody, but if they don't, And if they don't go to a doctor or they haven't been, I'm not going to be like, all right, we need to get this diagnosis because I need to treat you like what it says for the depressive symptoms or this, but it's, I treat them more like holistic as a, not holistic with sage and stuff, but like, well, we want to tilt the hands of the whole person.

tanya:

And although we do need to diagnose for insurance, we have to, they need a diagnosis, but we don't, it's not something, and it's within the first session, that's a requirement from them.

Erin:

Yeah.

tanya:

And we don't have any, I think most of us don't have a desire to do

Erin:

that. Like it's usually, you know, sometimes it starts as adjustment disorder until you get to know them unless they have something else and then you're like, oh wait, you have the symptoms of anxiety or depression or something else. And that's why I usually do ask if they've seen a doctor because sometimes people are like, oh no, I never, oh wait, but I was diagnosed with anxiety two years ago. I'm like, okay. So then I find out, oh wait, they do have general anxiety disorder. And then I will talk with them. I'm like, they fit all the symptoms. So they definitely do have that or whatever it might be. But it's not fun having to think in those terms all the time.

tanya:

Yeah, it's definitely not. And in fact, I think a lot of us I mean, I'm, I'm speaking for myself and of course you can add to it, but I like to turn that part of my brain off because I don't enjoy using it too much. Like it can be a tool. It's not the end all be all of therapy. And I think some, I don't know, have you ever been approached by someone or messaged by someone that maybe you haven't heard from in a long time? They're like, Hey, you're a therapist. Can you blah, blah, blah. And they talk about a diagnosis or like some policy that has to do with therapy or social work and those types of things that just with any other professional, we've gone to school, we've gotten a master's. We've had to do an internship. We had to do two years post masters of like basically almost free labor for it to be able to get that licensure and go to a lot of schooling. And we, it's. It's not to say that we don't, we can't talk shop here and there, but people just coming in and wanting free therapy that are in our lives. It's yeah, that's another family

Erin:

friends. Yeah. Just even, yeah. So yeah, I will occasionally get ran like sometimes I'm not, I love being a therapist, but sometimes like in situations like the kid's school or something like that, I won't tell people what my career is. I'll just. Yeah. And why is that? Because I don't want all of a sudden being the person that people are like, Oh, this is happening or this is how I'm feeling. Or what would you do? Try to get free work out of you. Yeah. I'm a narcissist. It's, I don't know. Maybe they're just annoying. I'm not going to diagnose anyone because I'm just here volunteering as a mom.

tanya:

Exactly. Like we have different roles in our lives and it's not, we don't necessarily want to turn that part on. And that's not to say that we can't add something here and there because we're a therapist, but I've gotten messages randomly. I'm just going to say it on Facebook where people I haven't talked to. And I don't know how long that will ask me certain things. Not even, Oh, Hey, I know I never talked to you like ever really. Maybe I passed you in the high school, but you know, this about diagnosis of this, or my kid has this. Oh, wow. And I understand the, the, the need, the desire, the desperation. I get that. I'm not trying to be insensitive to that, but it's, it's a little, it's a little, I guess, frustrating is the way to put it because it does happen. And people saying, Oh, what's your opinion on this and that? And like policies that you're dreading happening to your field. And you maybe don't want to think about it. I don't want to talk shop all the time. Do you

Erin:

know?

tanya:

We, that's, we're, we're compassionate people. We're understanding people. We know what it's like to be on, on the outskirts. You know, I know I'm generalizing, but I think that is probably why a majority of us are attracted to this field, right? I was going to say

Erin:

besides, like, usually there's some sort of personal reason why people choose. Like, it's like, okay, well, what, you know, like, and that could be another day or another time, but like what, you know, like a lot of people like, well, what brought you to become a therapist? It's usually.

tanya:

Yeah.

Erin:

Yeah. Usually.

tanya:

It's probably a lot of experiences we've, we've had, you know, or understanding or family members or friends or all of the above. Right. Because it is a very, you know, particular thing. It takes a lot of emotional capacity, a lot of. reserve to be able to have, um, that space. And I'm not trying to, to, you know, you know, toot our, toot our horns, but I am at the same time because I don't think they get tooted enough. Yeah. I really don't. I don't think we really get, I think there's all these mis very misconceptions, you know, very much misconceptions about, Our work and, and what we do and, um, and it's, it's not looked at. So it's, yeah, I have a, I

Erin:

have a myth or a fact, you know, for to ask. So I, I have heard, you know, and you see a lot of online too, with the different influencers and different things where coaching. You know, where people get the coaching certificate or they just start calling themselves a coach, or they thought they give good advice to their friends. So now they're going to start marketing themselves as this. Is that the same as therapy? Is that the same as being a therapist?

tanya:

So I think if you do not have the therapist, if you don't have the counseling education, because some therapists will kind of, Go into the co the coaching world. Mm-Hmm. which I think is, I, you have to kind of decide that for yourself. Right. But if you are just going into coaching and saying, well, I'm really good at giving advice, right. I'm really good at this. You have to be very, very careful about that. Mm-Hmm. because it, it can blend into this clinical aspect that we deal with, um, and. I, I think some of those things can be very effective, but you have to be very, very clear. And, I do not think it's there. No, I, I, no,

Erin:

I don't, I don't either. It's just, I think it waters down our profession a little bit. And because I even hear from clients like, Oh, well, I went to a coach or. Before I started seeing you and then you try to ask what the qualifications are and it's a lot of times It's they don't have their master's not not that I'm gonna be a master snob But to in order to be a licensed therapist, you have to have at least your master's.

tanya:

Yeah I mean you but you worked for that education. You have that knowledge bank. You have that awareness you worked hard in those internships pre and post And, and that gives you experience, that gives you an understanding of why you, you can't, you know, do this intervention with a person or, you know, um, you know, why it is important for them to, to know that they're not your friend versus your, you know, therapist kind of thing and the different approaches that you take. It's very important. It's a very important distinction. And that

Erin:

goes back to, we talked briefly about like some of the ethical standards, like, So, bye. really having the clarification that, you know, where we have this professional relationship, we're not friends. And that might not be fully explained in coaching or other things where I know, again, going back to the consent form, that's definitely something that is mentioned in the consent form, even as far as like, if we see each other in public, I can't approach you, you have to approach me, you know, it's, Because of confidentiality.

tanya:

Yeah, it's absolutely, I mean, there's just so, there's the whole gamut of, of things, like everything that we learn in school. A lot of things you learn in your experiences, in your internships, and your, you know, to get your licensure along the way when you're a baby therapist, right? You know, all those things are, it's so important to be able to even distinguish if somebody is, you know, subclinical or somebody is, you know, Clinical, right? You might not even know that as you know, somebody who's saying I give good advice and I can, and I'm not trying to say that people who are coaches that, you know, that they're not effective and that there's some that are very much have great experience and that couldn't be able to distinguish that. But you don't really know as a consumer going and saying, what are the credentials? Well, I have this certification that I took, you know, maybe for, you know, I saw one, I think for like, it was. hour or something that said you're a professional, whatever coach, you know, for life experience coach or whatever. It's not like the, there's not a governing body over it. There's not the code of ethics.

Erin:

Yeah. They can practice anywhere. They can like where we are bound by where our license is. So I'm in Florida, so I can only practice. I can only see clients in Florida. I can leave Florida and still, the way Florida is with tele, because I, I only see all my clients telehealth. So I could leave Florida like on vacation or something and my clients are still in Florida and I can still see them. But my clients can't go to, you know, Massachusetts and I, I wouldn't be allowed to legally see them.

tanya:

Right. Right. And because of the bounds of, of your licensure. Yeah. And those are things that we, almost agree we pledge to because we believe in, in how it governs us and how it holds us accountable for that. And those are very important things when you're looking for an ethical provider, when you're looking for a competent provider. Provider, right. that's a great point because, you know, there's, I see so many and I'm really, I'm not trying to put down people that are coaches. it's just that, you know, I've had a couple of people actually, even in my personal life say that they, you know, they wanted to, they wanted to be a therapist, but they wouldn't want the bounds of that. So they'd just be a life coach or something like that. And I didn't have the energy levels to get into it and to be like, okay, well, There's issues with that. And who am I to say, you know, if that's what you want to do with your life, go for it, you know, that's, that's, you know, but that's not something that, you know, knowing what we knew on the path that we had to take, I, I'm, I'm very happy that we have that because there were things that I, I didn't understand about that. I had been to therapy prior to going to grad school. I didn't understand that about like things that, that bind you and, things that are sacred And therapy and being a therapist, right? Yeah. So I don't know that that would necessarily be, the case for a life coach. I don't know if they have a strong code of ethics, if they're able to, I mean, go for it, if they're effective, if, if it's helping people. Yeah. Sure. It's just not something I would. Yeah, but there,

Erin:

there is a difference between licensed, licensed mental health counselor and, what, what do they call them in Massachusetts LPC? Or are you LMHC? LMHC. So it's the same. Licensed mental health counselor. I wasn't sure if it's different. Yeah.

tanya:

Yeah. It's true though. It's true. It's very different. Cause, because somebody could wake up tomorrow and say, I'm going to do this and I'm just going to go market my business. And. You know, I'll be a life coach and

Erin:

well and I have even seen people who aren't a therapist or who will put like on their credential a psychotherapist which that Yeah, i've seen that like with like Coaches or other people in the past and, and you could only have that if you're licensed, like if you see a psychotherapist

tanya:

yeah, that's, that's definitely not something you wanna be messing with it. And people do, they misunderstand that because you see end job titles you see. Counselors, and sometimes we can be interchangeable with like counselors, therapists, psychotherapists. And so some people think, Oh, well, I think as long as, you know, if I got this position that says I'm a residential counselor, then I'm a therapist. Yeah,

Erin:

counselor and therapist are a little different because you could be, you know, you can be a drug counselor, which you might not need. Yeah, you do. Might not need any degree. You could have a certification or yeah, depending.

tanya:

Yeah, depending on the state, but that certification is

Erin:

Yeah, it's pretty hard. Is that the cap? Yeah, it's very difficult

tanya:

Yeah It's it's something that I mean You know, and I guess I guess that's important to me the level of commitment because how much you put in your time and energy that shows Right commitment to it and how much you're willing to dedicate You your life, your time to it. And, you know, as opposed to someone that just is saying, Hey, this seems like kind of, you know, money that I can make. I'm pretty good at this. Let me just go ahead, you know, slap this on here and, make some money from that. You know, it's a little insulting to our, to our profession, to all the hard work, to all the time, the energy that we had to invest in that. And it is not. It is not the same thing that you're studying there at all. So yeah. is there anything else that's kind of maybe been either asked of you, things that you've heard, something that maybe we can clear up. I'm trying to think if, uh,

Erin:

Oh,

tanya:

what the,

Erin:

um, confidentiality is that

tanya:

confidentiality. So

Erin:

if you know, so if it's confidential, does that mean that if I see the person they're talking about, can, could I say anything? So I've had, I've had, I've had some laughs with some clients in the past, like where it's like, They'll be like, Oh, well, I have to tell you, I'm going to tell you this, but. You really can't say anything to them. I said I can't I I legally can't say anything right to anybody

tanya:

Unless you sign a release specifically saying even if I want to even

Erin:

if I think this is the greatest story or What the heck but no, I I always tell them I said You can that's the whole point of I you can I cannot tell a soul Unless you're gonna hurt yourself hurt someone else child abuse elder abuse Legal, legal, everything, legal court matters, everything stays, everything we talk about stays here. I think a lot of people get confused because again, they might be used to just talking to their girlfriends or the boyfriends or siblings or whoever they, you know, but whoever they talk to about stuff, it's,

tanya:

yeah,

Erin:

yeah. So, but they don't realize like, what is confidential, confidentiality truly mean? Because a lot of times you'll tell, you tell somebody. You know co workers i'm like don't say anything, please. This is really important. Then next thing, you know Sally knows everything that you talked about and then you're like what the heck So but confidentiality is a lot different than talking to your friend or your co worker or your sister your brother or whoever it's We legally cannot say anything.

tanya:

Right. It's protected by HIPAA, which is, you know, the medical, your medical information is, is, um, is safe, is private. It stays between, you know, whoever, you know, between your therapist and yourself. unless those three exceptions that Erin mentioned before. Um, or if they sign a release, if the patient decides to sign a release to say, Hey, you can release specific information. And that's also listed what is specified, you know, what, what information you can talk about. And I think you're right. I think some people do get it mixed up sometimes and think, Oh, it's not a big deal to me if they talk about this, but we need it in writing. We can't, we can't just say, Oh, they said that. Yeah. They're fine with that. We have to, we have to have that in writing with a release or it's not going to happen. Um, or what does it be

Erin:

awesome if we could just have every family member sign a confidentiality agreement before we talk to them? Or like, it's like what has solved like so many issues in life. Wouldn't it? Yeah. There's a lot of clients. I, I, if they weren't my clients, I would want, I would be like, these are really cool people. I'd want them as my friend. But, but yes, I have, when I saw, especially when I saw teens, there were times when I had to almost check them where and remind them, like, you know, and also it's a healthy thing to just remember to let them know we're not their friend. And maybe that, cause they might be stunted or looking for friends or that parental figure or something. And so it's like, right. Yeah. You know, we could be there. We can give you the tools, we can help support you, but we're not, we're not that resource of friends. Like we're not going to be hanging out with you and. Yeah.

tanya:

And it's, and some of it I think may be appropriate that, and not saying that, you know, we're, we're their friends, but some of it I think may be appropriate questioning, like, oh, this feels the same. And so to point that out, it's, yeah, like you said, it is a good distinction for them to be like, oh, okay, this is, this is healthy. And this is an adult that's keeping appropriate boundaries.

Erin:

Cause you might even be. Tanya, that could have been like the first time. That that kid teen may have had an adult look at them and respect them and laugh at their jokes and not tell them to be quiet, not tell, you know, whatever is happening at home or school. Where they don't have to feel like they had to put on something or hide or whatever is happening to them. This is their, it's their safe space for an hour.

tanya:

Right, and that, and we want to keep it that safe space, but we also want to let them know that this is not, this is not the same safe space you may experience with your friends. It's a different one. But I am going to be a healthy, appropriate adult in your life. And we may have some, we may, you know, have some laughs. We may, you know, kind of understand each other and, which I do have to say, you know, teen clients and, you know, they're, they're great, you know, and kids are, they're great for that. But, um, you know, when it, when it starts to kind of get towards that, yeah, you do have to draw the line and, and not because you don't care about them, but because you care about them and you want them to know that, Hey, you know, like, I may not be your friend, but I'm someone that cares about, I still care about you. You know, and, and that, yeah, you're right. This is, this is a safe space for you. But in, in, in this way, in this, um, demeanor, right.

Erin:

this way where you're not texting me at 10 o'clock at night. Just stop. Yes.

tanya:

Yes. That's not okay. Yeah. That's not something and it's, it's, yeah, which is, you know, I, I think nowadays with technology and everything, the lines can be a little blurred with that, right? Because it's like, Oh, why wouldn't I, I was talking about that with my therapist. Why wouldn't I send them the mean when I sent my friend the mean kind of thing, you know, like it is probably tough for them to distinguish. So that reinforcement is just saying like, okay, yeah, we can talk about that, but we're not going to. We're not going to sit there and carry this on throughout the week, right? Yeah, you

Erin:

can send me one meme or two. Um, don't, please don't send me 50.

tanya:

Yeah. Just, you're limited to one. That's it. One at a time. One

Erin:

a week. One a week, then you're cut off.

tanya:

Yes, exactly.

Erin:

But some of them are pretty funny. Some, some, some, some of my clients make me laugh. Well, most of my, most of my clients are pretty funny, but, um, but yeah, more than, more than, more than a couple of memes. Yeah. Yeah. And that goes personal too. I'm about, I'm gonna, I'm gonna just be annoyed.

tanya:

Right. Cause that's cutting into your time. Even if it is funny, it's something, you know, you may be trying to conduct therapy. You may be trying to have dinner with your family, you know, and that's not necessarily something that you don't want that space coming into this. Yeah.

Erin:

That's another thing too. Like, so If it's during work hours, and I don't have clients, I'm like, okay, that's, that's a different feeling than if it's, than if I'm getting a text after hours, because then I might think, Oh gosh, is something wrong? Where text feels different to me than email. So if a client emailed me, you know, whatever time, it wouldn't feel as intrusive as texting.

tanya:

Right. Yeah. Because an email, I think it's kind of understood that not everybody is constantly checking their email, but a text is, it pops up and ding, you hear it, right? That's kind of more of the common paradigm of it, which, you know, I think brings us Maybe the end of this. I don't know if there's, there's other stuff that, um, you know, that, but it's that we do, we do really care about these, these people. Right. You know, like, of course we're, we're seeing them. We're invested in their lives. We're hearing all their deep personal things. You know, we, we really, you know, we ask about their, their dogs, their, their kids, their siblings, how's school, how's work. You know, we, these people, you know, it's a little bit of a different dynamic because they don't necessarily know as much about us. I mean, some, some therapists choose to self disclose. That's kind of a whole thing in and of itself. And some people, um, are kind of more, conservative about it. You know, or have different theories about it. Um, it's kind of up to, you know, how you were trained and what you feel and, and the, the clientele that you have. But, um, you know, I, I think that it's, it's interesting because we're, we do a deep dive into their lives. They don't necessarily do one into ours. That wouldn't be appropriate, right. For them to have a deep dive into our lives. But so it's, it's, it's kind of that dynamic where we, we certainly were invested. Yeah. I mean, I

Erin:

think, I am, I think I'm more of a share. I'm not like, Hey, this session's all about me. Sit back, sit back quiet. Let me tell you. All about my past, let me tell you, let me tell you all my past drama. No, but I, I'm going to, I'm going to one up you, but I, can you imagine that? I had a therapist like that. Oh my God. Oh my God. I was like, what the hell? So, I, I actually had a therapist who cut me off, who one upped me, and I felt like I gotta stay. This is what therapy is, you know, before I became a therapist. And I went to her for years until I finally realized, I'm like, what the heck? So, but I do disclose, like. I think everybody knows Paige, like all my clients, all my clients know Paige, they, um, some know I have kids, like I don't share everything, like some know I have kids, some know I'm from Rhode Island, some know my mom died, some, you know, like, it depends. Like I have some clients who I've been seeing, I have one client I've been seeing since I was in practicum. So, so by sharing like a little bit here and there, she probably knows a lot more and she probably knows a lot more than the client I've just started seeing like six months, you know, so.

tanya:

Yeah, definitely. Yeah. There's a relationship there. Yeah. It's a little different than when you just started. Yeah. So I

Erin:

mean like in little, like, you know, like when there's things happen or not, you know, like, or if, you know, some, sometimes I will share like, oh yeah, well. Something like that. Some, you know, like I had a difficult relationship with that person in my family or whatever, but I don't like say like, hey, this, but yeah, I try to share just, um, you know, just a little, like, what is that? Like more humanistic approach. I don't want to be, I don't want to be the blank slate because I've gone to therapists like that too, where from one extreme to another, I think I. I, I did the one who overshare and I was like, oh my God. Just, just, this is like the worst to one who wouldn't share anything. Like I, which can be very unnerving. Yeah. Like, and I would even ask, I'm like, do you have any pets? Do you have this, are you married? Like, she would not share a thing. And, and I was like, I was like, what the hell, like, just tell me, just tell me, just make it up. Tell me you have a cat. You know, like, just tell me you got a kitten back there. Yeah. Just make my day. But that's also is like, you mentioned like knowing the animals and stuff. That's one thing I really enjoy about human telehealth since I've made that transition. It's like, I'll see a cat walking past the keyboard or, or I'll see the dog sleeping in the corner. Or I'll hear the dog or. Like I'm a big, I'm a huge animal person. So I just like, love seeing like the, I mean, I love seeing my clients, but I love seeing their animals. It's really fun.

tanya:

Yeah. Yeah. Me too. Yeah, I totally agree. It, it brings about a different element in there. That's really sweet and innocent and, but also is somewhat of, You know, it brings out maybe a different side of the person or just, um, you know, I don't know. It's just, it's just nice if you like animals, it's just cute,

Erin:

you

tanya:

know, it's a nice element.

Erin:

I sometimes feel like I, something's wrong with me, but I do remember all of my clients dogs and cats names. Like when I see them, I'll be like, oh, how, so, uh, where's, that's impressive. I have, I have issues, but like, I, I have issues. No, I think that, that's, that's really nice. That shows

tanya:

you're really invested.

Erin:

Like the little animals, you know, some, some I don't and I'll, uh, you know, like, and I always, that's in my intake too. Like I'll ask, I'll ask, I ask, like, like when I do my, my history, like when I'm first meeting the person, I'll ask him like, one of the questions is like, do you have any animals? Yes or no. If they say no, I instantly delete, say, forget it. No, but I, This is not going to work. No, but I, I do, do wonder. I'm like, Hmm. But I do, if they have animals, I always ask like what type, how many, what are their names? And it's really, it's really neat to, to hear them talk about them. And sometimes they'll be like, Oh, here they are. You know or something and so that's kind of fun.

tanya:

Yeah, it's nice to see how people, you know, talk about and respond to their animals. It definitely can bring out different, different, uh, personas and different feelings and make them more comfortable too. What about you?

Erin:

Do you share or do you, do you not share or what do you do for?

tanya:

I do. I do. I would say, um, I actually on, on one of my profiles, I think I even had a picture of Lucy, my dog. Um, I don't have a problem sharing little things kind of like that, that make you kind of, like you said, kind of more, give you a more human picture. Um, I, you know, I even consider kind of, Uh, you know, even like a background or something like that as, you know, kind of maybe general as this may be. I even consider that kind of a way of

Erin:

a share. I do like yours and it does give personality. It, it, it's fun.

tanya:

Thanks. Yeah. I, I like to kind of, you know, that's why I like to do that. I, to me it's fun. And I think when I first started out, I thought the rule was like, don't tell because I had had therapists who just literally. Would share like basically kind of nothing, but like not in, you know, if I asked, I think they maybe would share a little bit, but it was very much like, you know, kind of that, no, we don't want to share, you know, like blank slate kind of thing. And I, I held to that, but then I realized, you know, working with kids, you can't, you can't do that. And then, you know, I started to realize this is just not, how would they feel? You know, this is all about feeling, you know, seeing what they're feeling and relating to that. And that's like,

Erin:

yeah. A normal person is not the blank slate. Like it's, um, right, right. You know, you want to be able to share a little bit.

tanya:

Yeah. It's, it's, I mean, I think it's, you know, that kind of golden rule of if it's, if it'll enhance the, uh, the intervention or the, the rapport or the, um, kind of clinical, You know, standards or, you know, something that kind of, that enhances the, the, the therapy kind of takes it, you know, if, if sharing that will enhance it and help out a little bit, that's, it's definitely worth it. Like if somebody is talking about how. you know, they're, I don't know if, if, you know, they had a sibling who maybe is tough to get along with. And maybe if you feel like, okay, this is something that might help them, kind of something that I did. With this, you know, without getting too, too into it, but just saying, you know, sometimes if, you know, like I, I had, you know, a friend who, who maybe had this, this brother who, uh, you know, they, they just would, would only see them on holidays or whatever, or, you know, or I have, you know, my sister, you know, sometimes I, it's, you know, or I have a family member who I can only do this kind of thing and showing that, you know, these are, these are the boundaries that I choose to use, you know, it's not something you would have to, but. Okay. Um, yeah, it normalizes things for them, you know, and kind of makes them feel like okay sure like, you know Other people have these issues and it can they survive

Erin:

or you know like I had to step away from my family because of this or I chose to get close to my family because of this or You know, right. I chose to just fill my house with animals because of my family. No Yeah. Yeah. I mean, can that

tanya:

definitely

Erin:

can be a response. No, but it's, it's, you know, and it's interesting too because when we were in school, I, you know, I know Tanya and I have met this to get, you know, we've gone to, we went to school together, so we have a lot of shared, um, memories and, um, professors. But like we were pretty much told by most of the professors to. Not share.

tanya:

Yeah. Yeah, or I mean there were some I think that were like at your discretion, but make sure it's kind of clinically Relevant or relevant to what you're talking about that it would enhance it. I just remember that that word like it would yeah You don't want to take away

Erin:

That's what like you don't want to take away that like you don't want to make it all about you You don't want you don't want to be you don't want to you don't you don't want to one up You don't want to be the one upper

tanya:

right like you don't and you don't want certainly if you have a client who's really Sensitive you don't necessarily want to be like Oh, well, you know, um, you know, when, you know, I, I really didn't, I didn't sleep well last night and I'm just, I'm just exhausted, you know, and they may be like, worry about you kind of thing, or like, I'm really sick, but I showed up kind of thing. Like, you know, you have to be careful about some of those sensitivities too, because then that changes the dynamic of who's, who's

Erin:

trying to

tanya:

treat.

Erin:

That's interesting. You say that. Cause it's like when I, I mean, I've shared with you and you know, like I had cancer and blah, blah, blah. But I've had some clients who were like, Oh, well, you know, I don't want to talk they talk about friends who had cancer and stuff They're like, well, I don't want to upset you. I'm like, it's not about me you know like or like anything and I i've had to tell them that i'm like My anything is not about me myself, you know I'm a therapist and I have my therapist hat on has nothing to do, you know And so that's also where you have like yeah that overly empathetic clients who are or like, oh wait I don't want to you know, like I know You, you know, this happened or, um, you know, I don't want to upset you. And it's like, this, I'm at, this is my, and I kind of say this a lot. This is my job. I chose this. This is, I'm at work right now. This is, I'm able to switch, you know, whatever's happening in my life because I do have, cause I have self care and I see a therapist and I, you know, I, I try to, you know, I try to stay grounded for the most part.

tanya:

And yeah, as best you can as a human, right, you know, and you know, it's, it can be tough sometimes, but yeah, and, and that's a, that's a good point too, is. You know, that there are some big events that sometimes you do have to tell your clients because you might be out for a while, like, you know, a diagnosis or, you know, something like that, or, uh, you know, a death in the family, something like that. You might have to say what it is, and that can still be navigated as, you know, I'm, I'm okay, you don't have to care about, I just want you to know, because I'm going to be out for a while. Out for this amount of time, right? You know, and people are still going to care. They care about you. You know, they're, they're, they're going to, but you just, it's kind of how, like you said, how you kind of switched that back. Yeah. Cause I had to, like

Erin:

when I had my surgeries, I had, I was gone both times for a month and I had to tell like, and that's when I had to actually, I had to really break, be personal and be like, Hey, this happened, this happened. I'm going to be gone. And. Yeah, it was difficult. And I made sure I didn't tell anyone until the end of each session if I didn't want to make it about me at all. So I'm like, the last five minutes of session, after the session was done, I'm like, Hey, I gotta tell you something. You know, just because I don't want, I wanted to make sure a session was done. You know, like, so it wasn't about me. And it was just,

tanya:

yeah, it's going to be so tough to navigate. I mean, especially when you're, you're dealing with that, I guess that's something too,

Erin:

I do, um, off topic or something, but if I want to talk personal, I have a couple of clients who we talk TV shows and movies. So sometimes I'll wait till the session is over and then like, we'll be like, okay, session's done what we're rescheduling for the next one. And then we'll be like, oh, wait, have you seen the show? Cause we'll, I have a few that will, and then I'm like, all right, we'll talk Silliness. You know, and, and it's, so we talk

tanya:

Yeah, that's just like good for the rapport kind of thing, you know? Like it's just, just being human, right? It's that human element. But I will do

Erin:

that after, but I, I don't know, I don't know if it's like I feel like, okay, I can talk now. Because, because session's over and I don't feel, or just have fun.

tanya:

I kind of, I even kind of can do that at the beginning. You know, like sometimes I do that, maybe I shouldn't, but I, I do that at the beginning sometimes just to kind of ease into the, you know, for. Yeah. Are are not really open or you know kind of need that opening kind of yeah, like how we were

Erin:

talking Like hey, did you see wednesday? Did you yeah,

tanya:

yeah, just to just to have that.

Thanks so much for listening today to the Wicked Psychotherapist podcast. Be sure to like and follow us on Apple, Spotify, and Amazon, or wherever else you listen to your podcasts.

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Erin

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Tanya Santos

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