I’ve been on a pretty steady soapbox about video games, and play this past week, and that was not a coincidence. The post I did about HIPAA attracted a lot of positive attention, and some negative. I think the title had something to do with it, in that it was a tongue-in-cheek title. There’s no such thing as a 100% HIPAA compliant practice, and I was poking fun at the fear-based mentality that sometimes consumes us when it comes to our practices and being sued. When my readers poked back, I realized that I needed to explain my perspective, so this post will hopefully clear things up in terms of using technology in therapy and preparing your practice for health care reform. So let me try to do that now:
We live in an era of fear.
That’s it in a nutshell. There is so much change and synergy going on today that it can be overwhelming. Technology, in particular social media, is evolving faster than many of us know how to use it. So we turn away from it in fear and disinterest. The HIPAA issue is in many ways the symptom of that, but it is also a red herring. The way we live and work is changing, and we don’t want to change. We want therapy to begin with the first phone call or the greeting in the waiting room, occur only in the office between two people talking, and end at the 45-50 minute mark. And for many of our patients, that works, and for much of the time, that works. But things are starting to slip, expand. Our potential patients want to know something of us before they even call, so they’re looking for our website. Patients from all over the world are seeking out therapists with particular expertise via Skype rather than the brick and mortar office. And between sessions our patients are following us on Twitter, asking to friend us on Facebook, or reading our blogs. The ability for us to remain as mysterious as we used to be is being challenged. We are googled, and this raises our own ethical concerns about whether we should google our patients. So technology scares us, and we feel it threatens our profession rather than opens new avenues to us to practice our craft.
We are also scared of health care reform, ACOs and global payments. We have grown reliant on the way we have come to do business with health insurances. In the 1980s in Masachusetts, insurers like BCBS offered their subscribers $500 worth of coverage, that was it. There was no parity, and many of our patients paid our full fee out of pocket. Somehow they found the money, sometimes they went without treatment. In the intervening decades many of us made a “deal with the devil,” agreeing to play by insurance companies’ rules in return for the steady fee-for-service reimbursements we got. Sure we sometimes complained about how long it took to get reimbursed, or the clinical reviews we had to do, or the paperwork. But we signed up for the insurances for a reason, we wanted security and steady referrals. And we raised a whole generation of therapists who saw insurance reimbursement as a necessity, not an option.
Worse still, we stopped needing to think with our colleagues and our patients about whether we were doing valuable work. Our patients grew to take it for granted that therapy cost $15, and we grew to think we might only be worth that much. So when insurance companies put incremental demands on us, we acquiesced. When they lowered reimbursement rates, we acquiesced. And we did this, we do this, because we are afraid. And because we are afraid, we keep doing business as usual and rely on the insulation of a third party reimburser to protect us from having the conversations we need to have with our patients on what and why they need to pay for their treatment. We bought into this system because we wanted to avoid those conversations.
Health care reform, if it survives, will be an amazing boon for Americans. Mental health parity has already in MA helped thousands of people get and stay in treatment. As our politicians hammer out the details, our professional organizations are being called on to weigh in on how to move to the new structure of treatment and reimbursement. And to their credit, they are doing what organizations like that need to do, ensuring that they have a place at the table, and speaking out loudly and strongly to advocate for patient care. And yes, they also represent us, but we need to understand that we don’t come first in many ways. The people who need to fight for our businesses are us.
I need to advocate for my own business, make my own business plan, set my own fees, adhere to my own fees, set aside PB+5 or low-cost sessions to have a socially just AND profitable practice. I need to be able to have the difficult conversations, to tell people why I am worth more, why the work we are doing is worth more, than $15. That is my job as a business-owner, even if the business I am in is healing the mind and soul. I need to wean myself off an insurance-only practice, diversify my revenue streams.
In short, I need to become an Epic Therapist.
Epic therapists, don’t play it safe all the time. They know that to get the epic loot they need to try and fail and try and fail again. Epic therapists know they need to network with a group of strong co-players, and learn new strategies to try when the old ones won’t let them down the boss. Epic therapists “learn the fights,” they spend hours learning about how to be the best they can be and let other people know what they are good at.
Epic therapists aren’t good at working with every single patient problem or person in the world. Those type of therapists, who maintain that they can do equally excellent treatment with anyone for any problem are what I call “Non-Player Character Therapists.” In video games, a NPC is a character in the game like a robot, that anyone can click on and they’ll get the same conversation and quest. NPC therapists have no sense of agency.
This was all a long prelude to what I really wanted to do today, which was to introduce you to some Epic Therapists. These are people doing amazing work in their own unique ways. So here are three epic therapists:
Deb is a social worker in CA with over 25 years of experience working with adolescents and their families. Deb specializes in adolescents whose anger and distress have often landed them in a lot of trouble with the law, schools or their families. Deb is not afraid to fight for the kids she works with, and will often go head-to-head when she is required to testify on their behalf. When I’ve spent time with Deb I’ve been impressed with her energy and authentic cheerfulness. If you are looking for a therapist who “gets” teens and “gets” the technology that is so much a part of their lives, click on the link above and contact Deb.
Also in CA, Brenda is an LMFT who specializes in working with couples. She also specializes in advocating for the voice that may have a hard time speaking up. Brenda may not be the loudest person in the room, but she’s definitely one of the most attentive and thoughtful. In addition to her experience with couples, Brenda has a particular interest in working with couples where one or both partners has been identified as gifted. If you are looking for a therapist but are shy about therapists and therapy in general, Brenda is a good bet. Brenda is also beginning to branch out into online therapy, so you may want to inquire about that as well.
A seasoned clinician with an extensive background in psychodynamic theory and trauma, Carolyn has also been practicing for over 25 years. She has a specialty in evaulations for persons with complex trauma seeking immigrant status, and has testified numerous times as an expert witness. She frequently teaches and lectures on the impact of trauma from a psychodynamic perspective, and in her private practice she has a specialty of working with emergent adults (18-25) who are struggling to maintain their schooling or jobs after having had a psychotic episode or severe depression. Carolyn is not afraid to go to the deep places with her patients, and stay with them through the terror that can exist there.
These are just a few examples of the Epic Therapists I know. Who are some of the Epic Therapists you know? And what makes you an Epic Therapist?