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Episode Description
What other job pays you for your work and then takes the money back months later? In this first episode of the new unscripted format, Ashley Charbonneau and Morgen Villegas pour the coffee and talk about what being a therapist actually feels like these days.
They check in with their highs and lows, as people and as clinicians. They talk about how hard it was to watch the Cornell case unfold, and what to do with that anger when justice may be years away. Ashley explains what Kaiser Colorado’s review of clients with more than 20 sessions a year means for care. She also shares why proving medical necessity can feel like it’s working against the client in front of you.
There’s good news too. Their former guest Jill passed her LCSW exam. Morgen learned to do things scared during a nor’easter. And a shelter dog finally let herself be held.
They wrap up with their likes, dislikes, and middle fingers of the week: clawbacks, differential diagnosis, multi-state licensure costs, and the supervisees and consultees who make the work feel new again.
Grab a cup and join them.
Transcript
Coffee Chat
Morgen V.: We're unscripted today, so hopefully this, this new format feels like you're having a coffee with Ashley and I. Welcome back to The Art of Being a Therapist, the space between training and real life. And y'all, we're just gonna keep it real today. We've been releasing episodes since mid-July, and this has been truly a labor of love, and we're just really appreciative to all of our listeners and all of the people who have come to join us in our discussions.
And now we're just taking a little bit of a format pivot, if you will, and that doesn't mean we're gonna not interview people. We're just gonna add a little bit more here. Because of the richness of the conversations we've had, we've really found that there's also some space that we wanna take to, to share with you about our perspectives, too.
Ashley C.: With that, welcome to Coffee with Ashley C and Morgen V. You literally just made that up and I'm obsessed.
Morgen V.: Thank you. So our format-ish is we're just gonna kinda check in like we would in some of the groups that we lead. We talk about highs and lows as a person and as a professional over the last week, over the last two weeks, and then in the end we will also say what we like, dislike, and what we're giving a middle finger to in the mental health profession this week.
So yeah, Ashley, do you wanna start us off? Are there things that you already wanna share?
Cornell Case Reactions
Ashley C.: Yes. I think my low as a person and a professional is the same thing. As we are seeing this Cornell case unfold, I will focus on a very specific aspect, which was the district attorney shaming and blaming a victim on national television.
That was probably one of the grossest things I've ever seen as a woman and as a person who specializes in sexual abuse, and honestly completely flabbergasted, to tell you the truth. And it's not often that I'm surprised or caught off guard, but that was truly very painful to watch.
Morgen V.: I really agree with you, and I think we talked that day on the phone just because of our indignation- Yeah
around viewing that and witnessing that. So yeah, so that sounds like the low. Although there's a professional experience of it, there's also personal, you know, naming of that, too, so I appreciate you sharing that.
Ashley C.: Yeah. What about you? What is your low of the last week or two, personally and/or professionally?
Morgen V.: Consistent with you, I don't necessarily have a specific experience other than, like, the general exposure and re-traumatization experience through the Cornell case as well. I just worry, and I worry and I feel anger and I feel sad. We were kind of saying this, some things feel shocking but there's really no justice.
Ashley C.: And I think a lot of us want not just justice, but immediate justice, and I think it's a very difficult reminder for myself that this is a long-term case that we, if we choose to watch, that we are gonna watch unfold. The criminal case, if it proceeds the civil case could take two, three, four more years.
The criminal case, depending on how many people are charged and what charges are, and proceeding to trial could also take several more years. And it's really hard to sit in a space where you want justice and fairness and accountability, and knowing that it is not gonna happen any time soon, if ever.
Morgen V.: Yeah.
I mean, that's part of this liminal experience, right? Is we're really in the in-between of it, and yes, we would like immediate justice. I think accountability, starting from the top at Cornell, as well as the investigators that handled this so poorly, all the way down to the students who need to be expelled from the school.
It's been a lot of space holding, professionally and personally, that duality as a therapist and as a person, seeking my own support with it so that I can support others, too.
Ashley C.: Yeah, for sure.
Insurance Pressure Burnout
Ashley C.: I think another low is also part of my high, but I'll save that for a little bit later. The low, and we've talked about this in our last couple episodes, is related to insurance dictating care.
And I heard on Friday that Kaiser in Colorado is auditing or reviewing any client that has over 20 sessions in a year. And I was just like, "Ugh." There's not even a word for how ridiculous that is.
Morgen V.: Again, interfering in our treatment, interfering in the way that we carry out care, making it a commodification, making any kind of mental health situation or treatment or experience be part of a corporate structure.
So frustrating.
Ashley C.: I'm experiencing a lot of grief for something that has never been for some of these newer therapists. They are forced into a system to prove via documentation medical necessity and what interventions and what diagnosis, and to some extent, depending on the clinician and the client, that is always going to take away the art of being a therapist.
That is always going to impede the therapeutic relationship, and it makes me sad that so many student interns and newer clinicians are starting their careers in this space, and they don't have the support and structure in place to truly explore what it means to be a good therapist. But what else- Okay
do you wanna share
Parenting Highs and Lows
Ashley C.: about the low?
Morgen V.: I think my low is just continuing to feel the pressure of working and being a mother and doing well as a person raising children, especially two boys right now. I really do try to have a at least positive or neutral spirit while doing so. Yeah. But when they wake me up at 3:30 in the morning, it's just really hard to sometimes find balance with all the things.
Luckily, I'm in a place where I have more balance in my schedule. I'm not seeing so many people back to back, and I can take breaks, and I can rest in between people if I need to, like, if I don't have somebody scheduled, obviously. But I don't know. I just feel that heaviness constantly with me. Not just my own personal heaviness, but again, like, that collective heaviness around the identity of a carer, as a parent, as someone raising a child, and someone who has a desire to maintain a professional identity, and again, like, how untenable that can feel, and how there's sometimes, um, no solution other than to just continue to push through.
My older kiddos is having a milestone birthday, and I'm just having a lot of feelings about it, 'cause he's getting older, and I just, um... Yeah, I just reflect back to that, that person that I was when I first had him, and I just feel so much compassion toward her. She had no idea what the was waiting for her.
Ashley C.: Yeah.
Morgen V.: I feel like I kind of know what I'm doing a little bit more with what to expect or not with being a parent and with society. I'm trying to celebrate, but also inviting in whatever feelings are here with it.
Ashley C.: Maybe that was a celebration.
Morgen V.: That, that might've been a high and a low there. I don't know.
There's just, like, so many dichotomies happening.
Ashley C.: I'm wondering, what are your favorite things about each of your kids?
Morgen V.: Oh, gosh. They're... They just want to be with me right now, and they are just- Oh ... so sweet. They wanna invite me everywhere. They want me to see the things that they're making and doing.
They want me to go to all their sports events to watch them, and they just feel so proud and so excited when I'm there, and I feel the same. I really wanna be there. I can't always go to everything. But I just love that I can see them developing integrity, honesty, responsibility. I can see them developing kindness, um, concern about other people.
In my son's class, they will do a check-in. They do a little social-emotional thing where they'll say what their celebration or concern is for the day. And I just think that there's just so much sweetness in witnessing that. And then my younger one, just really learning about how to advocate for himself and say no to what I would say are other boys already starting to develop kind of some bullying tendencies.
And so really advocating around that and standing up for other people when he sees things that are unjust. So I hope that answers the question.
Ashley C.: Presence and the engagement and the love, you know, the joy of being in this phase of life with them. That doesn't negate the challenges of parenthood, I'm sure.
Morgen V.: Yeah, that's right.
That is kind of what happened. Thank you for asking that, 'cause it's like when you wake up this early, it's hard to
Wins and Joyful Moments
Morgen V.: remember.
Ashley C.: Highs of the week. So I talked to you a little bit about this offline, but myself and a dear colleague of mine who is a very experienced and well-respected trainer, we did a four-ish hour training on Friday, and the topics were documentation, medical necessity, level of care.
And what I thought was going to be quite dry was actually an awesome training. People were highly engaged. It was in person, which was just so lovely and makes such a huge difference. There was so much gratitude. There were so many hands raised. On Friday, I was kind of reflecting, there are so many things all of us are thinking about, and right now I think documentation, proving medical necessity, and level of care are three of those things a lot of people think about or have to think about all the time because of insurance pressure and insurance standards.
And there's not a contained or planned space to talk about those things, and then all of a sudden you get 40 people in a room and it's like, "What about this? What about this? What about this? What about this?" And you're like, "Holy cow." Like- This is awesome. Just learning from each other and having a shared experience.
Sometimes that's what it's about.
Morgen V.: I love that.
Ashley C.: It was very cool, and it was one of those things where, you know when a trainer kind of drops something maybe slightly personal- ... but it's super relevant to everyone, and then you're like, "Oh, here we go."
Morgen V.: Yeah.
Ashley C.: So we were talking about diagnosing and proving medical necessity, and I gave this example around anxiety, and I described I'm a highly anxious person, like pretty neurotic, I would say, at my baseline.
But I manage it well enough to where I don't have distress or negative consequences across life domains, right? At least not enough to prove a diagnosis or medical necessity. And I am comfortable sharing that example because I think it resonates with so many people, but it's also such a common example of client presentation.
How do we know someone meets diagnostic criteria? When you really look at all the symptoms that are required to meet a certain label, you have to prove distress. And sometimes it's a really nuanced thing, and sometimes it's a very difficult thing for me as a provider to do because I want clients to know that I see them doing the work, and to have to provide a label for the sake of reimbursement over time that is proving, quote-unquote, you are so symptomatic, you are experiencing distress across life domains, like that's kind of a mind fuck, for lack of better word.
I know for a lot of us, this is automatic and we do it all the time, and hopefully we're collaborating with clients and hopefully most of the time it doesn't cause a lot of stress. But the nuances are really interesting to discuss, in my opinion. I could talk about diagnosing all day long.
Morgen V.: We're figuring it out, especially with these types of trainings that you're describing and the ways that we figure out how to make this work for ourselves and for our clients, 'cause they deserve it.
So do we.
Ashley C.: I agree.
Morgen V.: Cool
Ashley C.: What was your high of the week?
Morgen V.: Let's see. Oh, gosh, it's so good to reflect on this, 'cause I... Whenever I'm at work, I just feel so in my zone, and I don't even think about what's going on for me. I went on a trip back east to see family. I guess this is more of a personal high where I got to reconnect with people that I hadn't talked to in many, many years, maybe some even decades.
And it was just so nice to feel like I could just be myself, like really unapologetic, and just take up space and dance. And I made reels, so there's evidence of me dancing, and it was just like, it was just really fun and really joyful.
Ashley C.: Love it.
Morgen V.: It was for a wedding, by the way. I wasn't just dancing randomly.
But speaking of like, kind of being unapologetic and doing things scared, I'm really not, I'm not a happy traveler, and I also get a lot of anxiety about weather. And there was a nor'easter while I was there, and I'd never... I don't even know what that is, and then all of a sudden it's like raining and like pouring water into subway stations and all the things, like being really hyped up in New York City.
And I just had watched the Andrea Gibson documentary.
Ashley C.: Yeah. They're one of my faves.
Morgen V.: So good. And I feel like they said something about doing things scared, and I was like, "I can do this." And I just did it, and I got through it, and it was actually a really life-changing experience. And I came back just feeling like my cup was really full.
I came back a day late 'cause of the storm, but everything worked out.
Ashley C.: Oh, man. And I certainly don't wanna minimize any stress related to last-minute- ... flight changes or impacted travel plans because of weather, but talk about really having a joyful experience and turned out to actually be a lot of fun.
Morgen V.: It was fun.
And there was a brainstorm during the wedding, and it was beautiful, and then I got to spend extra time with a friend that I was with there. It was something that I really needed, but I didn't really know it until it unfolded.
Sometimes- It was great ... the universe gives us exactly what we need, even if it is not planned.
Ashley C.: Absolutely. Yes. Absolutely. So a lot of radical acceptance practice. I would love to name another professional high of mine.
Morgen V.: Please.
Ashley C.: I have a supervisee finishing up this week. And he is a phenomenal clinician, and I'm so excited for him to move into independent practice. Oh my gosh, and for our listeners, Jill passed her LCSW exam.
Morgen V.: Oh my gosh, that's amazing.
Ashley C.: Yes. So for those of you who listened to episode two with Jill, thank you, Jill. Very first recording Morgen and I did -
Morgen V.: That's right ...
Ashley C.: with a guest. She shared her experience of really struggling with the ASWB as a system, and the ASWB exam, and taking it multiple times, and really feeling stuck.
And she texted me last week and passed the test. And the joy and the pride and, oh my gosh, I am just over the moon for her.
Morgen V.: I'm so appreciative of that update, Jill. Congratulations. Talk about figuring it out, right? Like, figuring out using our grit and tenacity to try to find a path forward. I'm really proud of you.
Ashley C.: Yeah.
Morgen V.: And oh my gosh, and thank you for sharing about your supervisee. Mm-hmm. You got to really see that person- Yeah ... develop and transition into- a deep competency in this field. Yeah. What a cool milestone. Um-
Ashley C.: Do you have any other highs to share?
Morgen V.: Have I shared about my dog on this podcast? I think I've just shared on social media.
This is definitely a high because we struggled. I've never had a dog before. We adopted her from a shelter in April, and Ashley has been one of my dog mentors, so to speak. I have mom mentors, I have dog mentors, I have therapist mentors. I have all sorts of mentors 'cause that's what life is about, is trying to find, essentially it could be like a sisterhood, right, of people who have supported me through different phases.
So thank you for that, Ashley. But the first three months she just was... I didn't know how to take care of her, didn't know what she needed. It just felt so stressful all the time. I thought zoomies were never gonna end at night. And the other night I was talking to my husband, and I was picking her up and I, she was actually letting me hold her.
She hadn't let me do that. And I just said, "You know, I think I really, really love her. She is literally now my baby girl." Aw. "She is now a part of our family." And he looked at me and he said, "Oh my God, I feel the same." Ah. He said, "I absolutely love her and I could never imagine our family without her." I totally get it now.
I get it how you now start- The dog, counting the days. You're like, "This dog has to be with me forever."
And she is just, she is my baby and I am obsessed with her, and I just cannot wait to see her every day, and I love going outside with her. I love taking care of her, and I just love how she loves us so deeply and so unconditionally.
I've never experienced that in my whole life.
Ashley C.: Oh, that is so beautiful. And- I get to pet sit her soon.
My obsession with my dogs is a fraction of the obsession my spouse has with our dogs.
Morgen V.: Yes. But just thank you so much for helping me through that, 'cause it was so hard. So if you have a new puppy, you got this. It just takes a minute. It does. Maybe like three months.
Ashley C.: And attachment theory works with dogs. I love it. That's me. I love it, I love it
Morgen V.: Okay.
Likes, Dislikes, Middle Finger
Morgen V.: So are we doing middle finger like/dislike?
Ashley C.: Yeah, let's do it since we haven't done it yet.
Okay.
Morgen V.: We actually haven't, have we? I'm just gonna go-
Ashley C.: Usually we agree with our guests- Right ... but I feel like that's cheating.
Morgen V.: Yeah. We need to figure out our own, and here I am off-script. I'm like, "I need to be prepared," but I probably could think of something, I'm sure.
Do you wanna go first?
Ashley C.: Yes. Okay. So my middle finger for the week is I wanna say insurance companies, but we say that every single time. So I'm gonna specifically call out Kaiser and this 20 session crap, and audits, and I don't know if we've talked about it a lot, but the, or even at all, the potential for clawbacks.
In what field do you get paid and then money taken away months or years later? In what field do you provide a service, get paid, and then have that payment literally taken from your bank account? Yeah, that is the insanity that we're living in right now with the mental health field. Yeah. That. I would say my dislike for the week is
Maybe it's not a dislike, but it's like a huh. Like, how is this gonna evolve in my career, and how are my feelings toward it gonna evolve? But I'm gonna say differential diagnosing, and I say that because this came up on Friday at that training, and it came up with a consultee more recently. What do you do when a client has symptoms that overlap so many labels?
I think it's a meh for me because I really enjoy talking about diagnosing and hearing what other clinicians have to say, and how do you ask questions about this symptom? How would you get more information about this presentation? How do you phrase this? How do you know that a client understands the word that you're saying?
Does your client even know what an emotion is? How do they know what anxiety or worry is? And those are really just intellectually stimulating conversations that I really enjoy having. But it's a meh because so many of our clients present with so many symptoms that I don't wanna say that diagnosis doesn't matter because that is absolutely not true, and that is absolutely not fair, and that is absolutely dismissive to what some clients need and what their experience is.
But I'll say the meh is we're focusing so much sometimes on the, quote-unquote, "right diagnosis" instead of targeting a symptom, and I wish that was talked about more.
Morgen V.: I love that. Can I share just some feedback on that?
Ashley C.: Yes.
Morgen V.: Yes. That's why, that's why I love IFS. It's a depathologized model where you don't have to work with a, a specific diagnosis.
You just work with the person in front of you, understanding the parts of them which can show up as emotions, thoughts, or body sensations. So anywho, you know how I am about IFS.
Shout out to IFS. Shout out to IFS. Always. But I hear you. It doesn't always translate, though, to being a, um, reimbursable modality.
Morgen V.: Um, you know, through insurance or whatever. So anyway, I love that you shared that, though. I share the same dislike, or maybe meh. I don't know. I think dislike. I just feel like the DSM is very limiting. My dislike is licensure payments. I'm licensed in several states, and I have to pay a lot of money to maintain my licensure.
I don't get reimbursed for any of it. Yes, it's considered- Ugh ... an expense for my business, but it's also really hard to keep track of all of the different states' requirements, and so I've realized that I'm missing several continuing education credits despite being pretty meticulous about counting them and keeping track.
And so I'm just, like, scrambling right now, um, with one of the states that I'm licensed in, and it's just hard and frustrating. And I don't know. I know other people have to pay for licensure as well, but it just seems like quite a big hardship for the profession.
Ashley C.: I agree with you, and I didn't realize how lucky or loosey-goosey Colorado is with regard to continuing education requirements and supervision requirements until I got licensed in Washington, and then it was like, "You need X amount of this, X amount of this by this date, and it's not your renewal date.
It's actually your birthday on an off year, and you renew on- Mm-hmm ... your birthday, not on this day."
Morgen V.: Yeah.
Ashley C.: And I was like, "Oh my God. I need a, to upgrade my spreadsheet system."
Morgen V.: Yeah.
Ashley C.: I hear you. It's so funny, but I'm like, how, I ... Like you're saying I don't know how I'm going to stay on top of the specific requirements that I'm not used to.
Morgen V.: We should talk about multi-state licensure one of these days.
Ashley C.: We should. We should.
Morgen V.: Okay, what's our thumbs up?
Ashley C.: Our thumbs up. Honestly, my thumbs up are these rock star supervisees who are open to feedback, wanna learn, wanna grow, are super smart, super insightful, and just becoming awesome, more independent clinicians.
Morgen V.: That's beautiful. Yeah, I love that. I'm in a similar boat where I feel that way about my consultees that I'm working with, just really integrating IFS and EMDR so beautifully and understanding their own alchemy as clinicians-
Ashley C.: Yeah ...
Morgen V.: that there can be a translation, there can be a way to do this work that feels that feels right for each person.
Um, so yeah, just getting to witness that, I'm really enjoying that so much. It's like breathing some new life into my career right now, which I'm just really enjoying being a consultant. And a podcaster, not to-
Ashley C.: Yes! Yes, yes, yes, yes. I just squealed and I hate squealing, but it was worth it. Thanks to our listeners for hanging with us while we drank coffee and spilled some tea.
Morgen V.: Thanks to all of our listeners again for all of your support. Please give us a like or a follow or a subscribe. It really does help people to find our podcast. Thank you again for joining us on The Art of Being a Therapist, and until next time, take care of yourselves.
Ashley C.: And each other
