What is so “trusted” about the Trusted Provider Network?

Written by: Brittany Hunt, LCSW
Clinical Oversight Specialist at TPN.health

As a licensed clinical social worker, the concept of trust is an important one to me. I see trust as intimately linked with respecting the dignity and worth of a person, one of the social work core values. The majority of my work has been in the anti-sexual violence field, where I have worked with sexual assault survivors at various parts of their healing journey post-assault. The most important part of my job was trusting the client: trusting their story, trusting that they were in pain, trusting that they had the resilience to heal, and ultimately trusting that as a society we can end sexual violence. By having this trust in my clients, I hoped that they would have trust in me. Forming relationships with clients through shared trust, even the very short-lived relationships that blossom when responding directly to a crisis, has been by far the most impactful part of my social work career.

When I started working on the TPN.health clinical team, I was worried about losing the special connections I made doing direct service work. Social work is inherently relational, and how could I feel these relationships on a tech platform from behind a screen in an office? Like many people in our increasingly digital world, especially during the COVID 19 pandemic, I have had to rethink relationships and connection. Technology is an amazing tool to bring people together all around the world to share, learn, commiserate, and connect. I was ultimately attracted to working at TPN.health because of its potential to fuel relationships, and its focus on trust.

TPN.health strives for our network to be filled with the best clinicians out there, the people you would trust with your loved ones’ care. How do we do this? Whenever a new user signs up for TPN.health, our clinical team verifies their license with the relevant state board, to ensure that every professional on our site meets the criteria to treat clients in their state. Another feature that helps to make sure that our users are credible professionals is the endorsement feature. Endorsing a colleague on TPN.health signals to the greater community that this is someone you know is a caring and competent professional. These endorsements are important, especially when making referrals to professionals you may not have worked with yet.

Trusted clinicians’ voices are involved in every step of our development, including our digital beta-referral feature, which will allow clinicians to more easily find other professionals for their clients on a secure platform. In addition to our team of licensed clinicians, we want to hear from other clinicians from diverse fields and backgrounds to make sure that TPN.health remains a trusted resource. Just like how we need to trust our clients for them to trust us, we know that we will need to trust our users in order for you to trust us. Please, drop us a line on how you think TPN.health could be helpful in your work. 

About the Author

Brittany Hunt is a licensed clinical social worker originally from Rhode Island. After graduating from Vassar College in 2012, she moved to New Orleans and began working in the anti-sexual violence and reproductive justice movements. She loves reading, throwing dinner parties, and karaoke.

Brittany Hunt, LCSW
Clinical Oversight Specialist
at TPN.health

The Case of Termination

Written by: Maria A. Avila, LMFT, MCAP

I recently resigned from an organization where I had worked for almost 16 years. In order to allow the different groups of people I worked with digest and accept the news, it was decided that I should proceed in stages. After revealing the news to the leadership group I was part of, I addressed those colleagues that I supervised. We  gathered in my office with my director present and I delivered the news. After the initial blow, the discussion was diverted into questions and concerns over other matters. The conversation was among the staff and director. The announcement of my departure quickly got me off center stage, to my relief. It was at this moment that I realized how this experience could be translated into termination issues with clients. 

The work of emotional and behavioral transformation can be quite intimate between a clinician and their client. In working with those at an intensive inpatient or intensive outpatient level, the process of termination usually comes to fruition sooner rather than later. Working with clients in an outpatient setting brings about the same  process but perhaps after a longer period of time. Regardless of the level of  treatment, clients reach a time when they feel they are ready to depart from the work they started. How this procedure is handled can be of upmost importance in the  therapeutic process. Dealing with termination of a therapeutic relationship is based on how we, as clinicians, view this issue, and especially, how comfortable we are with it. In the example of my resignation, the diversion to other issues from the end of a relationship with an organization and coworkers demonstrated my own discomfort with sadness that takes place in this process of loss. 

When insurance companies dictate the length of relationships we are to have with clients, it forces the issue must faster. We have a better idea of how much time we have and certainly have the opportunity to begin the steps needed to prepare a client  for the end. If one’s relationship is not controlled by insurance, then the time to build  this closeness may be more fluid. Whether the client is working in an individual or  group setting a certain level of trust and understanding has transpired. There are several questions that should be addressed. Do we wait for the last session before  trying to access feelings around this loss? Do we assume that the client does not have these feelings as they have not come up since the day termination was known? Do we force discussion of the process because we assume that there must be something  there that needs to come out? Do we assume if the client prematurely leaves right  before the deadline or begins to act out that they were never that invested to begin with? How may using humor deflect from the feelings? All of these questions are aimed at addressing our own possible misconceptions of the termination process. They are also intertwined with our own feelings of saying good bye and with endings in general. Let’s look at the different scenarios. 

Do we wait for the last session to address termination issues? 

If you have successfully engaged a client into the treatment process and have established a bond, it is only logical that the end of this relationship will have some effect on them. Pretending that it will be business as usual is an oversimplification of what relationships are about. Think of when a client brings up important issues at the end of a session. Do they really want to deal with them? In a time when relationships are challenged, clinicians need to try and model effective interactions that contribute to positive relationships. Encouraging discussion of difficult and negative feelings, allowing this discussion to flow as well as being able to validate these  feelings are cornerstone in our ability to model effective communication. When we wait for the last session to do this it cheats the client and others, especially if in a group, to have had the opportunity to explore and communicate the accompanying  feelings. The pressure one may feel about having to express something at that  moment does not do justice to the therapeutic process. The last session should be a  time to summarize and express any other feelings or thoughts that have been expressed previously about this issue.  

Strategies: Clinicians need to be able to recognize their own struggle in dealing with  the end of a relationship. An awareness of this can help us to be more attuned to others’ struggles and help them access issues that may arise from termination. Giving enough notice allows for this process to unfold. Depending on how much time we have, two or more weeks may be sufficient. In the case of planned vacations or  absences on the clinician’s part, the same principle can be practiced. Give them sufficient time to know you will be away. Even if the absence is temporary, we  underestimate the effects it can have on some clients. 

Do we assume that the client does not have any feelings as they have  not come up since the day the termination date was known? 

The termination process can reignite feelings similar to those clients that are grieving losses or have been abandoned or rejected. The defenses these client may have used  to deal with the trauma could manifest in detachment, disengagement and other  behaviors that appear indifferent. One can mistake these for an absence of feeling versus a survival technique. The clinician may think that lack of expression of feelings may be due to the client’s level of disinterest or distance in the relationship. If clinicians are not aware of their own discomfort with endings, they can easily align with the client’s distance, justifying that it was a superficial relationship to begin  with. 

Strategies: Bring up the topic in subsequent groups to introduce the idea that this is  an important issue to be addressed. It allows others to think about what they are  feeling in regards to this at different times. Confront the indifference and ask directly  what they think of leaving the relationship.  

Do we force discussion of the process because we assume that there must be something there that needs to come out? 

The best moments in therapy are usually unplanned. Clinicians need to respect the pace of clients. Feelings cannot be rushed, no matter how much insurance companies try to rush the process along. Expecting that a client is ready to discuss feelings about termination at a specific time may be unrealistic. The clinician’s job should be to prompt the discussion, not force it.

Strategies: Create an environment that allows for clients to feel safe about what they contribute. Respecting their silence or resistance in addressing an ending creates this safety. If the client does not have anything to say in this regard, let it go. 

Do we assume that if the client leaves right before their last day or begins to act out, they were never that invested to begin with? 

A common pattern seen in clients towards the end of their treatment is that they may appear to deteriorate toward the end. Much to our disappointment, we may infer that they had not really learned much to begin with. We may react with annoyance, frustration and anger not seeing it as a sign of sadness due to the upcoming separation. Viewing it as such can allow the clinician to engage in a discussion of loss and sadness which could redirect the patient’s energy and coping. 

Strategies: Family therapists may say that prescribing the symptom is indicated here. This can also be described as reverse psychology. It means that the clinician makes a suggestion which is the opposite of what is expected from the person. The clinician may say to the client that the occurrence of these behaviors is natural in this process of termination and predict that they will begin to engage in them. This techniques usually stops the acting out behavior from occurring.

How may humor be used to deflect? 

All too often the defense of making a joke or light of intense feelings is seen in therapy as a defense against pain. Many times the client may lack insight on what they are doing and distract from the therapeutic process by making others laugh. In a group setting this may become contagious, encouraging others in this deflection.  

Strategies: Increase awareness of this behavior as a way to deflect. Help the client understand their feelings more honestly and help them allow themselves to feel these feelings. 

The delayed process involved in dealing with my resignation certainly helped me deal with feeling the upcoming loss and be able to talk about it with others. It allowed them the same time to be either silent or react as time went on. At the end, I can only be thankful for the opportunity that aided me in this termination. Going forward I will be more sensitive to recognizing a client’s vulnerability in this process.

About the Author

Maria A. Avila, LMFT, MCAP is a licensed marriage and family therapist and master’s level certified addiction specialist in private practice. She has over 30 years of experience working with individuals, couples and families. Along with her clinical experience she has taught at Barry University and the University of Miami and has conducted numerous workshops and presentations. Maria was the clinical supervisor of a renowned addiction treatment center in Miami and was previously in charge of the family program. She created a website especially for those struggling with this issue. You can visit this website at substanceabuseanswers.com or MariaAAvila.com.

Maria A. Avila, LMFT, MCAP

My Social Work Friend… Whose Needs Are You Meeting?

Written by: Cindi J. Jeffrey, LMHP, LISW

Idealism in Social Work

I found a paper I had written for my undergraduate social work degree. In it, I alluded to the fact that I wanted to change the world. My idealism was prolific throughout the paper; however, my vision of how I fit into the world may have been a tad skewed.

Interestingly, I am not the same professional in social work when I began this journey many decades ago. Furthermore, I am not the same person. Personal experiences, professional encounters, and traumatic cases have provided me with a new outlook on how I view our profession. Looking back at the time that paper was written is almost embarrassing. I wonder if I truly helped my clients or rendered them dependent upon me.

Social Work Goals

As a social worker, I have always made it a point to be more personable and open. I worked hard to break the stereotypical vision that most people appeared to have of the white-gloved woman going through your house and looking for things you have done wrong. I focused on what was going right, and after I earned some trust, we could go into what was not working so well.

There is a fine line between enabling and empowering our clients, and that line is often drawn in the sand. Additionally, that line appears to be constantly moving and redrawn. As a young social worker, my goal was to “fix” everyone and every situation I encountered. I did not want anyone to suffer, nor did I feel accomplished unless a problem was solved. Only once the issue was taken care of was I comfortable leaving the people involved.

Enabling or Empowering?

As the years progressed, I gained more experience, and I learned how damaging enabling a client could be. While those identified problems may have been taken care of in the short term, the client learned no skills during that process. Once I was removed from the case, the same issues were likely to return, leaving the client in the same situation as when I entered.

Listen, I get it. It feels good to help. It feels good to be needed. However, when we solve every problem for our client, we meet our needs, not theirs. The client may be grateful and express themselves as such, but who did we actually help? Whose needs did we fulfill?

In social work, our jobs can be diverse. Many of us went into the field due to our personal experiences and are very good at what we do. At some point in our career, there must be a defining moment to see the clarity of our responsibilities. If we continuously enable our clients, we are not working for them; we are working to meet our own needs.

Check Yourself as a Social Worker

It is our responsibility to draw that line in the sand. We are social work professionals. We need to meet the needs of a client, not meet our own needs. It is our job to continuously monitor ourselves so we can meet the needs of our clients. It is our job to empower our clients in order not to need us anymore. Moreover, do not forget to take care of yourself, my friend.

About the Author

With over 25 years of Child Welfare experience, Cindi brings a well rounded approach to individual and couples therapy. Understanding how the family influences one’s perspectives can enhance a person’s ability to see themselves and others through their unique lenses. Recently, Cindi has been providing therapeutic interventions for seniors in nursing facilities, focusing more on adjustment disorders, end of life, and chronic illness issues. In her spare time, Cindi enjoys biking, walking and reading.

Cindi J. Jeffrey, LMHP, LISW

Changing The Conversation

For some, there’s a negative stigma surrounding the word ‘therapy’ that can serve as a major deterrent from seeking help. Many may feel disappointed in themselves or judged by loved ones. Some even grapple with feelings of guilt or worthlessness after recognizing the need for therapy. As a clinician, do you seem to find yourself looking for effective ways to normalize getting help for your clients? 

The negative feelings a person may have regarding therapy can stem from any number of past or current experiences. Consequently, there is no one recommendation that will help you remove the stigma for each patient – but a varied approach could help address and normalize these issues. 

Ask Your Clients About Therapy Sessions

It is natural to focus on the immediate matter at hand during therapy sessions, whatever the reason may be. However, it is also important to ask clients about their thoughts on why they are seeking help and how they went about it. Some may share their feelings about being in therapy or how others have reacted to the information. This may be important to understand their immediate attitude and how you can help break the stigma surrounding seeking care.

Break the “Crazy” Myth

Research from Bradley University points out that the stigma surrounding therapy is directly correlated with society’s view of mental health. It confirms that these stereotypes reduce the likelihood of people seeking help and also hinder the healing process. Those who seek help often struggle with personal feelings or external bullying that paints a picture of the “crazy” person needing treatment. An open mind is essential to getting better, and sometimes professionals have to help their clients get to that point. Anyone can benefit from therapy – no matter what their background is.

Teach Coping Mechanisms

Professional behavioral health services can help people overcome some of the most devastating trials in their lives, one of the many reasons why it’s so valuable. However, if your client does not know how to cope with the adverse reactions to therapy from others, they may begin to see therapy as part of the problem. Prepare them for potential negative reactions from family and friends and equip them with the coping mechanisms necessary to tackle this. Then, return to the issue at hand.

Consider Group Therapy

Research done by Bradley University believes that clients may feel less awkward about therapy once they realize how many other people from all walks of life rely on it. Occasional group therapy sessions may help make this possible. If you do not personally host group therapy sessions, you may recommend local community outreach programs instead.

Be Mindful of Word Usage

Sometimes, how clients feel about therapy comes from subconscious reactions to specific words. For instance, if someone already thinks they are ‘crazy’ for seeking help, terms like ‘patient’ and ‘suffer from’ may not help break this mindset. Research  confirms that these terms and others like them often have negative connotations that may also dehumanize the individual. It also recommends reconsidering the phrasing of diagnoses. For instance, it is better to say “someone who has schizophrenia” instead of labeling an individual as “a schizophrenic.”

Encourage Daily Sessions

The more often someone engages in a particular activity, the more desensitized to it they become. Your client may not have the means or time to meet with you several times per week. However, there are other things they can make personal time for each day. The regular addressing of mental health may help to desensitize the negative feelings that accompany therapy sessions. These are some tasks to consider assigning for personal me-time sessions such as journaling daily, keeping a gratitude journal, and doing daily meditations.

Take Varied Approaches

As mentioned earlier, the reasons behind the stigma people internalize may differ. Take time to understand the problem and the client before deciding how you will address the issue. In some cases, you may find it is better not to address the issue at all or not in the beginning. There are many instances of clients starting sessions enthusiastically and only running into negative perceptions from others after the fact. In some cases, they may never experience this negativity at all. Being the first to bring up the potential stigma to prepare patients before it happens may do more harm than good.

Regardless of how you think your client should treat therapy, they will have their boundaries in place. Strike a balance between guiding them in the right direction and respecting their existing boundaries. 

The Bottom Line

One of the biggest mistakes behavioral health professionals make is to wait until the beginning of sessions to advocate for clients. The work begins outside of the office. It starts with family, friends, and even other colleagues. Educating the general public can help reduce the likelihood of negative reactions for others. There are more people in therapy than ever before. Millennials have been credited with spearheading this development. This trend signals that the stigma is lifting, making it easier for you to normalize therapy. Having a stable platform to depend on for strong referrals can further help build trust in behavioral health services as part of a standard, holistic treatment. Start your free trial on TPN.Health to access more trusted referrals today.

Lessons From My Mentors

Written by Brandy Price Klingman, LCSWBACS

In my career thus far, I’ve been blessed to have some great mentors, supervisors, and colleagues. These leaders have helped shape me into who I am today through their generosity and knowledge of wisdom. In the spirit of sharing the wealth, here are my favorite tips for new or developing therapists that I have learned from many mentors and supervisors (P.S. I’m naming these great masters to honor them.)

1. Strangers on a Train

An early tip from a great mentor came from my internship’s first supervisor, Butch Robicheaux, LCSW, BACS. I was excited to be interning at this site and had prepared a beautiful binder full of handouts for my clients, covering every topic from coping skills to grief and loss. 

I asked him, “What should I do before going into my first individual session?” He looked at my color-coded binder and was kind enough to say, “That’s very nice, but you won’t need that. You will have a conversation in this session. You will speak to this person with sincere curiosity and compassion like a stranger on a train. You don’t need to have anything wise to say because the connection is good enough to start the relationship. You won’t connect with a handout from that binder.” 

I often reflect on this “strangers on a train” guidance and smile because I’ve now made my career off of this simple piece of advice. The importance of a connection that comes from the simplest of conversations filled with compassion and curiosity can change the session’s dynamics from ‘therapist driven’ to the ‘client here and now.’ It’s helpful because there are so many problems a client could bring into a session that are out of anyone’s control, and I could never create enough handouts for all those stressors. But, I can always go back to the idea of a conversation with a stranger on a train.

2. Crisis Is Contagious, So Prepare Yourself

One of my first jobs required me to provide psychotherapy to groups of 10-12 people in a partial hospitalization program. I loved this work. I enjoyed and feared these groups. Often these settings had many personalities and a shared struggle of emotion regulation. The job was simple in my mind – find the problem with all the clients, and fix it. 

But the issue was complicated because there was always a crisis. Luckily, I’m good at crisis management, and during this time, I considered myself a professional firefighter (always looking for small fires to put out, as I was feeling better and better about my skill set). However, I was exhausted at the end of the day, week, or month, and I knew I would quickly be spent by the end of my career. This must be what they taught us in school about burning out. I understood at this point. 

When I discussed this with my clinical supervisor Karen Travis, LCSW, BACS, CGP (even more letters behind her name), I told her how well I was managing these crises, and she asked me how I felt. I described myself as tired, overwhelmed, and anxious. She then told me, “Crisis is contagious girl, and you are catching it.” She discussed the importance of understanding the client’s crisis separate from the therapist’s. She reviewed the importance of not meeting their situation with my crisis of “managing,” “fixing,” or “resolving.” She taught me how to help them explore their concern and process their feelings around it. 

Karen also told me the importance of allowing them to sit in the crisis until they were ready to move on. I will forever hear her voice when I think of rescuing my clients in crisis. I now even reposition myself the same way she did when I notice this happening in a session (very relaxed, arms casual on the chair, shoulders back and low, and voice soft, calm and confident). I’m grateful for this lesson as a professional and as a person. It turns out to be great advice for parenting, too!

 3. Permission to Feel in the Session

In school, I had a professor, Sherry Smelley, LCSW, who taught a Grief and Dying Class. The class was particularly difficult for me to remain in my cerebral safety zone due to all of the presenters’ vulnerability in sharing their experiences of grief or loss. At one point, I remember a speaker sharing something so sad, the entire class (including me) became tearful. When I asked my professor, “How are we supposed to hear these kinds of stories and not feel too much?” She smiled and said, “Well, honey, you are supposed to feel…you are human. It’s what you do with these feelings that’s important. You’re permitted and even encouraged to feel in these sessions.” She said this with a soft, buttery voice and a southern accent that reminded me of my grandmother. 

Permission to feel is vital in our daily work. It is our job in individual therapy to serve our clients in the ways they need, and one of those is by checking in with our feelings, thoughts, and judgments as a barometer of the room and the world concerning them. Our emotions are important and helpful in figuring out ways to serve our patients best to achieve their goals. 

This advice is incredibly useful these days due to the overwhelming stressors of current times. I encourage my staff to be mindful of their stress, grief, worry, fear, anger, etc. as they walk into a session. This personal awareness improves their ability to connect to the client in the here and now. 

As I write this, I am mindful of so many things my early mentors and supervisors have taught me – I could go on and on. For now, I will stop here, flooded with gratitude for so many great lessons from the masters who took the time to reach out to me. #blessed

About the Author

Brandy Klingman, LCSW-BACS

Brandy Klingman, LCSW-BACS, is a skilled psychotherapist with a small private practice, as well as an owner and operator for mental health and addiction clinics. Her mission is to improve behavioral health standards of care and decrease barriers to accessibility for all. She does this through direct patient care, professional supervision, academic/university affiliations, professional consultations, public speaking, business development, and legislative advocacy. She is a coveted speaker in professional workshops, academic settings, and trainings.

Who Are The Trusted Providers On Our Network?

As a behavioral health professional, it’s known that life challenges may make it difficult for people to cope without seeking help. Patients start asking, “Where can I find a behavioral health provider?” However, clients may not know about all the different types of resources available. They may understand that to be a behavioral health professional, you have completed some training in a field related to psychology, but they may not understand the various education and training levels required for specific credentials and the high degree of specialization involved. In this blog, we will go in-depth about the multiple licensed professionals our subscriber directory consists of; as there are many fine distinctions among the various practice areas that may help you to refer the patient to the right professional.

This information varies from state to state

Counselors

These professionals have at least a master’s degree in psychology or related fields, such as family counseling. Their specific training allows them to evaluate a person’s mental health and apply therapeutic techniques to help with addiction, job issues, conflicts in families, general stress, etc. If you have a client who is grappling with a particular problem, such as addiction, you may have to refer them to a counselor with specific training addressing that particular problem.

Psychologists

Psychologists need to have licenses and training in clinical psychology; psychology is a pretty broad field and only certain training paths can do therapy. Psychologists don’t go to medical school, but receive their advanced degrees in different psychology or counseling programs. If you have a client struggling with problematic thoughts/behaviors or having difficulty coping with stressors, it may be beneficial for them to see a psychologist who takes a specific approach. For example, dialectical behavioral therapy and cognitive behavioral therapy are mainly designed to teach coping skills and help clients change problematic behaviors and thoughts.  Child psychology is different from that of adults. If you have a pediatric client, it may be helpful to find a psychologist with specific training in dealing with this age group, whether in education or counseling.

Psychiatrists

If you have a client whose issues seem to stem from an underlying medical problem or whom you believe would benefit from a psychiatric evaluation, you may need to refer them to a psychiatrist. A psychiatrist starts by going to medical school to earn an M.D. or D.O. degree. To become a psychiatrist, the newly minted medical doctor has to undergo additional training in the specific field of psychiatry.

Like psychologists and counselors, psychiatrists may complete additional training to treat specific types of patients primarily. For example, some psychiatrists specialize in treating conditions in patients of a particular age, such as the elderly or children and adolescents. Psychiatrists can provide the same types of services that psychologists and counselors do related to diagnosing, assessing, and treating mental health disorders. However, because they also have medical degrees, psychiatrists can also prescribe medication to patients, which most behavioral health professionals cannot. The ability to prescribe medication can be incredibly helpful in treating patients with substance use disorders. A psychiatrist may provide medication-assisted treatment programs for addiction that combine FDA-approved medications that block the effects of illicit drugs with behavioral therapy and counseling, taking a whole-patient approach.

Nurse Practitioners

A nurse practitioner has undergone advanced nurses’ training and is licensed to provide general health care services. Working under the supervision of a medical doctor, a nurse practitioner has the authority to examine patients, make diagnoses, and prescribe medication. A Psychiatric Mental Health Nurse Practitioner receives training specific to the practice of mental health. Like nurse practitioners in other specialties, a PMHNP works under a doctor’s supervision, in this case, a psychiatrist.

Social Workers

Social workers are trained to help people cope with challenges in every stage of their life such as child abuse or neglect, domestic violence, unemployment, housing situations, etc. A licensed social worker focuses on clinical skills and developing relationships with clients while operating under an agency’s authority to deliver intervention.Further education and supervision can grant a licensed social worker with the qualification of a clinically qualified social worker (LCSW). These professionals work in a wide variety of settings to provide emotional support, mental health evaluations, therapy and case management services to people experiencing psychological, emotional, medical, social and/or familial challenges. Their scope mirrors an LPC and can individually practice.

A measure of overlap between the services provided by different behavioral health professionals may be confusing to clients. When patients seek help, clinicians have a responsibility to assist. Fortunately, when you subscribe to Trusted Provider Network, you gain access to resources that aid referrals to reputable and trustworthy behavioral health providers in multiple specialties.