Telka's Talks: 11-week program and training materials

1.  Apply the tools to your own personal challenges, stress and emotions first, before attempting to teach the tools to others. Begin with wise mind, the map , the 4 choices  and Feelings are not Facts . Once you know how to personally utilize those tools, in addition to EIQ skills,  cognitive reframing  , how to peel the onion ,  stress, mood and relationship tools, then you are ready to teach others these skills. Watching all the videos on this site helps increase insight and understanding.

2. Begin Solution-focused, goal directed treatment by explaining what it is, and what it is not. The tools are evidenced based strategies for achieving treatment goals, addressing symptoms of emotional distress and mental illness, improving coping skills and emotional intelligence in all areas of one's life. Clients who simply want "someone to talk to".. that's all... no specific symptom relief, no changes, no mentoring, coaching or guidance of any kind because they really want someone to listen and THAT IS ALL THEY WANT... are not compatible with this treatment modality. 

3. During the first session, create the treatment plan using  the map—fill in the map worksheet . Explain the 4 choices , fill in the worksheet 

4. Each week review progress with the client. Ask the client to assess their progress, identify choices, strengths, fears and resistance. Invite the client to choose which topics and tools they wish to address at the beginning of their appointment. Some sessions will be maintenance or deeper practice to master a tool before moving on to another tool or topic. Review is normal, not a fail.

5. Motivate the client toward change by reducing shame, amplifying strengths and focus on credibility of the tools.  Apply tools from the Change Model when appropriate.  

6. Frame tools as opportunities to increase emotional intelligence. 

7.Therapy must instill hope.  We instill hope via encouraging problem-solving, education, support, resources,  compassion, and self-care in our delivery of mental health services.

8. ALWAYS, allow client to take responsibility for healing. Consider this analogy: attending therapy is not like getting a hair cut where you just sit in the chair and your stylist does all the work; washing, cutting, drying and styling.. then you walk out of the salon looking your best. Attending therapy is more like having a personal trainer at the gym. You identify your strength, conditioning and nutrition goals, then together, you and the trainer create your workout and wellness program (best plan includes what you will do consistently to achieve desired results)—then you do ALL the work.... EVERTHING.. while your trainer says helpful things and encourages your efforts.

9. Because you began treatment with the end in mind, each session is moving toward skill building, symptom reduction and problem-resolution with end goal of graduating from therapy. With each improvement, you can proudly reflect, "I think you are getting closer to putting me out of a job. You are thinking like a therapist, good for you! :)"

This is a question therapists will ponder throughout their entire career. The good news is that there are numerous research studies, publications and opinions on the topic of therapist self-disclosure in mental health treatment. The bad news is that there is not one-right-simple-answer that guarantees success in every situation. Helpful articles that shed light on the topic are:

Self-Disclosure in Clinical Social Work (socialworktoday.com)

The Do's and Don'ts of Self-Disclosure (psychotherapynetworker.org)

#MeToo: The ethics of counselor self-disclosure (counseling.org)

1. Be aware of the rules of conduct and ethics as designated by your professional licensing board and those of your employer. For my profession, as a LMSW, The NASW code of ethics states: “The NASW Code of Ethics also obligates social workers to pay close attention to issues in their own lives that may lead to inappropriate self-disclosure or boundary problems (standards 4.05[a-b]). ... In the final analysis, social workers must adhere to the maxim, “Do no harm.”

A common definition of inappropriate self-disclosure defines: “Inappropriate self-disclosures are those that are done primarily for the benefit of the therapist, clinically counter-indicated, burdens the client with unnecessary information or creates a role reversal where a client, inappropriately, takes care of the therapist.”

2. Take ownership of your bio, marketing and online presence. Google yourself to see what potential clients see when they search your name. You may claim free sites to correct and modify information. Set strict privacy settings on all personal social media. Check the rules of your license and profession when posting reviews, opinions and other information online.

3. Remember this is a small town in the 2020’s. Social media makes everywhere a small town, but Lansing really is a small town. Many of the studies and publications about therapist self-disclosure are written from the assumption that the client knows nothing about a therapist until the therapist self-discloses, which may be possible in Chicago or Detroit. Practicing therapists in a town this size have no presumption of privacy when out in public. Be aware that you may not have to disclose your favorite dining and shopping destinations, your romantic history, or where your kids attend school because those details may be something incoming clients already know.

4. When considering whether or not to disclose personal information as a clinical strategy, a good rule to follow is “when in doubt, leave it out.”  Caution until clarity. Once information is out, you can’t take it back. Clinical supervision can be useful if you are still unclear.

5. Once information is shared, you have no control over it. Sharing clinically appropriate personal information is similar to public posting on the internet—once you have released the information, you no longer have control over it. Whatever you share, make sure you are ok with it coming back to you from other sources, getting repeated, misquoted, even becoming part of your reputation. “No control” may sound scary, but remember, you never had control anyway. Anyone can say anything about you even if you never disclose personal information. 

6. Practice self-awareness. Practice using your inner observer tool to notice yourself as you interact with clients. 

1. Do you self-disclose differently after that third cup of coffee? 

2. When you are anxious , intimidated,  irritated or bored? 

3. Do you self-disclose differently with clients who you have worked with for a long time, sliding into familiarity that threatens objectivity? 

4. Do you notice more or less self-disclosure at different times of the day, week, month or year… or when working with different ages, genders, or ethnicities?

7. Intentional self-disclosure is a judgement call, use it wisely. Famous mental health icons like Marsha Linehan, Brene Brown and Kay Redfield Jamison just to name a few, have successfully made  public self-disclosures that have shaped the profession.

8. Learn from mistakes. Feel the embarrassment, learn the lesson and continue on with a greater understanding. Every therapist makes miscalculations regarding too much or too little self-disclosure. Reading the links to articles included above provides examples of honest mistakes and miscalculations. For more information about what NOT TO DO as a therapist, check out Common Complaints Patients Have About Their Mental Health Therapists AKA Why Therapists Get Fired.

I. Check out Therapist Tip#1

2. When you understand how humans respond to change--how we get stuck in old patterns of thought and why we resist change, you have more insight into influencing behavior change.

3. Therapists are humans too, so we have to overcome our own resistance to change. We have to face our own fears before we can instill bravery in others.

4. Listen to this podcast to learn more about change, resistance and removing the barriers. Hidden Brain: Work 2.0 The Obstacle's You Don't See  Nov 2021    52 minutes  

5. Consider the Miracle Question Tool.

6. Practice reframing the "shoulds" into "coulds"

The answer depends on YOUR intention. Do you intend to include long-term, supportive therapy in your service line?  If yes, carry on.

If no, then explain your brief treatment model. If the client is not interested in your services, then refer the client to a therapist who offers the preferred service. Therapy, like other medical professions, requires transfer of care when clients' requests are outside of a therapist's area of expertise, scope of practice or service line. Therapists also make referrals when treatment fails to progress, requires a higher level of care, or when a referral to another provider is in the client's best interest. 

Brief, solution-focused scheduling is client centered—based on the presenting problem, medical stability, clinical progress, and client motivation. Unlike traditional supportive scheduling—which schedules weekly or biweekly appointments indefinity with no end date, solution-focused scheduling continues to assess progress toward desired goals and treatment completion.

Brief, solution-focused CBT scheduling and treatment guidelines:

1. A brief therapy model is not compatible treatment for psychiatric emergencies, case management, legal issues, active addictions, severe and persistent mental illness (SPMI) including episodes of suicidal or self-injurious behavior, psychotic disorders nor for those with histories of repeated inpatient hospitalizations. 

2. Scheduling is determined clinically in partnership with the client. Basic tools including Diagnosis, map and coping tools are shared in the first one or two sessions. The client takes responsibility for choosing the frequency of additional scheduling based on needs, motivation, and progress.  

3. Questions at the end of each session help establish the scheduling partnership.

a. “Did you get something today that you found helpful? What helped? What was not so helpful?” 

b. “Would you like to schedule another appointment, or would you rather think this through, run with the work we did today and get back with me about scheduling?” 

If they choose another appointment,

c. “How soon would you like to return? We will choose a time frame that is not so soon that you have no time to practice or implement what you learned today, and not so distant that the delay causes more stress, or the tools are forgotten.” 

4. A client entering the first session with significant level of need (Moderate difficulty functioning at work, school or home) will typically choose to return in 4 to 10 days to secure the tools, supports and resources necessary to stabilize before expanding time between frequency of visits. 

5. Clients who present as minimally impaired and relatively stable may choose a return date between 1 and 4 weeks. Some prefer time to utilize tools and make progress prior to their follow-up appointments. 

6. Duration of brief treatment: Once stable, clients may reach treatment goals in less than 12 sessions with a statistical average of 6 sessions (according to pre-pandemic insurance data). 20 sessions may be required when stability is hindered by physical health or the presence of an ongoing external stress such as poverty, domestic violence, divorce, family crisis or pandemic.

7. Final session: Repeat the testing completed in the evaluation session when applicable, to provide the client with a measurable “before” and an “after” score of symptoms. For adjustment disorders that lack significant symptoms scores, review original presenting problem then discuss progress made and readiness for “graduation”.

8. Brief therapy model allows for returning to therapy on an “as needed” basis. Successfully discharged or “graduated” clients may return when symptoms return, or when new issues arise.  To ensure continuity of care, therapists should prioritize these returning clients to the top of the scheduling list by offering them first choice of cancellation openings. Because brief treatment scheduling offers rapid client turnover, new openings pop-up nearly weekly.

9. Wait lists for services: When brief treatment therapy caseloads grow very large, continuity of care requires that therapists limit or stop taking new clients. The influx of former clients returning for additional brief work will fill the schedule.  A good standard of practice is to schedule incoming service requests within one to four weeks. Do NOT hold unscheduled clients on a wait list for more than 4 weeks. If you will not have space to accommodate a request within 4 weeks, make a referral elsewhere. Extended wait lists for mental health care should be avoided for obvious reasons.

10. Documentation with returning former clients: Most insurances do not require nor allow billing a new evaluation (90791 code) within 12 months of the final session unless there is a new diagnosis or change in insurance that requires another evaluation. If a new evaluation is justified, an easy way to reduce the documentation with returning clients is to attach the prior evaluation to the newer one. Write “see attached evaluation (dated.)”  Update any changes or document “no change”. Document the presenting problem as “Client returning to this therapist for a new treatment episode to address (insert reason for return)”.   Electronic charting offers additional opportunities to streamline returning clients data collection.  

So every decade has the popular terminology of the times. In the 70s through the 90s, rather than using the ACE and talking about trauma informed treatment, the popular psychology of the times was about dysfunctional families and the core beliefs of people raised in dysfunction. Codependent and ACOA are terms that would today be considered trauma related. You can find the ACOA/Laundry List material on this sight in the self-esteem material.

1. The Should - Could Tool helps facilitate identifying, challenging and problem- solving resistance. 
2. Always focus on what changes someone is willing to make. The person who owns the problem solves the problem. Therapists may reframe, identify choices but never problem-solve FOR the client.
3. Small attainable steps are HUGE. Trying the "one minute" changes for starting new habits. 
4. Notice values and intention. Is the resistance congruent with values or does it involve a moral conflict?