Things You Learn in Therapy
Things You Learn in Therapy
Ep 153: From Telehealth to Moral Injury: How Therapy Is Changing and What Clinicians Need Now
The ground under therapy keeps moving, and we’re digging into why. We sit down with returning guest Marie Sloane, LPC, to trace how telehealth became the default, why insurance cuts and clawbacks are reshaping private practice, and what it really costs to keep care accessible without burning clinicians to ash. Marie shares the realities of leaving agency life, navigating panels directly versus using intermediaries, and the surprising leverage you can gain by simply asking for a rate increase. We get candid about the trade-offs of platforms like Alma and Headway, the tension between sustainability and access, and the quiet math behind student loans, healthcare, and the hours a therapist can truly carry.
Then we turn to the culture shift powered by TikTok and social media. Openness is rising and stigma is falling, which can jumpstart meaningful therapy. But there’s a catch: self-diagnosis trends and algorithm-friendly “advice” blur traits with disorders and can worsen compulsions. We talk about how licensed voices can step into the feed with clear, compassionate education—translating buzzwords into grounded care and helping people move from scrolls to sessions.
The heart of this conversation is moral injury. Beyond burnout, it’s the pain of acting against your values—or watching systems do it—because the rules demand it. Teachers triaging classrooms without aides, clinicians pushed to see nine or ten clients a day, frontline staff who lived the pandemic up close while hearing it denied. We name the guilt, shame, and betrayal that follow, and why “do more self-care” falls flat when the workload itself is inhumane. If you’ve felt that strain and wondered what to call it, you’re not alone—and naming it is a step toward changing it.
If this episode resonates, share it with a colleague, subscribe for more real talk on the future of care, and leave a review with the one shift you’d make to improve access and sustainability. Your voice helps shape the system we all rely on.
For more about Marie, check out her website: Marie Sloane: counseling and consulting services – Online Therapy for People in Arizona, Texas and Minnesota
This podcast is meant to be a resource for the general public, as well as fellow therapists/psychologists. It is NOT meant to replace the meaningful work of individual or family therapy. Please seek professional help in your area if you are struggling. #breakthestigma #makewordsmatter #thingsyoulearnintherapy #thingsyoulearnintherapypodcast
If you or someone you know is struggling with mental health concerns, please contact 988 or seek a treatment provider in your area.
If you are a therapist or psychologist and want to be a guest on the show, please complete this form to apply: https://forms.gle/ooy8QirpgL2JSLhP6
Feel free to share your thoughts at www.makewordsmatterforgood.com or email me at Beth@makewordsmatterforgood.com
www.bethtrammell.com
All right, welcome back, Mr. I'm your host, Dr. Beth Tremell. I'm a psychologist, and this is Things You Learn Therapy. I am always so happy when I get to record uh episodes with some of my favorite people that keep coming back on the show. And my guest today is in that category. And so I'm so glad Marie said yes to coming back. We're kind of chatting before we started recording about just the number of changes that are happening in our field. And so I am excited about where this conversation is gonna go. So thank you for saying yes to being back. Thank you for honestly, I think we seem to kind of operate under like, this is what we like to talk about. And then let's just kind of like, let's just, we don't have to have an outline or we can we can kind of have this conversation off off the off the cuff. And so I'm excited about that. So Marie, could you introduce yourself to folks and tell us something fun about you that's going on right now?
SPEAKER_02:Yes, thank you so much. And again, thanks for always having me. I know, like I like we were talking about, I didn't come in with a super solid plan. So I'm always down to just do the off-the-cuff thing. Um my name is Marie Sloan. I am a licensed professional counselor. I'm licensed in the states of Arizona, Texas, Minnesota, and soon to be Montana. So over the last couple of years, I have expanded and some into some other states. Was hoping the compact was going to make that a little bit easier, uh, but and that's how I got Minnesota. But everything else has just been doing it the old-fashioned way. But I have a primary focus on trauma, a lot of different uh angles that I have, you know, worked with over the years. But I I I do tend to work with a lot of comp uh complex trauma, PTSD, those things. I'm EMDR trained. Um I do IFS with my therapeutic practice. And then this year I'm gonna be shifting a lot more into the direction of like somatic uh release of trauma. I'm gonna probably do some TRE training and some other things because that's the direction I definitely want to go in the future. Um, I'm running out of fun facts about me because I'm pretty sure this is like the fourth time I've been on. Um, and I was thinking about it and I was like, oh, what's fun. Um, I don't have as many tattoos as I would like. I wish I had more. And I think that's the right, it's not super fun, but it's just a fact about me.
SPEAKER_00:I love that fun fact. And actually, you already gave us a bunch of fun facts about your practice, and that is great. And so, what is the next tattoo you want to get?
SPEAKER_02:So I'm I'm working right now on a half sleeve on my right arm, and it's like halfway done. It's very pouchy, but it's a nature scene. It's just a straight up like waterfall in the forest, like there's lots of green and trees and peaceful. I live in the desert, and I've always felt out of place in the desert. I've always actually wanted to live in a place that's green and rain and water and plants and all of that. And so I've always felt very out of place here. So since I can't live there for the foreseeable future, um, I decided to get a tattoo on my arm.
SPEAKER_00:So it's so funny as you're describing like this desert that you live in, and then you're like, I just love trees and water and vegetation. And it's I don't know if listeners were catching on to how that's the opposite of what's happening for you.
SPEAKER_02:Yeah, absolutely. In Phoenix, there is very little of that, and not that the desert doesn't have its like own beauty to it, and it's not that I don't appreciate certain things, but I I grew up at the base of the Rockies, and even then it was a little bit high desert, at least we had all four seasons. But out here in Phoenix, I just I miss the seasons. I know that winter sucks and all the things, but like I I just do miss the variation and like the the vegetation. And when I get to go somewhere green, like you know, when my my husband's from back east, when we go back east, I'm always just like, oh, it's so green and pretty out here. You know, it's just I don't know. In retire or like after my son is done with you know his schooling and everything here in the southwest, I'm out. I've already told my husband, I was like, get ready because we're we're out of here.
SPEAKER_00:Well, listen, it's not actually green or beautiful here in Indiana. In fact, it's snowy in 16, and there's nothing. I mean, I guess there are evergreens, but yeah, anyway, it's it's good in both.
SPEAKER_02:And I know, and my husband comes from that like Baltimore area, and so he always jokes like you don't have to shovel sunshine and all the things because, like, you know, it is miserable in the winter, and I totally get that. So I think we're looking more maybe like Carolinas, like where it's not like severe winter, but I guess like green water, you know.
SPEAKER_00:You can get the bottom both. Yeah, that sounds glorious.
SPEAKER_02:Yes, it does. We'll see if we get there.
unknown:That's a few years away.
SPEAKER_00:Speaking of glorious, though, you know, some of the shifts in our field have been glorious. And some haven't been. Yeah. And it's it's interesting for me as a director of a training program where it's like I'm trying to teach them how to be great therapists and what kind of feels like a quickly changing field. I mean, I think about I started my practice, you know, in 2004, 2005, and it felt like the first 10 years of my practice, it was like copy paste, you know, like I was seeing clients, they were coming in, I was doing my best CBT work. And there were some other modalities, but it it just didn't feel like we were growing at the same rate as we are now in terms of different approaches and even different ways in which we even implement that approach. And then all the stuff with insurance and managed care and you know, the joy of when insurance companies get to tell us how to do our treatment. And so I'm just curious about what stands out to you in terms of kind of systemic shifts in the field that we can kind of start chatting about.
SPEAKER_02:Well, I interestingly had like the complete opposite experience that you did because I am right now just kind of coming into my like 10th year-ish of therapy practice. Um, and it has been nothing but change, I feel like for me. I started in the substance use world. And again, a lot of that was very basic, like CBT, running, you know, it was quick work, was really basic. Like I had people for a month, maybe six weeks, and it was I got really great exposure to lots of different uh like co-occurring things. There was, of course, in the substance use world, there's always going to be trauma, there's gonna be, you know, other things that are going on. And so I got to touch on so much of that, but that was pretty consistent, like, and that was pretty predictable for the first, I would say, like three-ish years. And then COVID hit, and that changed everything for me because I could no longer be there every day. My son was in kindergarten during COVID, and so he was a little and he was at home on a screen, which you know, I don't know if you've seen five and six-year-olds on the screens for attempting eight hours of schoolwork, but that just was not gonna be not gonna fly. And like I couldn't be in person, I couldn't go. Like there was nobody else. Like I was a single mom. So I couldn't, and I was forced to make a shift um as a as an associate to uh individual therapy via telehealth. And that was really the only way that I could keep working and you know, stay in the field and do what was, you know, do what I needed to do to help the kiddo. And I ended up doing a little bit of a hybrid as things opened back up, as his school opened back up and he went back. Like the treatment center that I had been with, they kind of kept me on doing a little bit of telehealth work here and there. And so, you know, as things opened back up, I would go back and I would do IOP or I would do, you know, work for them kind of part-time. And then it took me another, I would say two years to really get burned out on the agency work and recognize like what they were paying me was just not sustainable. And like building my private practice, I was like, why would I stay with you guys full time when I can make you know triple the amount hourly and all the things? So eventually, as I transitioned all the way into private practice, I that was, and I've been 100% virtual ever since then. Um, and so that changed. I never I know I never saw myself being a virtual practitioner. Like when I was in grad school thinking about my career, um, I thought I was gonna be in substance use way longer. And I I just like there were so many things that we just didn't plan for that just happened and changed the trajectory like very quickly. Ultimately, I did I really loved this space and I've grown in it and I've you know started accepting insurance after a certain amount of time, and now I do supervision and I've you know ex it grown into it, but it has just been nothing but change, I feel like, since the start for me.
SPEAKER_00:Well, it is interesting that the pandemic was kind of right in the middle of kind of your last 10 years, right? Where that just shifted. I mean, obviously the the pandemic shifted just about everything, but in our field in particular, it was like our whole model is sitting in a tiny room together, not even close to six feet apart.
SPEAKER_02:Yeah.
SPEAKER_00:So how are we going to actually do this? And I'm curious because I haven't been in the insurance world in a while. I kind of, you know, I'm on listserv and I read different things. And where is insurance at right now in terms of I'm gonna say the word threaten because it was not long ago, and by long ago, maybe in the last year, where I was reading something where insurance companies were kind of threatening to decrease the reimbursement rate for telehealth therapy. Um, and is that is that still a thing that is happening, or do does it feel like it's kind of flying under the radar now that the research has supported that telehealth and in-person health can be equally as effective, that they maybe are listening to that, or are they still pushing back?
SPEAKER_02:Well, I would say because I'm only telehealth. Um, always, you know, since I've been messing around with insurance, uh it's I I've only been telehealth. And I've had several of the companies that I'm paneled with drop their rates already in the time that I've been with them. I think I started accepting insurance in 2022. And so I have seen rate drops, but they were across the board. They weren't just for telehealth, they were just across the board. And the rumblings that I am hearing within the communities now is that that's going to continue. Is that um like they are going to continue to cut the rates of uh behavioral health professionals in an attempt to save money? I'm not sure if like what the rationale is exactly. I don't think that it helped any that recently one of the like there was a list that came out of professions that will be considered like not professional anymore. Um, you know, nursing and therapy was definitely on that. I don't know how they're going to go about that because it is a broad range of licenses and you know varying levels of things that we do. It's a it's so I don't know how they're going to do that. But if an insurance company can look at us and say, well, you don't have a professional degree or your license isn't a PhD, so we're not gonna pay out, like I feel like the groundwork is kind of being laid for that to be potentially happening. And what I'm also seeing is, and this hasn't happened to me personally, but I it's a scary thing that a lot of people are talking about, whether it's on message boards or whatever, um, is that there are a lot of companies that are going back and retroactively now reviewing several back several years and doing clawbacks in hundreds of thousands of dollars. Not just like, you know, oh, this client, you didn't do this and that and the other. I saw a post from a um a psychologist who does primarily like she was the paid supervisor at a big agency. So basically all of the incident to billing was done under her NPI number, which is how basically an agency can charge for associate level licensees to accept insurance, which makes it easier to give access to care for people. I mean, a lot of a lot of agencies, the bigger agencies, especially the ones that accept Medicaid, do that. And this particular uh insurance company came in and did a giant audit of like 140 of the, like they pulled 140 of the notes and they denied like 137 of them. So it was like to the tune of over half a million dollars that she had 20 days to pay back, supposedly. And I don't know, I'm I'm assuming she's probably gonna try to legally fight that somehow, but it's scary that that kind of thing is is becoming more and more commonplace in the world of third-party payers.
SPEAKER_00:Well, and it's unfortunate because I think it's the very thing that is pushing most clinicians to not accept insurance. You know, I think a lot of clinicians are going to strictly private pay. And when you talk about limiting access, it is just so hard. And I am one of those people, right? When I I left kind of full-time private practice in 2019 and have done very, very, very limited um individual work off and on since then. But when I left private practice, I didn't continue um the paneling with insurance companies. And so it just becomes such a hassle. And so it becomes a real conundrum for our field because therapists and providers um, you know, want to take a stand and say, I want to show you what I know my value is, and the the client who maybe needs to have it go through their insurance and can't afford to pay out-of-pocket expenses. And I, you know, I'm not here to judge one way or the other because I know I know the conundrum. And uh it is not an easy one for anybody on either side because therapists don't come into this wanting to limit access. Therapists come into this because they want to help people, but also they have to be able to pay their bills. And so it, yeah, it's a real conundrum, I think.
SPEAKER_02:Yeah. And I have a handful of clinicians that I work with as clients, and that's uh one of the things that I see. Um, and this is again like this, I could go on about this for an hour alone. Um, is there with with the ever-changing world too, healthcare is going to be one of the big sticking points because for a lot of people, like I have the lovely privilege of having a husband who works um for like a big corporation and I get healthcare. That is going like that is probably the one thing that allows me to be able to accept insurance because I'm a dual-income household, and I don't have to go out into the marketplace and pay um the equivalent of a mortgage payment to now have health care. Yeah, like that's another thing. Like we go down that road all day. But it's for some of my clients, like to keep their health care, they have to stay with these bigger companies. But then the bigger companies, because of what the payers, you know, the third-party payers are paying out, are not paying them what they're worth. But then there's this like, oh, well, and this is my biggest issue with grad school. And you hear this a lot that we get we get socialized in this field to kind of be like, well, you didn't get into therapy to get rich, you know, you you came here to care for people. And yes, we did, of course we did. But we also don't didn't go get master's degrees to be like poor and unable to pay our bills, and like with our student loan things, and like the student loan structure is changing, like some of the income-driven repayment options are are going away. And so, like, between the cost of our our health insurance, our our student loan payments to get this master's degree, all of the additional training that we pay for after we get a master's, you know, to do anything is and get certified in anything is thousands and thousands of dollars. So you're right, like it is this place where we we have a lot of education and a lot of training. And then we have to go this route of I want to be able to provide that to people who need it, but then I also want to be able to live at least comfortably. I don't even need to be rich, but like I want to be able to, you know, not working paycheck. And yeah, and it's a real, like you said, it's a conundrum. And I don't hate on anybody that goes the cash pay rate only. I don't, I I I understand it. And like my supervisee is cash pay only. She's gonna say cash pay only for her. That's because, you know, she can't accept insurance. And in the way it's structured in Arizona for a uh supervised private practice, like she can't even do the incidence of billing with me anyway, because that's it's not the structure. I I don't, I don't, I encourage people to do whatever is going to be right for them. I do love accepting insurance for that reason because like I like using my insurance for therapy when I go to therapy. Like, you know, it's it's nice to be able to do that if you have it and if it's an option. And I do, we do want to make it accessible to people and not make it, you know, another mortgage payment if they're gonna be going weekly and you charge$200 an hour. That's$800 a month. That's a lot of money, that's a huge investment. And like there are some people that can do that, and that's amazing. And there are a lot of people that cannot do that. And so again, it is it's this struggle between like, you know, I I want to be a good care provider and I want to do the work with people who need it. And then I also want to have some stability and safety, and you know, those like bottom of the pyramid things that we, you know, as educated people with several degrees, think would be easy, but not okay.
SPEAKER_00:So I have I have one last thing because I'm thinking my friend is like in my ear telling me this particular part about insurance. And um, so I've I've had several friends who've left private practice and they've gone out or left group practice to go into solo practice. And with insurance, um generally it has been true that you know, very few of the insurance companies will raise their rates, but they um, like you said earlier, have kind of been tightening up their rates. And um, she learned that if she called her insurance company and said, I want a raise, they gave her a raise. Now, it wasn't like a million dollars a raise, but even$5 a session in terms of rate increase. Uh, I think both she and then she told another friend of ours, and then, you know, it was like everybody kind of found out hey, listen, if no one else is going to give me a raise, I should probably ask for a raise. And so I don't know if that will work for everyone. I don't know if it works for every insurance company, but she She said, you know, it was worth the phone call to say, hey, I want to appeal my rate and I want a rating rate. And she was like, and I got it.
SPEAKER_02:And here's the here is the part of that that there's another layer of complication for funding world today. If you are directly paneled with insurance companies, you can do that. And you can call them and say, after a certain amount of time, you can say, like, hey, I've actually gotten more certifications, or I've done this and that and that, or whatever. Um, and you can ask them. Again, the worst they could say is no. However, the other big development that has happened in the solo practice and group practice world is the real big emergence of these tech companies like Alma and Headway that uh you panel with and they do all the back end work for you. They take care of all the things, they market it as this like you get very consistent payouts. Um, and there's a trade-off always, right? You can't ever negotiate your rates if you're with them. So if you are paneled with insurance, like I accept insurance through Alma for I think most of them, like most of the big ones, like United and Cigna and Aetna and all the optimum plans or whatever, um, BCBS is the only one that I had to directly panel with. And so they're the only ones that I can go to at some point in time and be like, I want to raise. Because Alma has already stated, like, this is the negotiated rate. We've negotiated them to be quote unquote higher than the payout rates, you know, with whatever. And if you ever do leave Alma and decide to panel directly with an insurance company, you have to start at their like, so let's say you've been accepting Aetna through Alma for five years and you've been getting the same rate. When you go panel directly with Alma and, or I'm sorry, with Aetna and leave Alma out of the picture, you have to start at their like incoming newbie rate and then work from there to be like, hey, I want to raise. So it's this trade-off of like these tech companies did make it easier for people to accept insurance, but at this, and they like, you know, they have a legal team supposedly that's going to help with prevent clawbacks and all of these things. But at the same time, it is a trade-off always. It's always, there's never a perfect, like, oh, this takes away all the issues. And there's, you know, the things on either side. So that's the other thing about it is that some people, if they have just been paneled through one of these big tech companies, can't just approach that company and say, I want a rate increase.
SPEAKER_00:Like they won't get it. It is a real conundrum. I mean, it just keeps, you know, and then in the back of everyone's mind, they're like, Well, why do you even take insurance? Well, because, you know, I mean, it's just this like circular thing. Anyway, okay, we're not gonna talk about insurance anymore. Okay, here's the other thing I want for us to talk about. So I've been thinking a lot lately about TikTok therapy, right? You know, social media therapy, and I think there's good and bad. And in fact, I've um I've done another episode talking about like the good and the bad about social media and how it has kind of given a platform for mental health. Um, and so I've been thinking a lot about that. Um, and some because I have been trying to put more out on TikTok because that's where people are. It's like, well, if that's where people are and that's where they're getting information, then we probably need to meet them where they are. And how can we do that well? So, as I've been thinking about this, so I want to talk about this just maybe briefly, and then I want to talk about moral injury because we kind of started talking about that. But I don't know what you think about so I'm gonna say what I think about this just recently, and it's just kind of my my ramblings recently, and then I want to hear your thoughts. But the thing that I've is I've been thinking about what some of my best clients have been, and best is relative. I'm just thinking about the clients that I think maybe got the most out of therapy or client that I think, yeah, like they kind of got the best bang for their buck in terms of therapy. One of the traits that I have found, and this is anecdotal, I probably should look at the research and see if it's out there. One of the things is their openness. One aspect of being a great client is being open to new ideas. And I'm curious if the plethora of information that's out there right now makes us perhaps more prone to openness to different ideas. Maybe not that I'm gonna accept them as my own, but I feel like as I, you know, even as I'm scrolling, it's like, oh, well, that's an interesting idea. Oh, that's interesting, or oh, I don't know. I'm just curious. And I might actually have to, I'm gonna write this down. I'm gonna look at the research and see if it's out there. But I'm just curious about that idea that maybe not all of TikTok therapy is bad for us. And by us, I mean therapist. Maybe it's not bad for us as therapists if people are starting to like question what's going on in their life or question the fact that maybe they don't need to suffer alone anymore. Maybe that maybe TikTok therapy isn't just our competition as therapists. I don't know.
SPEAKER_02:Murray, what do you think? I mean, I think that there's again, like all, like all things today, there's no one right 100% answer. But what I have seen, um, and I think a lot of therapists have probably experienced this, where they'll have somebody, a new client, roll into therapy and be like, oh, I have this and I have this and I have this, and I have DID and I have, you know, some big borderline personality disorder and all these things. And I'm like, okay, like, and I'm sitting there listening and I'm saying, okay, let's talk about that. Where did you get this diagnosis? Oh, well, I did a fick, a TikTok finger challenge. And I'm like, okay. And I have to really, really try very hard to control my face at that moment, which is great that I'm telehealth. So I can see myself going, you know, like scrunching all of my face together and be like, stop that. And be like, okay, let's talk about that. So um I'm glad that you had the opportunity to, you know, do this thing and it obviously resonated with you. Let's actually take a look at like the DSM five and talk about what these diagnoses really are, because you can have traits associated with, you know, you can have dissociative tendencies and not have DID. You can have, you know, like some BPD type tendencies and not have a personality disorder. So I think it does open the door. Like you said, there's that openness of, oh, I saw this thing, it made sense to me, and now I'm coming to a professional. It's that piece, that that last piece of do I then go to a professional and learn about this like from somebody who's done the, or do I just continue to look at all those videos and then tell people I have BPD and I'm being treated for it, but really it's just TikTok, or I'm talking to AI, or I'm, you know, doing those things. So I think it's that double-edged sword. I think it can be really great because it gets the message out there. I think it can be great for practitioners to start spreading information. And I think it really is up to the licensed people to get themselves out there to combat all the bad content that is nonsense. And yes, that's out there. Quote me, I don't care. Yeah, um, it is out there. You are not wrong. There is, and there are people that that have created very aesthetically appealing to the algorithm content, and their content is trash. Like it is the stuff that they say. I'm like, oh my God. And they're sitting there with like this microphone, like acting like they're on a podcast and like they're being interviewed, and they're probably not, and they're just like a self-help guru, and I'm like, oh my God, like you're being so awful right now. So I really do want more licensed people to get out there and start putting good information out there so that people can understand and delineate the difference between like a licensed person and then just somebody who called themselves a life coach. Not that everybody does that, but you know, like there's nobody to oversee that. So, and I think it is like the people who are open to, oh, I never put that together, that this could be connected to this thing, or that, you know, I might be carrying trauma in the body, or that, you know, like these ideas that are out there and it gets them curious and open, and then they want to begin to learn about it, and they come to us like those are really good clients. But I think it's for for people who don't have the capability or the access to then like follow up with a professional, then it can become a little bit like they can either like like if they, for example, have OCD, um, they can now start to like really have that be part of their OCD and like their checking or their you know reassurance seeking or they're you know, it can it can be very, it really just depends. It can be very destructive or it can be very helpful.
SPEAKER_00:I love that you kind of came full circle kind of to that, that it's like, yes, it it may be really helpful in terms of bringing awareness to a lot of different issues. And, you know, it's really I think it's doing a good job of destigmatizing mental health, but if not sort of checked or followed up on, or you know, kind of not not digging deeper, it may be kind of dangerous. I mean, I think that's well, that's the message.
SPEAKER_02:Again, like the thing that happened on TikTok recently with like the lady who was talking about her psychiatrist. Like, did you see that whole thing? No. Oh my gosh, I forget her name right now. But it was like a whole saga, and she was having like a whole breakdown, like live on TikTok, but everybody was tuned in, and she was like, She had fired her psychiatrist, I guess, or like he fired her because of this counter-transference thing that was going on. She like named him, he got doxxed. It was like a whole thing, and then it got like deeper and deeper into this. Like, she was talking to this AI bot that she was like in a relationship. It was bizarre. I really wish I could remember the name of this woman. I'm pretty sure if you googled it, you could find it. We probably would find it. I'm sure. Like, and it was it was a whole saga. And that was the kind of stuff where I'm like her having this access to this AI bot thing that, and she had like named it and was like asking it like that was not helping her mental health. It was like she needed an actual professional. She probably needed to be medicated. I don't know, I'm not a psychiatrist or a psychologist, and she was not my client. But yeah, it was like watching this all happen. I'm like, this is where AI is is fueling a fire rather than being helpful. Um, and again, like being like having this happen in real time for millions and millions of people to watch and comment on and do all the things.
SPEAKER_00:I'm like, that is not that is not the helpfulness for not the helpfulness we're looking for. No, no. Oh my gosh. Okay, we could have a whole episode on on social media and the social media and AI and all the things and how it's shaping the way that we view the world and ourselves and our feelings.
SPEAKER_02:Yes.
SPEAKER_00:Listen, I am a big fan of AI. Um, but I definitely know that we yeah, we just don't know enough about how all of this is impacting us.
SPEAKER_02:Um well, and I just think also too, it's just like anything new, just like when social media hit, like it's gonna take us some time to learn how to use it and how you know long-term impacts. And, you know, and I think there's absolutely like an appropriate use for it. And then there's some of the things that people are doing, which is anything, anything new. It's true. There's gonna be the people that don't use it correctly, and that, you know, it it'll be a thing. But yeah, it's it's a useful tool that we don't know how to wield quite yet.
SPEAKER_00:Yeah. Or how it's gonna impact us, um, kind of in the long run.
SPEAKER_02:Yeah.
SPEAKER_00:Okay. One thing that we talked about kind of before we started recording, which I know we're not gonna have enough time, so we're just gonna have to come back and talk more about this, but we're gonna talk about this as um as much as we can in the next like six or seven minutes. All right, speed round. I'm here for it. Oh gosh, okay. I recently uh led a talk on self-care and on kind of stress and joy. And one of the things that I um have kind of heard about, and I know you have read an article about, and are just it's just sort of coming up a little bit more, I think, and our in our work is this idea of moral injury. And so I want to talk a little bit more about that. I think moral injury has been around for a while, but mostly within the PTSD and mostly within like, you know, folks coming back from war, having to kind of manage their these feelings that didn't really like fit into a whole lot. It didn't really fit into like a another category, except to describe this idea of sort of this distress that they were feeling about doing things or being a part of things, yeah, violating their morals, right? And so it's like I don't like the way things are going. I don't like the way I have to do this, I don't want to have to do this, or I didn't want to do the thing I did, but I was told to do so. I felt like I had to do so, somebody ordered me to do so, or you know, to save my job, I had to do this thing. And I think we're talking more about it because I think it's not perhaps that it's happening anymore or less, it's just that now we have kind of this name for it. So, how are you seeing this show up um, you know, in your practice or even in your own life?
SPEAKER_02:Well, and I have seen it a little bit more, I think honestly, since COVID started. I think there was a lot of it. And again, like you said, in the past, the people who have really dealt with this and and put a name to it have been in what we typically think of like the PTSD situations, like front lines, people on the front lines and combat and and things like that. But the idea itself, and the way I've been learning about it, is that it is this observation too, not even direct participation, but an observation of things that are happening that really do are happening in complete opposition to a core moral value. And so the way that I have seen it showing up for people, especially over the last couple of years, is like, well, during COVID, when everything started, there was, I had a lot of nurses and a lot of people in the medical field that were dealing with COVID on the front lines and seeing how it was happening, and then also experiencing that you know, the people who were saying COVID wasn't real or pushing back against masks or doing those things. And they felt that was so that was like a moral injury to them that they were like, I am watching people die on a daily basis. Like I know this thing is real, and then you know, wear a mask. You know, like that was it was very like there was a lot of that. Yeah. So I saw it starting there, but then I feel like ever since then, it has kind of also spread out into the world at large. With like now we see a lot of people, especially with unfortunately, like this very big divide that we see, which I think kind of started, I think it started before COVID, but like COVID made it yeah, we were all alone and we were hunkered down and we were on the internet, and you know, it just made everything very loud and everything very polarized. And I think a lot of people are starting to what it started showing up as, I think at first was burnout for a lot of people. They felt very burned out. And if you had any other extenuating factors, like, you know, you are neurodiverse or you are grieving or you are, you know, part of a population that felt under attack, then that made it extra. Yeah. And so everybody was thinking it was that and burnout and COVID. But as time has gone on, and now as things are not behind us with COVID, but like they're not as, you know, in the forefront, it's more like the flu now, which was kind of what they said it would be. Now it's this people are seeing what's happening in the world around them and then also still feeling that very big and on either side. Like it doesn't matter what side you're on. People are it's the pressure and the the temperature has gotten so high that I think a lot of a lot more people are starting to feel that they resonate with that issue of moral injury because it's beyond burnout, it's now this other thing. And that creates a lot of feelings of helplessness. And I think that's what really kind of brings it up for people if they see things going on that they don't agree with that are really like in opposition to their moral values and they don't know what to do. Yeah.
SPEAKER_00:And I think kind of broadly, we're talking about this idea that, you know, I just kind of pulled up a definition here that it talks about this like really profound feeling of guilt, feelings of shame or betrayal, or just sort of like, and that betrayal may be from someone else, it may be from my own self and what I thought I would do in this situation, right? And it could be because somebody in authority has told you to do something that you're like, I don't think I should have to do that. But to keep my job and to protect my family, I have to do that. It may be, you know, a personal transgression of some sort, right? Like you're doing something or someone does something that you're watching that you didn't intervene. And I um I sometimes think about this idea when I'm in classrooms where teachers are kind of in this place that the comment that I often hear them say is like, I just feel horrible because it this just isn't right. You know, like for me, that's almost like exactly what we're kind of talking about, yeah, the kind of feelings that people have. So the example that comes up a lot is when a teacher has one or two students that, for example, might have pretty significant behavior challenges. And so the teacher has to intervene a lot for those one or two kids, but in doing so, then ignores the other 20 or 22 kids or 25 kids in their classroom. And so that really just goes against kind of who they are at the core as a teacher and educator. And I want to provide a safe environment that's enriching for learning. And I just feel like I can't do that, and that doesn't feel right or good, but I have to keep showing up every day. And so that's one way that I see it. And as I have kind of talked more with people about it, there's more people that are starting to feel like that actually makes more sense because I can't really be mad at this child because I know this child isn't trying to be difficult. I can't be mad at my administrator because they they their hands are tied. Like I think this sense of helplessness to what you were saying is like helplessness, hopelessness, guilt, just now it starts to make sense when you can put a label on it. That's like, oh yeah, that's why I've been feeling that way.
SPEAKER_02:Well, and I think part of it too, for me at least, is the like kind of to bring it full circle back what we were talking about earlier, is some of the systemic things that make that the case. Like if our teachers had more resources in the classroom, you know, then, you know, if we had more aids or we had more whatever, then we had more support, then it wouldn't be as big of a deal. And so we're like, well, why don't we have that support? Well, you know, we can fund this or this, but we can't fund this. And there's that like systemic piece where it comes down. Or like again, for clinicians, and I again, like I said, I have clinicians who are working in the mental health field and are seeing nine to ten people a day. Nine to ten clients that you sit with per day. Like I, as a, and I again, I know I have a lot of privilege and I don't have to do that grind. I am not gonna be a good therapist after like six sessions. I'm not. Like my brain is gonna be toast, and I you're not gonna get a good version of me. You're not, and that's why I won't do that anymore. But again, I have the privilege of like I've built this whatever over time and I'm not in that situation. But I think for them, they don't want to see nine or 10 people per day, but that's the requirement for, you know, billable TCU hours or whatever they're called. And and you know, that's the expectation. And when they try to advocate for themselves to, you know, the C-suite people or during these town halls or whatever they're having, and they they aren't acknowledged or they're glossed over, or they say, Oh, okay, thank you for sharing that, and then they don't change anything. That's when they're like, What am I supposed to do with this? Like, I I want to be a good therapist, I care about my clients, but I can't be a good therapist after seeing nine people. Like, and I can't either. I don't think anybody would be. Some people are built for it. I'm not gonna lump everybody in and judge them, but like I myself am like useless at like six is my max per day. I can see six people and be good at what I do. After six, uh, probably you're not gonna get a good version of me.
SPEAKER_00:Well, and I think to what you said, I just think that is the picture of how hopelessness kind of breeds is that you know, you talk to people, you tell people about it, and then they're kind of like, yeah, okay. You know, and I think that might be why people start thinking about this feeling as burnout. Oh, I'm just so burned out. I'm so tired of this, I'm so tired of that. And now it's starting to be like, yeah, I mean, you still may be burned out, but it may also be part of your burnout is actually because of this repeated moral injury. Yeah, and a bit of a betrayal.
SPEAKER_02:On top of that, sometimes, like when my sister was working, because my sister has always worked in community mental health, because God bless her, that's just what she's built for. She's also um, and right now she's working in like a more of a social work role. But anyway, when she was working in and then kind of the same expectation, like when she was outpatient, she would have to see seven, eight, nine people per day. And when she would come to her supervisor and be like, I just feel burned out, I blah blah, they would put that back on her and be like, Well, are you doing self-care? Are you doing this? Are you doing that? And like, so it's there's almost a little bit of that gaslighting that happens too, that like if you're feeling burned out, it's your fault because you're not taking care of yourself. But really, it's like, no, I'm just tired because I you can't box breathe your way out of seeing 10 people a day. Like, I'm sorry, I don't, I don't care how good your self-care routine is, like that's gonna burn you out eventually. It might work, like there's one-offs here and there where I can do that. But like if you're consistently, that's the expectation, and then you're telling me it's my fault, I'm burned out, like that's gonna come compound and become that more of like a betrayal of like I trusted, like I trust that you're yes, it worked for you and you say you care about my well-being and our clients' well-being, but then you're making me do these things.
SPEAKER_00:And it it's it's a thing, you know. Oh my gosh. I mean, the faces I'm making right now, friends, I mean, it's just like the things I want to say about all these things. And I just wrote down like, yes, we need to come back and we need to talk about moral injury again, and we need to talk about therapist burnout, and then, you know, maybe even exploring, because I think to your point, sometimes it's the supervision that our younger therapists or more kind of like newer therapists are getting that is putting them in these situations that then they feel like this is what my career has to be. And so they're like, Well, let's just self-care.
SPEAKER_02:And then I just want to vomit, you know, I just want to be like to your failing because I'm not whatever, or I'm so and I have one client and she comes, um, and I've been her therapist for over a year, and it's part of her self-care is to go to therapy. And she's like, I just like at the end of the day, I just don't have the energy to do anything. Like, I know if I went to the gym, maybe that would be good, but you know, like I just want to lay on the ground and like, you know, I'm just a blob. And I'm like, yeah, like the I'm there's not a whole lot I can tell you about that. You know the things that you could do, but if we don't have the energy for them, you know, and who does have the energy to do anything other than be a like exist after seeing 10 clients in a day?
SPEAKER_00:No one. Just no one. Okay, well, we we've got to pick this conversation up the next time. So Marie, tell people how they can find you and the work you're doing.
SPEAKER_02:Um, so I am like in the middle of a social media ban for myself to speak for my own mental health. I'm proud of you. I'll do the TikTok thing. Um, but my website is the best way to find me. It's Marie Sloancounseling.com. There's some good resources. You can contact me through there if you want any of the resources that I have. Um, drop me a line. It's a good way to good way to reach me. I love that.
SPEAKER_00:I love that. I love that you're here. I love that we're gonna get to come back because there are so many more things that I want to say right now, and we have to go. So I knew we were not gonna have enough time, but I just wanted to dabble my toe. And now I just know. You should just know I do not want to dabble my toe. I just want to dive all the way in. And so next time you could just say, listen, Beth, I know that that's not really who you are, just a dabbling kind of person. You are just like a jump in the deep end, kind of splash everyone around you kind of person.
SPEAKER_02:Right. Well, maybe I'll just have like a a little, like a smaller topic rather than this huge, broad thing that I came in with.
SPEAKER_00:No, but it's so good. It's so good because it's so important to bring light to these things. So anyway, listener, thank you for being here. Marie, obviously, thank you for being here. I'm so grateful for you and the work you're doing. And I um I hope your social media step away brings you so much joy. And um, yeah, until we can get back together next time, I hope you're safe and well. And listener, same to you. So thank you so much. Ciao.
