Things You Learn in Therapy
Things You Learn in Therapy
Ep154: Chronic Illness, Ethical Care, And Realistic Boundaries with Destiny Davis and Dr Victoria Rodriguez
What if the best way to serve clients starts with taking care of the therapist’s body in the room? We sit down with Destiny Davis and Dr. Victoria Rodriguez to challenge one of the field’s quiet myths: that clinician comfort is a distraction. Through lived experience and clinical expertise, they lay out a clearer path where water breaks, seating, pacing, and boundaries aren’t extras—they’re the foundation for sharper attunement, cleaner thinking, and more ethical care.
We dig into the messy middle of practice: how to self-disclose without shifting focus, what to do when a client shares your diagnosis, and why “failed” disclosures can still be gold for treatment. You’ll hear practical strategies for building resilience into your schedule—telehealth setups, three-hour intensives with breaks, tapering from weekly to biweekly to monthly, and batching medical appointments. We also examine continuity of care with fresh eyes: if a client cannot stabilize without weekly sessions, is private outpatient the right level? It’s a tough question that protects both safety and sustainability.
Community is the throughline. High-quality consultation groups, especially with other chronically ill providers, turn isolation into problem-solving. Cross-disciplinary collaboration—bringing PTs, OTs, and RDs into the conversation—helps you navigate the loop between symptoms, function, and mood. Along the way, we surface hidden biases about disability, replace them with a disability justice lens, and offer a humane template for therapists to model self-care that clients can actually use. If you’ve ever powered through pain, ignored a full bladder, or felt guilty canceling for a flare, this conversation hands you language, tools, and permission to practice differently.
Subscribe for more grounded, clinician-centered conversations, share this episode with a colleague who needs it, and leave a review to help others find the show. Your body matters here—and so does your work.
To register for the conference, sign up here: https://www.chronicillnesstherapists.com/
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.
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Feel free to share your thoughts at www.makewordsmatterforgood.com or email me at Beth@makewordsmatterforgood.com
www.bethtrammell.com
Hello, listener. Welcome back. I'm your host, Dr. Betramel, and I am thrilled to be back sort of in the studio. Although I don't really have a studio, it's really just my office. I'm just back behind a mic with some amazing guests again. And I am so excited actually for today because we have two guests, two great experts here to talk about things you learn in therapy. And so I'm um just really grateful to have folks who want to come on, talk about things that matter. And so hopefully today will be nothing less than that. So we are gonna start um by allowing my two guests here to introduce themselves and tell us something fun about them. One guest you will recognize as um a friend of the show, and then a new guest that hasn't been on yet and hopefully will be a very fast friend to all of us. So, Destiny, how about you start, introduce yourself, tell us something fun about you, and then Victoria, as usual, you can jump in after that.
SPEAKER_00:Okay. Um, yes, I'm Destiny Davis. I have a private practice here in Atlanta, Georgia, um, specializing in chronic illness and chronic pain for the last six years. And yeah, this is actually kind of my entire life. Outside of this, I have a two and a four-year-old. They both uh they turned two and four this week. They were both born two years and three days apart from each other. So I guess that's my fun fact.
SPEAKER_03:That is amazing. And a two and a four-year-old is extra amazing. Um, and in probably all the best ways. I'm maybe just gonna leave that one right there. So great, great to have you, Victoria.
SPEAKER_01:Yeah, hi, my name is uh Dr. Victoria Rodriguez, and I'm in the South, just like Destiny. I'm right outside of New Orleans, and I specialize in chronic illness, medical PTSD, and my private practice. And I guess a fun fact about me and what's going on in my life since I last appeared on the podcast, is I'll be speaking at two upcoming conferences. So tomorrow I leave for the Bahamas for the women's professional conference. Well, I'll be talking a little bit more to physicians about what we're about to talk about today was what is it like to be a chronically ill therapist, um, chronically ill provider and taking care of yourself. Um, and another fun fact is Destiny and I are getting to host the first chronic illness therapist conference uh in Atlanta, March 6th and 7th. So we're really looking forward to that.
SPEAKER_03:I am so excited for you both about this. I um and we're gonna talk about the conference here um in a bit too, because I can only imagine the um the effort that needs to be put in to put a great conference on. And I know that you will want it to be a great conference, but before we get there, um, Victoria, you've been on before to talk about um chronic illness. We've had a couple of conversations, and I am not kidding when I say, like, I come back to um one of our moments on one of the podcasts together where you know, you you sort of challenged us to say, like, no one's gonna take care of your physical comfort except for you. Right. And so I I have thought about that so many times where I like, oh well, I I just have to sit in this chair, even though, you know, at a conference or in a class or something, and I feel miserable. You know, I feel miserable, my whole body is miserable, and yet it just feels like the thing I'm supposed to do. And I keep coming back to that moment. And so um, I I'm just excited about where this is going for providers in particular, because I think um it is it is a little bit interesting um because in training, and this might be my first question for both of you is you know, in training, they are very intentional about making sure that therapists know that uh it can't be about you, right? It can't be about therapists. So every question, every intervention, everything has to be toward the client's direct care. And so I think about that obvious and necessary aspect of training and how that probably sometimes gets in the way of therapists who have um their own needs, even in the middle of a therapy session. You know, we're gonna probably dig into this, but I'm even thinking about like, I think back to sessions where like I had to go to the bathroom, I just had to pee so bad in the middle of the session, and I just didn't. I just kept like suffered through it until the end, and just how what a terrible way to be a therapist. I wasn't the best version of me for that client. And so, anyway, I'm just curious about um kind of how you start approaching this work with therapists who probably have had this mindset and and probably lots of other mindsets around their own illness and wellness. And so I don't know, both of you are kind of nodding your heads. What's the thought bubble over your head um about any of that?
SPEAKER_01:Well, Destiny and I just ran a um intensive a a week ago on chronic illness, chronically ill therapists, being a chronically ill therapist and counter-transference. Um, so I have a lot of thoughts I'm putting together. I'm wondering, Destiny, yeah, what's coming up for you coming out of that intensive?
SPEAKER_00:Yeah, well, um, less about the intensive, but a little bit more about um the idea that we were all taught, like it's that you have to, you know, the client is first and foremost what what we are doing in this job. That's they are working with us so that they can get help and we're the helper. However, I don't really know why the narrative has always been there for you can't drink a cup of water during you can't, you can't like if your client sees you drinking water, then they might think that you're taking care of you and not paying attention to them. And it's just like it's so individualistic, it's so like that hyper individualistic culture. And it's like, actually, if I drink my cup of water, then I'm not thinking about, or if I go to the bathroom in the middle of a session, then I'm not thinking about how bad I have to pee, and I'm not thinking about how dry my mouth is. And I promise you, I'm a lot more attuned to you when I'm drinking my cup of water. So that's that's my thoughts on that.
SPEAKER_01:Yeah, absolutely. And you know, something I hear from a lot of therapists and maybe how we're taught in grad school is that comfort is a pie, and there's only so much to go around in session when in the reality is when you also center your own comfort, your own well-being. I think especially when you have a chronic illness, is it really normalizes that for our clients and provides modeling of what it can look like to take care of yourself. And I I think like what you said, uh, Dr. Jamel, is it it also just helps us be better therapists. It helps us show up better in our sessions.
SPEAKER_00:Yeah, I'll just add, I I always like to tell my clients, especially the moms that I work with, um, this always comes up a lot with them, but what's best for one person in the family or in the relationship dynamic or whatever contact we're talking about, what's best for one should be what's best for all. And so if it's not, we have to rearrange something. What's best for one doesn't just mean what they want, it means what is truly best for the individual and the larger community, the community at large, whether that's just your small family or the classroom you're teaching in or the therapy space or an organization that you work at. If something is off kilter there, what's not best, what's what's happening is not best for all or not best for one, then we've got to rearrange something.
SPEAKER_03:Yeah, we have to pay attention to what's happening if we're noticing that dynamic. Yeah, I'm curious too, Vic Victoria. What came up for you? And I you're Dr. Rodriguez now. I feel like there the first time you came on, you might have been Victoria.
SPEAKER_01:Yeah, it's um the revolution, right?
SPEAKER_03:Um it is. And so now, okay, so now I get to call you Dr. Rodriguez. So, so Dr. Rodriguez, your thought came back to that intensive. And so I'm curious, kind of what did come up in that intensive. Um, maybe that you were anticipating, or maybe that was like, oh wow. I feel like every class that I teach, I come in with what I think I want them to know. And then I'm always learning so much from people that are taking classes. I'm guessing you did too.
SPEAKER_01:Yeah, when I think about this intensive, what was and and destiny, let me know if I'm I'm that sounds accurate or not for you, but I I noticed a lot of therapists were bringing up um, yeah, just this intense amount of of emotional labor. I think, like you said, should I drink the water? Should I use the bathroom? Um, just it's kind of questioning their own. I I think like what you said earlier, Dr. Twil, just questioning your own needs of, okay, I'll just sit in this chair, not even questioning how uncomfortable that is for them or how that chair might not work for them. I I will say a little bit behind the scenes. So right before we got on, Destiny goes, Oh, I forgot my water, I'm going get my water. And then that reminded me, I forgot my water. I'm about to record. I need to grab my water or I'm going to pass out. And then Dr. Trenell says, I should also get my water. So I think that's a perfect example of again setting and modeling it and just reminding in a community care sort of way, uh, like what Destiny was saying, not a an individualistic way of uh again modeling what it looks like to take care of our bodies. Um, but I think that was the most surprising thing for me that came up in in that intensive is just yeah, how we were were taught to kind of center that client um or the client experience, even though, like what Destiny said, it doesn't have to be one or the other.
SPEAKER_00:And something that that I thought of as you were asking, you know, was there something surprising? And we actually did a Victoria, Dr. Redigus, and I did a six-week cohort um a few months ago. And that one, everything felt like a surprise. Um, and so we really took everything that we learned during that six weeks and the feedback we got, and we put it all into this three-hour training that we did uh this past weekend. And it felt like everything we were teaching about was just on par. Like people were in the chat saying, yes, this is exactly like the examples that we were giving was what people were feeling. And so I just I think that that kind of we we like feedback. Um, we take feedback and and really apply it into whatever the next thing that we're doing. And in the therapy room, it should be the same way. One of the things that happens all the time, especially when the chronic illness space, there's so much fear around like what comes up if we ask for feedback as the therapist. Because what if, especially if we're chronically ill? Like, what if we're not doing a good enough job? What if our fatigue is showing and that's what they tell me, you know, if I ask for feedback? And and I I do see it a lot in the Facebook groups too. There's a ton of like therapist Facebook groups that I'm in, and I'll often see, like, you know, my client gave me this feedback and I'm devastated about it, or I'm embarrassed, or I'm ashamed. Um, you know, and it's feedback is it's it's the most, it's the most rich data you can have. There's there's nothing better than just some direct, honest feedback. Whether that's you yourself asking for feedback on how you felt after you did a certain thing, uh, how did that affect your fatigue? How did that affect your brain fog? How did it leave you feeling for the next thing that you have to do? There's there's so much, um, so many different ways we can go back into like questions for feedback and and how that applies to every relationship that we have. So that's just a thought that came up from me around that.
SPEAKER_03:Again, in training, there's always discussion around self-disclosure. And so, what is, you know, kind of ethical self-disclosure and all self-disclosure is to be directly related to their treatment plan and what matters in session and that sort of thing. And so I'm really curious about this issue of self-disclosure, what the message is that you're hearing from therapists who are chronically ill, or what the message is that you're sharing, particularly around this issue of self-disclosure, right? So, how much, if at all, do therapists share about their own chronic illness? How does that, you know, where's the boundary in those things? And obviously, it's never clear cut. Nothing in therapy is ever clear cut. But I'm just curious about your thoughts around um that particular issue around this topic.
SPEAKER_01:So I will add, by the way, you guys can call me Victoria. Only my students have to call me Dr. Rodriguez. And I had one call me Buddy the other day. So I'm the same.
SPEAKER_03:Beth is totally fine with me too.
SPEAKER_01:Um, and so what I think about that, first of all, what a great question. I I think, especially as chronically ill therapists, we might be asking that a little bit more than other therapists because we might have to cancel due to a medical appointment or due to flare-up. Um, or even, you know, what I will add is we already self-disclose without saying a word. Even when I show up in my telehealth practice, I am self-disclosing uh appearances. If you use any sort of assistive equipment, um, so some therapists will you I I have pillows to to brace my back, or I I have I I know other therapists will use neck braces or um or just other stabilizing supportive equipment. Um, you are already self-disclosing um perhaps race or or gender identity or um or how you show up in the room or again any uh any of that adaptive equipment. And so I would challenge you are already doing a lot of self-disclosure long before you verbally self-disclose anything to that client. Um, yeah, Destiny, I'm not sure if anything's coming up for you there as well.
SPEAKER_00:Yeah, I think that's spot on. Um, we we really do. And I I think too, the idea of I I still believe that the self-disclosure that we decide to verbalize should be in the client's benefit, but it doesn't always have to be so like boxed in, like, how does this relate to their treatment plan or how does this relate to a specific goal? Sometimes it's just a matter of will them knowing this about me help them open up more, or will it help them reduce some shame here or there? And even then you might make mistakes around that. Sometimes you self-disclose and you realize the judgment that they have around that thing, now they're just judging you about it because they were not written that self-disclosure didn't help them reduce the shame. It actually, they just placed it onto you now. And so that's okay, that's fine. Can we notice that, see what comes up, and work with that? Now we know, like, oh, that shame is really deep. So it's data, it's always data. And I think that that's just really valuable. Can I add, um, we had a therapist reach out last night. Uh, I haven't even told you this yet, Victoria, but they they messaged me saying basically they they've been learning from us over the last few months, and and they said it that they've learned a lot and that they finally were able to put on the website um with for the practice that they work at that they have a chronic illness, and then they got their first client who directly asked to work with them from the website because of that self-disclosure. So it's, you know, I just think the proof, the proof is in the pudding. Uh, we've been getting this kind of feedback ongoing as as we've been asking our therapists that we're training for feedback.
SPEAKER_03:Wow. How cool is that? And what great impact, you know, that y'all are having. I love that. I want to celebrate that with you all, first of all. And as I'm as I'm sitting here thinking, I in the the last time that Victoria and I chatted, I disclosed that I have also been having this like chronic skin condition that finally I have found the right medication and I have no idea what the long-term plan is, but I have had no flares of that skin condition. And so it's like just feeling immediate relief. But I I know for 10 years it was just all consuming, you know, for so much of my day, it was just all consuming. As we're talking, I'm thinking about that mindset that I was in, and then how thinking about working with clients who are also chronically ill. And this would be true for just about any issue. And when I train graduate students, I'm almost always like, listen, whatever thing you're dealing with, it's gonna walk right in your door. And if it don't come tomorrow, it's coming the next day. Just like it's just that's just how it kind of goes, you know? And I'm just thinking about this with this issue in particular, it does feel like there might be even a bit more nuance to this particular issue because of the chronic nature of chronic illness, and that you're probably you might be the very best therapist, and they may be the very best client for you because you kind of share that experience. But then also I can think about moments where if I were a therapist to a particular client, I also would have to really check my reactions. And so I'm just curious about that. I and it sounds like that's part of what y'all talked about in terms of that counter-transference. And so, can you just sort of talk more about that issue, um, particularly around this um chronic illness? Chronically ill therapist working with a chronically ill client.
SPEAKER_00:Yeah, I think it's really important to be reflecting constantly in our profession. I think that that's really important. But as somebody with a chronic illness, um, you know, a lot of times some of the basic advice you get from your doctor or maybe even sometimes from other therapists is to track your symptoms. I'm not really a big, a big fan of like tracking. I think it's a personality person-to-person thing. But I I think that an intuitive kind of checking in with yourself is a different form of tracking. It might not be writing down on a piece of paper very logistically, you know, this, this, and that. Again, I don't think that's wrong. I just think it's like personality based on whether that data makes sense in your brain or not once you've collected it. But for me, the tracking comes from a very intuitive place. How do I feel today? What do I want to say yes to? What do I want to say no to? Can I check in with my body before I say that yes or no? Am I feeling tight and uncomfortable before I say yes about something? And then is that because, you know, why? Why am why am I feeling that tightness? Is it because I really want to do this thing, but I'm scared I won't be able to? Or is it because I don't want to do this thing at all? Right. So even like a tightness, somebody might be like, yeah, if you're feeling tight, then that's an automatic no. It's it's not like that. It's it's very person to person, it's very individualized, which is why truly AI will never replace us because it's too individual.
SPEAKER_01:Yeah, absolutely. And I I think too, if if you're experiencing um just maybe a stronger emotional reaction to a client that either has a similar diagnosis to you or uh yeah, just brings something up for you that you've had experience with. What we know from the literature is consultation groups really do uh help us process those uh emotions in addition to our own therapy. But I truly believe that our human element of a real Quality consultation group, maybe with other therapists who are chronically ill or therapists who specialize in this area, can help us sort through those emotions or at least have a space to hold those emotions so that they're not impacting our work in a negative way with a particular client. So I just can't say enough about a good quality consultation group.
SPEAKER_03:So to follow up with that, where if there's a listener who's like, well, yeah, that sounds great, where would I find a group like that?
SPEAKER_01:Oh my gosh, funny, you would ask about that, Beth. Um Destiny, you can speak more about your uh I know you have a consultation group that is free. Um even if you're not able to join that, I encourage you to reach out to other therapists in your state, maybe through your listserv or a local Facebook group and start one of your own. But yeah, Destiny, I'll let you share a little bit more about your group as well.
SPEAKER_00:Yeah, yeah, and I agree. I think everybody should be open and willing to starting, starting one. If if you can't find what you're looking for, people will follow, people will come. That's what I did four years ago when I started mine. Um, I had no idea if people were gonna join or not join, but I knew I just wanted it to feel like peer-led. I didn't want to feel like I was like teaching per se. Um, I wanted to be able to have a space where it felt like we were just peers getting together, consulting on uh cases in specific to chronic illness. So we meet every third Friday of the month from 1 to 2:30 Eastern. It's open. You just have to go on my website and sign up. I'll verify yet that you have an active license. And um it's actually open to therapists, PTs, OTs, RDs, um, because a lot of the Allied Health professionals are doing their own private practices now. And while they're not doing therapy, they are doing a lot of this emotional labor and this emotional work with clients. So I just think it's really important that we are working collaboratively.
SPEAKER_03:Okay, so I'll say the thing that I think maybe some people are thinking that it sounds like y'all had to overcome. And that is as a helper, sometimes it feels like one more thing to do. And if you have chronic illness, you have appointments and you have days where you're just not feeling great. And so adding a consultation group probably feels like just I don't have time for one more thing. And even though I probably like could wrap my head around benefiting from it, what was the thing that kind of like helped each of you get over that, those lies in your mind of like, I don't have time, or I, you know, how do you how do you help other people who might be listening take that investment and make that move?
SPEAKER_00:I I this might not be everyone's experience by any means, but when I was looking for my own, like to join rather than one that I was leading, I quote, didn't have the time because I couldn't, like I didn't really actually love that group. Um, and so I'm just being honest here. Like, I think once I found groups, like there is another group that I join every month and make it happen. Of course, sometimes that that you know doesn't work. But what's really helpful is when people have that's the the same time at the um every month, you know, like and and people have asked me, like, oh, do you have any other times for your consultation group? I'd love to make it, but I can't. The thing is, if I start changing the time, there's always gonna be somebody who can't make it. And so unfortunately, I have to keep it at the exact same time I started it at. You can you can make a change every now and then, but um, and then you have to people have to find a way to make their calendar work. Um, and that's what I did for the groups that now. Um, for somebody working in agency, communal, community mental health, I, you know, I get that. That's a little bit harder. For private practice, I think any of us can absolutely say, I am blocking this time off and I'm not seeing clients on this time.
SPEAKER_01:Yeah, I think about just the need to invest back in yourself. And I think sometimes, gosh, that's the right things that I would say, oh, I just don't have the time or the energy for, were maybe really things that I did not want to prioritize. There were times in my life, I think, like you talked about, Beth, you know, when I was going through a PhD program and and dealing with more chronic stuff, where I said, I I really just don't have the energy for this. Um, and that's okay. That just meant that group wasn't for me at that time. And any emotions that were coming up around that, maybe guilt that I couldn't invest in myself at this time or resentment that I couldn't invest at that time, was more about my, again, that counter-transforce was more about my own experience as a chronically ill therapist um versus anything else that anybody was doing.
SPEAKER_03:So I'm curious too, you know, because what I wrote down as we were talking is it probably comes back to thinking about what is your goal for seeking support in a group setting like this, because based on kind of what you want to get out of it, you might have to kind of search for, you know, destiny to your point. Like you might have to kind of search for the right group or find the right fit or create your own experience. Um and so as I say that, I also know that all of us have gone to sessions or classes or workshops that this is what I thought my goal was. And then I came out of it and was like, I didn't even know I needed this other part of it. And so I'm curious if y'all have heard from people or even experienced that kind of like second thing I'm talking about, that kind of like, this is what I didn't know I needed.
SPEAKER_01:Yeah, I think about the example that you gave earlier of I didn't even think to question if this chair was comfortable or not. And so the workshops that I found the most helpful around chronic illness are the ones that challenge the biases that I didn't even know that I had. And those biases could be um, again, this was very early on in my career, but one of the biases would be, you know, my chronic illness isn't bad enough for accommodations. Or the biases could be, oh, could that client even do that because they're chronically ill? And so it's I think it's so important. Again, that that kind of like uh group support or or challenging of those biases from a disability justice lens uh that allows us to show up as our best selves as therapists. Yeah, spot on.
SPEAKER_02:I love that. You're just like, yeah, same. She just said it exactly the way I wanted to say it. I love that.
SPEAKER_03:Yeah, so I think as as y'all have continued to do this work and both, you know, looking at the research and then also, you know, doing the work and gathering all of that feedback. And Destiny, I love all of the things you're saying around like feedback is just the most rich, useful data. Like any great therapist is going to be reflective on all of those pieces of thing. And doesn't, you know, I I'm actually teaching a course right now on professional development with my graduate students, and we're reading the book. Thanks for the feedback. Because I just think it's so true. I we don't get a lot of training, we don't get explicit training on how and what to do with so much feedback. And so sometimes we take in too much, sometimes we don't take in enough, or we don't spend enough time reflecting. And I I think back to moments when I was really drowning in my illness, and it was like I was drowning. So any feedback I got, like I just I was not making sense of anything. And so I just think about how, you know, I love what you said earlier about just kind of constant reflection. And to be fair, it was like there were some moments where I was just so fatigued, kind of all the time, that it just felt like I don't even have the energy to reflect. And I don't have the like emotional ego right now to carry feedback. And so I don't know, just yeah, what are your thoughts around all of that? Yeah. Um Vitre, do you want to go?
SPEAKER_01:But we're probably gonna say something pretty similar. I know you're more in the chronic pain space, but I think about even the neuroscience of what you know, when we're in a lot of pain or we're having a flare-up and we get in these loops of what did I do to trigger it? How can I get better? Is this gonna be permanent? Will this be permanently uh disabling? Um pain can sometimes really block our ability to take in new information because we're already getting so much feedback from our body that that we're having to pay attention to. So it could be really hard, I think. Maybe for your listeners who are especially in school or going through training at this time, it could be so difficult to take in new feedback when you're already getting so much feedback from your body on a daily basis. Um, yeah, Destiny, anything coming up for you?
SPEAKER_00:Yeah, one, I just I've been in that space. So I know what it's it's like. And yeah, it's very difficult to think about doing anything extra than what you're doing at that moment. And this is where I don't have an easy answer for it, but I do believe that we all deserve as many accommodations and support and help as as possible. Um, I think when we're in that space, we're also trying to do everything on our own. And I think it's the time when you need to ask for the most amount of help. And that's just sometimes with the face of a particular illness. We have to let I often give the imagery of like an old, ancient kind of healer's tent where there's like a tent and a person, a sick person inside the tent, and there's a healer attending, and that person is just laying there in the tent, and the the healer is giving medicine, giving soup, they're feeding the the sick person. Um, and that all that person's job is to do is to heal. They're supposed to lay there and receive. That's not exactly possible in our day-to-day grind, uh, especially we tend to see a lot of flare-up, they tend to do a lot of research on college students because of how much the stress impacts our physical conditions. Um, it's just really stressful. So I just think it's important to know that one, the system wasn't really created for us in mind, um, but we do have more accommodations available to us now than ever before, hoping it stays that way. Um and yeah, there's there's a bit of a paradigm shift with the disability ever since. Really, I mean, it's been a long time coming. Then we had laws change in the 90s, the EDA laws. And then even with the laws changing, it still took a lot of cultural shifts to actually start to come along and like accept accommodations as a not only a okay, you can have that over there, but even more like actually, we all deserve accommodations at different points in our life. Um, so I just think that that's really important to note.
SPEAKER_01:Yeah, it's a question of when we become disabled and will need help, not a question of if we will. And I think about uh certain other cultures that are more collectivistic. And I think there's also a lot more value placed on caretakers, um, teachers, uh healthcare professionals, mental health professionals. So I think like what you said, Destiny, it can also be very culturally informed.
SPEAKER_03:You know, I'm curious about this issue of pressure for and putting in air quotes continuity of care. So I know we've we've we've kind of touched on this a little bit before, but I think for the therapist whose flares um are unpredictable, or not or I just think about how that pressure impacts chronically ill therapists, because there is kind of this I mean, I'm not sure what to call it, like an unspoken rule, or maybe it is a spoken rule. I don't know. It's just like everybody kind of expects weekly therapy and you show up weekly, and then if you can't see your client, I mean, I remember pressure of my own when I would like go on vacation or when I would take a week off. And some of my clients were like, Well, who am I gonna see in this week, you know? And so that pressure for therapists to see clients weekly for continuity of care. I just wonder how that impacts someone who is managing a chronic illness on top of that, when it's an it's unpredictable how what percentage of my best self is able to show up today because of my chronic illness.
SPEAKER_00:I also think it's just so interesting that we have that that rule, that unspoken or spoken rule. And then we also have the rule that your clients aren't supposed to be too dependent on you. Right. Right. Completely counter. Victoria, were you gonna say something?
SPEAKER_01:No, okay. So this is my thoughts on this, but anybody is welcome. Email me to disagree. Don't email Beth.
SPEAKER_02:But I email me too. I would love it anyway.
SPEAKER_01:I this is how I conceptualize it. If you cannot leave for two weeks or a month and you are genuinely worried about your client's continuity of care or safety, is that client an appropriate fit for outpatient care? Because what if you did have an accident or or you died and you were unavailable for that client? Does and the client would really spiral after not having you there? Does that mean that they are an appropriate fit for outpatient private practice? Um, and so that's what I would challenge our listeners to where that's coming up for them.
SPEAKER_00:Yeah. And also maybe just a bit of a practical tip. I tell clients, and this is just my how I work. This is my theoretical, I mean, not my orientation, but this is just a way that I practice. I'm not even, I'm not even really solution focused per se, but I do tell clients in the consultation call that typically I see clients for four to six weeks weekly. And after that, we tend to go down every two weeks and then once a month. And that is pretty much how it plays out for almost all my clients. Some stay on weekly, some go to every two weeks before that. Um, but yeah, I just, you know, if if that isn't a possibility, then again, I think the level of care needs to be evaluated.
SPEAKER_01:I'll I'll also add, um, maybe because Destiny won't add this, but um I think Destiny, you're moving to more of an intensive or offering more intensive models, which I think you said is an accommodation for yourself. I'm all telehealth, it's an is an accommodation for me, so I don't have to um drive through traffic or I can do it from the comfort of home or or uh accommodate my environment however we need. So again, if you have that flexibility, don't feel guilty for using it. That's the whole point.
SPEAKER_00:Yeah. Yeah, I I love the intensive model. It's not right for everybody, but I start everyone off with a three-hour intensive now. Um breaks in between, like it's very accommodating and in all regards. I've even done it through telehealth as well as in person. Um, and if it ends up, if we feel like, okay, this this wasn't a good enough, like you actually do need some pretty consistent therapy right now that I'm making those referrals. Um, and this ends up being, it wasn't a it wasn't a loss. It was basically like uh an intensive intake that I now can warm hand off to either one of the clinicians in my practice or whatever clinician they decide to go with. I'm happy if they sign an ROI to do a warm handoff like that. Um there's so there's there's so much flexibility, I think, with being a therapist. I maybe it's just when I went through training or my own kind of upbringing and totally anti-authoritarian approach to life that I take. I hate rules. Um, but I just think this is the most flexible job out there. Like I don't, I don't see the rigidity. I I love it.
SPEAKER_03:Yeah, I mean, I think there are most folks who go into private practice because of the flexibility, because of the power they have over their um their schedule and the way in which they do work. And I think, you know, the field I think is shifting more to being less like there's one way of doing therapy and it's every week, and you show up and your appointment's always at four, and you just, you know, it's like they're just cranking sessions out. And I do think, you know, now that we have additional ways of doing it, I think it's growing in flexibility. And I think that's good for everyone.
SPEAKER_00:Yes. And I also just want to add another practical tip. I schedule my clients at the end of every session.
SPEAKER_02:Yeah.
SPEAKER_00:They all know that they will have a different time every week, every two weeks, depending on where they're at, every month. Um, and that's because all of my clients have medical appointments. All of them are like either self-employed or entrepreneurs or like they work from home but flexible. Um, so yeah, they that's for therapists listening to this, like no one is saying anymore that you have to have a client every Tuesday at four. And our lives have changed since COVID. A lot of people have that work-from-home flexibility.
SPEAKER_01:Yeah, and I uh I'm hesitant to say I feel like in some ways I'm the opposite, which again is great because we can all practice in different ways. Um I love consistency, I love the flexibility, but I'm I also am like, okay, I know I'm not gonna see anybody before 10 a.m. Uh, because that was my dream in community mental health. I was like, I can't work before 10 a.m. Um, so for me, I I love having both the flexibility, but also just really clear expectations um to where I know I, for instance, uh for your therapists who are listening who are chronically ill, I try, and I know it's not always available for every specialist. I try to schedule all of my medical appointments on Friday and just get them done all on a Friday. And I know I'm not gonna have any client uh interruptions on Fridays. I just don't take appointments on Fridays for that reason.
SPEAKER_03:I love this. Okay, so I could just keep talking about asking you both all these questions. And I also know we're coming up on time, and so um I will link to both of your uh websites um in the show description. But I'd love to hear anything you maybe wanted to share, maybe a last tidbit. And so maybe Victoria, I'll start with you. And I'm gonna ramble just a second longer so that you can remember what your tidbit might be. But and then we'll end with uh sort of Destiny, you sharing a bit of like your last tidbit maybe you want to walk away with, and then tell us a bit more about the conference.
SPEAKER_01:Yeah, my tidbit would be find spaces where your chronic illness is normalized. Whether, I mean, and I know Destiny and I are putting in a lot of programs, but it's so true when we have therapists who do multiple programs with us, whether it's the cohort, the intensive, the conference, you are just surrounded by therapists who are all dealing with the same questions around flexibility, continuity of care, counter-transfer, and self-disclosure. And it's become so normalized in these communities that I don't feel any shame or guilt. And I I hope other we can model that for other therapists about asking for these questions. Uh, so that that is my tip is to seek out your community.
SPEAKER_00:Yeah, I'm sorry, but that's exactly what I would say as well.
SPEAKER_01:I would be running a conference together, though. You can tell.
SPEAKER_00:I would be nowhere without my community. And yeah, whether you start it on your own or join in on someone else's, like, you don't have to reinvent the wheel. There's community out there, and it's invaluable. Like it's it's pair, it's imperative. If you, whenever I see somebody start posting about like, I chose the wrong field, I don't know that I should be in this field, I just my heart breaks. And I'm like, you need consultation. And yes, it's another thing on your to do list, but like it's going to save you. The right group is going to save you in this field. So that's my tidbit there. But yes, we are hosting the Chronic Illness Therapist Conference. It's our first national conference. We are so excited. We're bringing together eight presentations all about chronic pain and illness. So every presentation is specific to a different area of life for the chronically ill client. So that's sex in chronic pain. That's part being a partner with your body instead of an adversary. It's family work when one person has a chronic illness. It's mental health first aid for chronically ill youth. There's eight of them, neurodivergence in chronic illness, and we have the best speakers. We are totally biased towards them. They are great. All lived experience and research and practice experience as well. A physical therapist is even doing one of our presentations. So I'm really big on interdisciplinary care. I don't think you can work with chronic illness without doing interdisciplinary care. So the conference is both virtual and in person in Midtown Atlanta on March 6th and 7th. And you can email us for any accommodation needs. Our website has all of the accommodations that we're offering already listed. There's a ton built in already. But if we missed one, please let us know and we're happy to implement it.
SPEAKER_03:I love that. I hope that it just is filled to the brim with people who come and find the space for them, find their community. I mean, I love both things. I know once Victoria shared it, your face just like lit up. You're like, yeah, that's exactly what I wanted to say as my last tidbit. And so I think if that's what maybe all three of us are saying is finding the space where you know who you are becomes who you're supposed to be in that space without having to kind of stress or think or overthink about it. And so I'm excited for you all and the work you're doing. And I know it's gonna touch so many people in so many really critical and important ways. And so I'm grateful for that. And um, I'm grateful for you, listener, for being here today and for taking some time out to listen and um share with anybody that feels like the right person to share with. So, Destiny, Victoria, thank you for saying yes to being here today. And um, until y'all come back to talk again about how successful the conference was, we hope y'all stay safe and stay well.
SPEAKER_01:Thank you so much, but thanks guys. Of course. All right.
