In this episode of the Telehealth Heroes Podcast, we interview Dr. Laura Forsyth, a licensed psychologist who splits her time between California and the Turks and Caicos. She talks about how telemedicine allows her to deliver therapy from the beach, the importance of understanding local mental healthcare laws, and maintaining one’s own mental health as a practicing psychologist.
Episode transcript
Speaker 1:
In today’s episode of the Telehealth Heroes Podcast, I chat with Psychologist, Dr. Laura Forsyth who shares her experience delivering therapy from her Caribbean vacation home, how she maintains her own mental health, and how other psychologists can adapt to the new way of providing care.
Okay. Dr. Laura Forsyth. Thank you for joining us today.
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Oh happy to be here. Thanks for asking me to come.
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Tell us a little bit about yourself. Where’s your, what’s your training and your background and why did you decide to get into psychology?
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Okay. Well, I decided to get into psychology when I wrote my eighth grade career paper on what did I want to be when I grew up? And I guess that I had the notion of being a psychologist, cause that was, it was either a psychologist or sociologist. It was kind of a serious kid in a way, but I’d had the experience of being in therapy. And one of the things that impressed me about the psychologists that I met, although I don’t know if I could have articulated at the time, but came to understand later that they pulled from all parts of their, their persons, you know, their experience, their knowledge. We would that, that in working with someone, they were talking about biology and art and history and literature and neuroscience and, and, you know, I was one of those little geeky kids that just was like, ah, this is so cool.
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I want, you know, I literally like this and went forward in that way.
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Great. And where did your training?
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I started
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Out at Santa Clara university in San Jose. Well actually in Santa Clara and they had a masters program there and rapidly realized that I actually wanted to be in a doctoral program and was terrified of the dissertation. So that’s why I started initially with the terminal master’s program, but went for it and ended up getting into UC Santa Barbara is counseling psychology program, which is now a combined psychology counseling slash helical slash school combined model. But at the time that I went there at the end of the eighties, it was counseling psych. And so did my doctorate there, you know, involved in psychotherapy research of, and got some great direct training as well too. I think one of the claims to fame for UCF is that even though they are research-based program and oriented towards treating academics, the really strong practitioner training and incorporated into that. So I didn’t become an academic. I kind of jumped out and did the clinician and clinical supervisor role and in my, my career going forward from there, and I’ve done a little college teaching lungs along the way
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And understand your specialty is in ADHD. Was that, is it always been that case or is that something you’ve evolved into, or
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It definitely something that I involved I evolved into. I had no formal training in that. And since my specialty area is also college students and adults with ADHD, and at the time that I went to graduate school, there wasn’t even any real consideration of that. Again, we’re talking back in the way back eighties, late eighties, early nineties, but one of the first, well, the first professional job that I took after I became licensed was at one of our local community colleges here in Ventura county at Moorpark college. And the position of was bridged part of the time providing mental health services through the student health center, since in the California community college system, unlike say lots of other colleges, there are very few colleges that have freestanding mental health services. They’re typically embedded within another service. And so at Moore park, it was embedded within the student health center, good for access, by the way, they, the bridge position branched into the disabled students program.
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And so which it more park is called access. And what they were wanting to do was to have someone who could come in, provide ADHD and, and psych assessments for psychological conditions that would impact and create a disabling condition for students. So I had to teach myself about what does ADHD look like in young adults and not so young adults because community colleges serve everybody all, you know, traditional age on up. And that was the beginning of finding something that I was just like, wow, this is great. I could identify with it. I could, it made sense. I really like working in sort of a, a kind of a practical brain behavior sort of way. And it just evolved from there.
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And then how long have you been in private practice and what made you decide to make the jump from working for a school or a community setting to a private practice?
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It was, it was kind of a practical, pragmatic decision. I started in private practice in 2005 when it became clear that that the college was not going to increase the funding for my position. It had started as part time, half time with the intention of becoming full-time and, you know, college administration changed. And that wasn’t a PR you know, they, they weren’t going to do that. And I, some of you know, I had started a kind of a part-time private practice. And I think I was also teaching at that time. I was teaching a couple of classes at the local Cal state, Cal state channel islands. And so kind of doing a couple of different things and the practice was pretty small for awhile. It, you know, less than 10 people and just over time, it grew also for many years, I did have time at the college. And half-time correct. Yes
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And no. Are you, are you full-time in the practice now?
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Yes. Yeah, 2018. I just, I got to the point of where did that was, it was, it was time to make that change. And, and so, and unfortunately some of that was driven by the finances of it. It, it was just, it, it was, I can provide more for my family with fewer hours by going into, in solely over to practice. And it was less draining to do that instead I missed the college, but it was good. It was a good choice for me.
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No, as you got into this private practice setting, what were some of the biggest challenges you’ve faced and, and how did you overcome them?
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Well, I think my story is not all that different from a lot of people who go in there to practice from some kind of background where you’re working for, for an agency or some other institution that takes care of the infrastructure and that you have to learn to run a business. And so that, you know, kind of getting that set up, getting my own procedures in place of how do I do things, marketing, all that stuff that there’s, there wasn’t anything unique about it. And fortunately, even in 2005, when I started, there was the beginnings of, of what is now this enormous offering of support, collegial support, and training and suggestions and ideas about how to set up a private practice, how to do the business end of it. Well, actually back then, there really wasn’t as much of it, but there was enough, there was enough.
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And so I make took advantage of it, of, I, you know, spent a lot of time researching things, talking to people, taking advantage of every free resource that was available online, trying stuff out, building a website. And fortunately I had had had some good experience in the, the clinical supervisor sites that I’d done in some other things that I’d done of sort of setting up practices or, you know, kind of procedural things. Because when I was running the, the mental health counseling program at Moore park, I wrote procedures. And so I was kind of like, okay, what do we need to do? And what’s going to be my workflow. And I don’t know if I thought about it that formally, but, but it, it, that kind of stuff helped in setting things up. And so I did things the on paper for a long time.
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And then I, you know, I created all my own forms and all my own methods. And then I got off insurance panels when I realized that was like making me crazy and taking it too much time. And then, you know, went, did, went paperless and then someplace, I don’t even know when I first signed up, signed up with doxy me, but when it, when people started asking me, you moved away from the area, clients are moving out of the area, but wanting to continue services. And that’s when I put my, my foot in the water of doing telehealth. Right.
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So was it, was it you that moved out of the area or was it your clients?
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Well, clients one in particular who I’d seen for a while and he’d actually transferred. He was a community college student to then come to see me in private practice. And then when he transferred to a UC up north, we tried to, he tried, I worked with him to find a therapist there cause he’s, he’s one of those people who was managing a really significant mood disorder. And he’s really, I’m really proud of this guy. I’ve worked with them on and off for a long time. And so he was trying to connect with a therapist and not really it wasn’t jelling for him. And so I just remember one day he called and said, look, you know, is there any way we could do this, you know, phone sessions, whatever. And at that time, the other strand that was starting for me is that my husband had bought a house, a vacation for as a vacation rental and kind of a vacation and secondarily a vacation house for our family on grantor island, in the Turks and Caicos in the British Indies fantasies about,
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Could I work from there? How do people do
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This? And, and I remember actually I have this distinct memory of listening to a podcast or another psychologist was talking about remote work and travel and how he did this. And in this sort of little seed is planted. This happened. So then at the about somewhere around in then the, my client had asked about doing this and I, that was those two strands kind of came together. And that was the impetus to say, okay, let me try to do this. Let me try to tell her,
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So, so let me ask, are you in Turks and Caicos right now having this interview too bad? And that would have been
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No, let me see. Yeah, it would look different. It would look different. And, and, and it’d be fun to talk about that in a little bit more because in the last year, since the country view opened in August of 2020, after the first lockdown in the pandemic, we’ve been back and forth from there. I probably just spent six months out of the last 12. We’ve just got back a couple of weeks ago, but no, my, my set up there, it looks pretty different. Yeah, yeah,
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Yeah. This is my coconuts and stuff
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And oh, really fast internet connection, which I don’t enjoy in a developing country. Yeah.
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No, that’s interesting. No, I’d love to hear more about that. Like, so as you decided to test dip your toe into the water figuratively, and literally, what were some of those challenges that you faced that maybe were unexpected that you came in and hit head on that? Wow. I got to figure this one out.
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Well, you know, there’s always a learning curve with, with the new thing. And I don’t know, it been, it’s been at least five years. I did it. And some of it was the technology and working that out. Some of it was really mundane stuff like, oh, I’m squinting a lot. Oh, wait, I need to get computer distance glasses because of us old folks in Progressive’s and this part that’s the computer. Anyway, that I don’t know. It, it, there wasn’t anything insurmountable. I mean, like I got, if every time I had a problem, I’d look it up. Right. Every time I had a problem, I was like, okay, what do people do about this? And every time that they did that, I’d find something that was it sooner or later, I’d find some kind of solution. If I wasn’t getting a strong enough connection, I like, oh wait, if you get a wifi extender and plug the ethernet cable into that. Cause in my office, it’s too far away to run a cable out to the router in the waiting room, cleaned up the problem. If you, you know, just each time there was some something, right.
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Then, you know, the,
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There are people who are really willing to share their experience and wisdom. And I really been the beneficiary of that. You just have to look for it and ask. Right.
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And do you share your experience besides this podcast, but do you share your experience with others who are endeavoring the same? Yeah.
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And again, here too, it happens really organically one, well, back in March of 2020, when over a two or three week period, almost everybody went online. I, and a lot of other people like found ourselves in the position of responding to the queries that are, and that helped me coming out through like a professional associations I’m active in the Ventura county, psychological association, or, you know, my friend’s office mates. It just, if you just kind of worked up organically and, and I’m really proud of those people, because there are a lot of, you know, a lot of my psychologist, friends and, and I would assume, you know, non other mental health providers as well too, I’m just dialed into the psychologist through my professional association, didn’t have any background in, in going and going online to provide services. Lots of people were still, you know, they had perfectly good infrastructure that was set up.
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They’re using paper charts. They’ve, you know, they’ve got a good system. They’re using it. Lots of people, my age aren’t necessarily familiar, all that familiar with Skyping at all, or what we used to be called Skyping now is called zoom, whatever. But, but video conferencing of even, you know, informally with friends and family, so that, that transition to have to jump into any immerse into this was intense for a great many people and they did it. They did it. And now, now you don’t hear, I don’t see queries or hear people talking about how to, how to do telehealth. What they’re talking about is, Hey, what do you guys know about interstate practice? And th the questions have changed. The scope has changed as we’ve all evolved together,
So working from the Caribbean, did you run into any laws or regulations that you had to consider as you were doing this?
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I like, I didn’t run into anything because in the particular country that in the Turks and Caicos islands, there are no regulations specific to that. So it’s one of the things that would be regarded as not prohibited a little shout out here to the folks that person centered tech of and, and the trainings that they’ve had about interns, interstate and international practice in terms of being able to go and do that research and trying to find out what are their laws or regulations that govern the practice of mental health services within the country. So I did, I did do my homework ahead of time to figure out if that was an issue with, and it was a little unsettling to find that there wasn’t anything there, but that’s also too, I, you know, grateful to Bray Huggins and his crew at prisoner tech because they, they, that format of, okay, there are things that are permitted, there’s a regulation. You go through a process, you get permission. And then there are situations where it’s not prohibited where there just isn’t anything there. I also had to check with my own board to see if there were any guidelines or considerations. And basically California says what a lot of states say, which is, you can do it. If you are, you are beholden to the laws of the locale where the, where there is some kind of jurisdiction, you have to do it. Right.
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So even though the patient is in California, you still had to, and you were in the Caribbean, you still had to consider that.
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Yeah. And because typically here in the United States, it’s about what, where is the client located? Right. And, but you still need to check with your own, you know, your own licensing and your own jurisdiction to see if there’s some consideration, you know what California says may not be what every state says. And it’s our responsibilities as providers to, you know, to, to check that stuff out ahead of time. And maybe that’s one thing too. The where, how, how healthcare is changing is that many more people have had to think about those issues. And it’s, it’s, there’s, it’s becoming a little easier to look that kind of stuff up sometimes right now, I’m trying to figure out what the situation is for Switzerland, because I have a ongoing client who’s probably going to be moving there. And I got to figure out who to ask and how to find out about that. And, and that’s like a challenge that I and tangling with this past week. And we’ll see what happens. Who do I, you know, who do you send an email to you and how do
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You, right. Right. That’s, that’s where I’m at right now with that stuff. It’s like, we
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Need a road trip to Switzerland to figure that one out.
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Well, that would be it’s fun. I don’t know how to it’s funny, gorgeous country.
So, so looking back, you’ve been doing this for several years. You’ve gotten up and running with it. You’ve, you’ve done it from your office in California, but also in the Caribbean. What is the vendor experience experience from your patients? How have they adapted to this technology and embraced it?
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When I first made the transition across, there was definitely a small group of people who were not in acute need, who opted out and just sort of anecdotally, in terms of my small sample, those were folks who were not very tech oriented. Don’t, you know, maybe a little bit older in that way, but everybody else went across and they, you know, in varying degrees of, of seamlessness and the friction of, but everybody made that jump. And it’s funny too, cause I, I remember in kind of in the first couple of weeks of March 20, 20 thinking, okay, I need to do this. This is coming you, as the news was changing and then kind of wrassling with the, should I offer it as an option? Should I say, guys, we’re doing this, you know, how am I going to handle this? And, and being concerned about attrition and people dropping out of therapy.
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And then, you know, here in California, the Gavin Newson said you’re ever, you know, that’s it that we were, we went into the first part of the lockdown. So kind of cleared up the decision for me. It was for me, I had actually, I have a peer consultation group with a bunch of psychologists, girlfriends, and I spent some time going, why am I, what am I going to do in it? You know, how do I, I don’t know, I run a letter, how am I gonna do this? And then the next day, boom, the, this, the decision was off my plate and, and it actually went rather smoothly. So I, on my end, I did what I usually do, which was to cook up some documentation and pull things that other people had prepared about. How do you do this? So on my website, there was a step by step in here.
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Here’s how you do it. And man, there’s a modified version of that right now, but I don’t know as people necessarily, most people didn’t really even need that. We just kind of set it up and did it and had to work out the kinks of how does this stuff work and for you went, so even now, you know, I still have to work with people about, Hey, need light on your face. And you know, if you can prop that phone someplace, usually that it’s clear because the, you know, the, it uses less data. If the phone is stable, you know, the camera’s stapled a little, you know, kind of little tech stuff. Right, right. But that indivi, it goes, okay, the difficulty I can be in when the connection isn’t really stable and clear the connection to the connection and the connection, the connection technically, and the connection of interpersonally. So w that, that sometimes has been a challenge, but overall I’ve been, I’ve been very impressed by how people have leaned in to making that transition and, and going for it that I know that it hasn’t been everybody’s experience depending on the population that they’re working with or their settings. But for me, it has been, it’s worked well. Oh, that’s fantastic.
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When you were providing your care via telemedicine from California versus Turks and kick outs, w what’s what’s different, what do you have to do different and, and you prepare for those. Yeah. It
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It’s, it’s funny. I actually wrote a little thing about this recently where it feels to me like over the last six months of going back and forth, it it’s, it’s almost been like a single, like a repeated measures, design, single subject repeated measures decided, yeah. A B you know, California, grantor, Garland, California, grantor, ghrelin, and, and repeating it, it, there were the technical requirements of, of ensuring that I had the fastest and most stable internet connection possible. That was, that has been a really big deal. In fact, to the, after the first time that I was over there and doing my full slate of, of clients, I didn’t even tell him where I was going. You don’t tell people when you’re going to go to the Caribbean because it’s distracting and it’s not, I mean, I’m there, we’re working on them. I had to keep my, my background and stuff really neutral so that it’s like I’m working from home.
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And I was from just my second home, but I had actually ended after the first go round, where there was a day, thankfully on the weekend where we lost service. And I had a, I actually was hosting a book club of some friends here in California and lost service entirely that it became very clear to me that I needed a backup. And so there are two ISP on that island. And I am, we have accounts with both of them. And when we are on island, we have two internet providers and it’s, it becomes a cost of doing business. So actually this last time, these last couple of once we got that in place, what we did was if, because my husband works remotely as well, is that he’d be one, one, and I’d be on the other, oh, to ensure that we have the most bandwidth in the green, and it’s the most stable and the strongest signal, even with that, when you are in a developing country, it’s not going to be the same as it is in, you know, in a first world country.
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And, and so I can, I can feel the difference in, in have just, it’s more physical and cognitive effort to get focused in, for me, it makes a big difference. Having the literally things like the size of the display, bigger is better. More presence is more present, right? And so I’ve, you know, come every trip it’s evolved. I’ve, you know, I’ve tried different first. I was using an iPad. That was great. It wasn’t, the cameras were nice and clear, but it’s, it’s too small. I keep getting bigger and bigger and, you know, upping my, paying more money to get more bad because that, that doesn’t eliminate, but it minimizes the technical requirements or the technical static in the other way of it. The, I guess the only other thing that sometimes it is really different is that over the, our house on grand Turk, every so often somebody will say, is that a rooster in the background? Cause our neighbors have backyard chickens. And fortunately I can go, yeah, well, yeah, it is our neighbors have backyard chickens and where I live. That’s not that unusual where you for a county there’s there’s neighborhoods that have chickens. So they go, oh, okay. And then on, on, fortunately the donkeys that wander around the street there, none of them have gone off in the middle of a session. So
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That would be that I would have to do some explaining around.
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Yeah. Yeah. So like, let’s jump into your life while you’re on the island, living the island life, you’re, you’re meet with patients all day long. You’re senior, last patient you’re gone. What does your life look like when you’re, when you’re done seeing patients? Ooh,
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It will. If it’s light, I go outside. If it’s not, you know, if it doesn’t nighttime right outside and because it’s intense, it, it actually, I think is more tiring there than it is in my, you know, quiet well-equipped office here in California. Our house is right across the street from the beach. And so I’ll go down, down to the beach and just taking the horizon, taking the light, go stand in the water and let the, you know, let my brain air out. Yeah. Sometimes it, depending on how things are, we’ll try to, to get in the water before, because it’s east, you know, I’m on all my, almost all my patients, although I’m, I also recently just got licensed in Colorado. So we have more mountain central time folks, but, but the vast majority of my patients are Pacific time. So I played that three hour difference. And I mean, try to like, sometimes if I didn’t have people scheduled until 10 o’clock, I might go diving in the morning or go start it. And yeah, it is amazing. It is. It’s not all the time and it’s, but yeah, but it’s pretty cool. It’s pretty cool.
So Laura being on the island and, and working from the island, how does this mean, how does this impact your ability to maintain your own mental health as a provider
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In a word huge. It was, it’s been enormous in and helping me refresh. I, I truly cannot imagine what it must be like for colleagues and just people in general, who have gone through the pandemic, living in places where they were contained, you know, people in urban situations or of who don’t have ready access to outside space. Cause not just when we’re being on grand Turk, but even here in Ventura county have, you know, spent, worked on the yard, spend a lot of time outside walking, all of that, the necessity of being out of the room, whichever room we’re talking about and into the world and into my body and into movement and into all of those things, it, it has been incredible regular doses of vitamin C S E a R C C. I have been awesome. And interestingly enough, I realized recently that I have not taken a day off of work in 18 while I’ve last time I took a day off of work was in January of 2020.
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And it’s starting to wear on me now, but because we’ve gone back and forth. And even though I’m working, you know, doing my full, full slate in and working just as much when we’re in on grantor ground, this room when you were here, it, it hasn’t, it hasn’t been a, it hasn’t felt the same way it would feel as I think if I was, hadn’t gone that long without a vacation or any time off. Otherwise, the other thing though, that has made an enormous difference for my own mental health. Well, many other things, all the same stuff as everybody else is connecting with people. And again, the more I can do that face-to-face which means walking with my friends or meeting a safely distanced in the first part of the pandemic, that’s been huge and regular exercise. We were Supreme court fortunate here in our town that our local cycling studio or spin studio moved outside. It was one of those things that went into the parking lot under a big tent. Holy Molly, that was, has been, that was Saturday for a long time. And I’m so grateful that we were able to do that. So those kinds of things, it’s, it’s what everybody says. And it’s really true out in the world, body away from the screen, connecting with other people, taking care of just our human animal selves,
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Right? So being able to have that instant access to relaxation and nature allowed you to almost have vacation every day after work or before work at,
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To shift it. It’s funny. I did an Instagram post for, for the, the account for our house. Didn’t post it on my practice, Instagram because don’t wanna brag. But I remember one session where I was working with a client that I’ve worked with for a long time. And she was going through the process of being the primary caretaker for an older person in her family who was, who was dying and dying in a really difficult way. So, you know, and with that kind of thing, there is no making anything better. There’s just holding space for that person. They are bearing witness for their loved one and I am bearing bearing witness for them. And you’re just being present for all that. And I can remember one day after getting done with one of those sessions and, you know, wishing her well going outside and it was close to sunset and it just, I can’t even describe the feeling of, of opening up and taking in the beauty and the peace of the moment. No, because that, that things aren’t always in that intense, but when they are a lot of you kind of peeling yourself back and just, I just put them, you know, put my phone up and took a snap of that and posted it. And it, it really represented the healing that is available when you turn into the bigger world and having, having the privilege and the great, good fortune of having a beautiful place ready to hand it didn’t have to construct it. It was right there. But at that that’s been enormous.
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It’s an amazing story.
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Right. Right. You’re you’re splitting time between California and the island. Are there plans to go there full-time or spend more time? I mean, six months out a year is a long time, you know,
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At this point, actually. No. And, but for pretty specific reasons of part of it is the reason that we were able to go for so long, is it all of our guests canceled? That was the initial thing that got us there. And, and then also the necessity of going in and ensuring that the house was in good shape after March to August of, of, you know, being locked up and untouched, you know, and now that the demand is increasing again, you know, we’d say it’s a business investment. And so we’re hoping to, to kind of get back onto that fitting and B, just because of our family life here, you know, my mom is older and, and, and that was the one really downside of being away from home, you know, besides we have a house and an acre of land and from trees and stuff that has to get taken care of and animals, but that I’m, I don’t like being away that long.
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So we’re both in personal and, and then that end of business, you know, the, the vacation rental end of business reasons, I think we’re going to make, we might go for three weeks at a time down the road, as we get closer to, you know, to winding down for retirement. We’ll see, you know, it’s, it’s, there’s great things about being, you know, living in a place like that. And there’s also, you know, it’s, it it’s, it has its own demands and limitations. Right. And, and we were really fortunate in where we live here in Ventura county. It’s pretty sweet. It’s, it’s close to LA, but it’s not an LA you live in kind of a rural area. There’s lots to recommend being here. So, you know, I am supremely fortunate and grateful to have the choice,
Speaker: 1
But you’ve got the flexibility. So it’s not like you’re tied down to one or the other, you get a freedom to move around. Are there, are there any other locations on the horizon, like you mentioned, you got licensed in Colorado, you’re looking to get a mountain house as well.
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No, they did. They did. If I hadn’t even thought about that part now it turned to simplifying the license was simply because Colorado makes it easier than some states to, to when you, you know, to get a license when you’re already licensed. And, and I had started seeing somebody initially, who was referred by another client in Colorado was also fairly generous in their interstate temporary privileges. And so it was just something that I thought, well, let’s, you know, talk to the client, are you interested in doing this? And, and she was very interested in an appreciative that I was willing to do that. It’s, you know, I, I’m one of those people like, oh, Hey, this is a good idea. Let’s go try this. And sometimes it works out well. And sometimes I’m like, oh, what did I get myself into? Right. But with more, I think more and more people are getting licensed in, in multiple states, certainly as a psychologist.
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There’s the prospect of Saypac. Although what I found out in the process of pursuing licensure and AF are you familiar with that package is multi-state it, it’s a through the association of state and provincial another anyway, through actually on top of mind, you remember the exact organization, it is a move for interstate reciprocity. And so for, for when a state chooses to participate in Saypac to, you know, when they, when that is legit, it is a legislated, I guess, to join then providers on cycle of psychologists, practicing psychologists and other states who are members of Saypac. Some, a psychologist can join site pack, and then qualify. They have an internal qualification process. I don’t know how similar or different, different than it is to licensure to begin with, but you just can’t sign up. You have to qualify within them. And then you have reciprocity and con practice with any of the state within, via telehealth within you, the states, or I suppose, depending on where you are actually physically going to different places that our members of Saypac California, however, is not.
Speaker: 0
And it’s, it’s controversial. There’s some, a lot of conversation at the level of the California psychological association and what, you know, there’s there’s issues about, I don’t know what protection of trade or, I mean, they’re just, I’m not participating in that things. And so whether or not California will in the foreseeable future, we will have to wait and see. One of the provisions of Saypac is that even if you are licensed in a Saypac state, you cannot participate unless you are physically officed in that state. So even though California, Colorado is in and I’m licensed in Colorado, I cannot apply to and go through the process of getting qualified through Saypac because I don’t have a physical office there.
Speaker: 1
Gotcha. So even the virtual, it doesn’t count then Nope.
Speaker: 0
You gotta be physically offices. They’re very clear about that. And it makes sense. It makes sense, because
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Are you looking to expand your, your business beyond this one patient in Colorado? So just for this one,
Speaker: 0
If somebody, I mean, if someone in Colorado contacted me yeah. And I mean sure, but it’s it at this for me at this stage. And at my age of new, my practices generally runs full. I typically try to, I’m not working full-time full-time, you know, like maybe four days a week, so I’m not in, I’m not growing my practice, I’m maintaining it. And, and that’s, again, that’s a really nice position. I’m good with that. And my, you know, I’m 63 years old, so at my age, that’s okay. You know, that feels right at this point. And so again, I’m really, I have a lot of gratitude and about being in the position that I am in being able to do the things I’ve been able to do.
Speaker: 1
Yeah. That’s amazing. So as we wrap up this, this episode again, thank you so much for your time. I usually like to ask three questions past, present, and future. So if you were to go back, back into the past, what would you have done different? I got a lot of past
Speaker: 0
You practice. I would have held better boundaries between time at work and time at home. I would have made less money and spent more time with, or I would, well, I mean, I would have, I have held that boundary more firmly. Cause it, there, there was creep. And I worked, I think I worked too much and my kids were, were suffered because of it
Speaker: 1
Present. What, what, the things that make you successful today?
Speaker: 0
Ooh, same things that probably have contributed to my being able to do. Okay. And all the way along is that I’m really interested in what I do. And I’m really interested in the people I want to know. I’m interested in what’s going on with my mom, for my people that I guess I’m pretty, I have sufficient flexibility and frustration tolerance. You know, I can hang with difficult, you know, sort of thorny situations like the tech stuff. And I have no re no compunctions about asking for help or looking like an idiot or going, okay, hang on a second here. Let me figure this out in real time, that has to happen so that, you know, I, I don’t know. I, it, it, by being able to be transparent about that, I have rough edges, don’t know everything, and I’m going to try to figure it out that somehow people work with me on that one. And so it has really lowered my tension around, around it when, when things go wrong or when I don’t know how to do something or, you know, the signal drops or we lose audio or, you know, standard things. And I hope that as well as cushioning me, that it also provides a model for the people that I’m working with, that competence and perfection are two different things, either that you can be competent and fumble Bumble be imperfect and okay, fine. Let’s keep going.
Speaker: 1
It’s okay. You’ll survive. Right. Just roll with it. Yeah. Yeah. Great example, a future. What is the future of healthcare and your professional?
Speaker: 0
Well, probably like, you know, a lot of other folks and perhaps even kind of the evolving consensus, we will never go back to how it used to be. I think lots of, of, of therapists are going to maintain a hybrid practice and for a number of us that includes meeting with patients outside the office, more than we ever have before of we haven’t talked about it. But one of the other things that I adopted during the pandemic here in California, was walk and talk and wrote myself a gnarly informed consent that when you trying to think about all the possibilities that things could go wrong, but started to meet with people face-to-face outside, which was just such a relief for the people, for the subset folks who, for whom that worked about confidentiality concerns and, and comfort and all that sort of thing. And I think that we’ll always maintain that and more and more people have done that.
Speaker: 0
Our model of, of the traditional model of psychotherapy occurring within this contained space, this quiet health space, which has so much virtue to it, is it won’t go back totally to that, that it’s expanding and evolving, that we will continue to meet virtually more and more people will find ways to, to meet, to incorporate outside of the four walls of the office. And I think we’ll learn more about how to utilize that as a, as a method in the end, in the two to find out more about its virtues and how we can incorporate that into strategies and treatment planning as opposed to overdoing this because, you know, because we like it or it’s nice, but B has actually therapeutic benefit to it. And, and th that be in these expanded venues that who knows, I mean, whether that’s going to give rise to another line of psychotherapy research that will continue to refine more of what those common factors are and some of the core things that make therapy work and work better for people possibly, you know, that would like to think so, but we’ll see,
Speaker: 1
We’ll see you next time. It’s, it’s very interesting. There’s psychology is evolved and changed over time and, and you’re right. A lot of it’s happened within the confines of a room, but now innovation is happening outside of that room. Yes. And leveraging those same principles and the walk and talk concepts that I’ve never heard that before, but that is, that absolutely makes sense. As soon as you said it, it’s, it resonates. That is such a good way because it’s getting into it. It’s, it’s getting into the patient’s world, not bringing the patient to your world. Right. Yeah. And, and I can even envision a go to the psychology of the psychologist who goes to the patient’s home and does a counseling within the patient’s home. And, and people
Speaker: 0
Do that too, to, to a small extent in certain populations, you’re working with people with say chronic physical disabilities or illnesses, older people. There’s more of that. It’s, that’s been more the domain of social work, but it may, I think we’re going to get out of our boxes more in that way. The, the walk and talk thing has been interesting in that, in getting feedback from the folks, from, with whom I’ve done it, people have report some, you know, and again, a small sample in, you know, limited. So we gotta be careful about generalizing here, but that thing about when you’re not looking at somebody, you know, eyeball to eyeball, and when there’s space around, sometimes that can be very facilitative, the physical movement, the rhythmic nature of it, to be able to talk about difficult things in a grounding in a, in a, in a while, you’re doing something that helps you stay grounded in work with anxiety and with trauma, there’s this idea of the window of tolerance, you know, that, that in order to address things that are inherently disturbing, that there, that disturbance is going to come up to things, you know, tension, discomfort, little, you know, sort of the trauma, the echoes of the trauma, and that you try working to maintain somebody within that window is too much.
Speaker: 0
They’re going to flood or freeze too little there’s that avoidance. And it’s, you know, I’ve had people comment that it’s, in some ways it’s can be easier to get into things that are harder to tolerate while they’re outside of physical moving at this end on the, on the other hand, there have been times that we’ve chosen to come back and do a remote session because we wanted that quiet and the focus there. So, you know, and that’s why I say kind of being able to think about that in a little more systematic way and, and use it as a way to augment or to enhance an intervention, to be able to think about it about how’s this going to serve my person, how’s this going to, going to further the therapy that we’re doing and just have it as another tool in toolbox.
Speaker: 1
Yeah. Yep. And adapt it to the context and the needs of the patient. Right.
Speaker: 0
Right. And so it’s sometimes it’s improvising, but I think as time goes on, we’re going to understand more about, about what its virtues and limitations are and how to think about that in terms of somebody’s individual treatment. And, and I got to say, when we started doing, I started doing this with the folks that wanted to do it gosh, back a year, not quite a year ago. Oh. It was just having to get it to get out of the office and literally to get away from the screen. Yeah. Bear hugs.
Speaker: 1
Yeah. Absolutely. Absolutely.
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Absolutely.
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Since, since we, I thought I was going to go back to seeing people face to face when I came back from the TCI at the beginning of August and, and no, not, not here where we are right now, we’re working. Are
Speaker: 1
You planning to go back to in-person sessions?
Speaker: 0
I would love to, it’s just a matter of when, and some people can move. There’s a lot of variation, you know, even with, among the, you know, the, my colleagues about who’s doing what and mast and unmasked, and, but I’m, I’m a little conservative, I like to, you know, to mitigate risk where I can. Right. Right. So I’m holding off and because my people have taken well to tell. Right. Right.
Speaker: 1
How has your perspective of healthcare changed through this experience adopting this new technology, starting your practice, changing, how you did things with COVID, how has your perspective changed?
Speaker: 0
I’m not sure that it’s changed surely Brendan it’s, but certainly it’s you come back in a way, you know, to quote John wooden back to the fundamentals about rapport, engagement, attunement, you know, building that solid foundation and, and doing whatever’s possible to secure that, you know, certainly tele-health and, and using tech within therapy can open up and go in all kinds of different directions, you know, virtual interventions and, and things that, that can go past the scope of what I’ve ever done and will probably ever do. So, you know, I know it’s there. I just, it’s not my it’s not on my horizon, but I think for me, it is, it has taken me to reground in the things that, that we know to be true, which is the relationship is the foundation for all the therapeutic relationships foundation for all the work that you’re going to do and to do what I can to facilitate and foster that. And that was, you know, the connection, the physical connection, the technical connection, when that shaping, then, then we’re leaning in to promote the interpersonal connection and trying to, if that makes any sense kind of attending to that, not taking anything for granted and intending to that even more.
Speaker: 1
That’s fantastic. We’ll talk to Laura foresight. Thank you so much for your time today.
Speaker: 0
It is my very great pleasure. It’s been fun.
