The AAMFT Blog

4 Ways Private Practice Owners Can Save Time Every Day

This content is provided by Brighter Vision, an affinity partner of AAMFT. This information is not necessarily the views of AAMFT and should not be interpreted as official policy. 

While many therapists start their career partly because they’d like more control over their own work schedule, managing your time can be one of the biggest challenges when running a private practice.

When you’re handling sessions, marketing, appointment booking, admin work, business financials, and more, it’s easy to wish there were more hours in the day!

Here are a few ways you can start to take back some of that lost time every day so you can run a more efficient (and more profitable!) practice:

#1 - Move Your Appointment Booking Online

If this is a step you haven’t taken yet, it’s a must-do! Moving your appointment booking online is a major time saver because it takes practically all of your appointment scheduling completely out of your hands.

That means no more wasted time on the phone scheduling appointments, screening calls that may interrupt your day, or shuffling through appointment calendars in a rush. Instead, you’re giving your clients the flexibility and freedom to schedule their own appointments – while freeing yourself up at the same time.

There’s a huge variety of both free and paid online scheduling options out there, but our favorite is SimplePractice. SimplePractice is a HIPAA Compliant Solution that gives you access to scheduling, billing, and notes all in one place.

Working Remotely During the Pandemic: Boundaries Matter

For those of us fortunate enough to have work during the COVID-19 pandemic, we must balance gratitude with uncertainty. We are living through history in the making, and the massive sudden pivot to working from home can be overwhelming, particularly for those without prior remote experience.  

Everyone's transition to a remote work schedule will be different. For those who already work from home, the change will be more or less seamless. However, for many, this transition has been abrupt and mind-boggling. Work-life balance has become more daunting than ever before, as it all takes place from your home. Each of us will have a unique challenge to navigate. For a working couple that lives in a studio apartment, for example, it will be more complicated than for those whose space provides more privacy.  

There are so many considerations when it comes to navigating all of this "in place." Marriage and family therapists (MFTs) lead from the premise that nothing happens in a vacuum. All of life's demands still exist as you work from home. We are all coping with pre-existing stress on top of the uncertainty that comes with a pandemic. High anxiety about job security is a factor that keeps many of us from setting clear boundaries between our work and personal life. The geographical line vanished overnight, and most of us are scrambling and overextending ourselves to keep from engaging in catastrophic thinking. 

As MFTs, we know that setting and maintaining clear boundaries are vital to protecting our mental health. In our field, we talk about boundaries as enmeshed, rigid, or clear, and transparency is the goal. Think of them as your safe zone. Boundaries are about asserting your emotional need for protection. They are not about asking for permission but instead are about letting others know what you can handle. And, as we shelter, work, and play in place, your limits will be challenged. It is okay to be precise about what you can and cannot handle. Others are unable to adjust their expectations and behaviors if they are uncertain about what you need. 

Here are some tips for setting boundaries while working remotely during the COVID-19 pandemic: 

Hold Yourself Accountable: Setting clear boundaries is up to you. You are responsible for your own needs. It is not always easy to assert your needs, and even more so if you are worried and anxious about job security. However, you are doing yourself and others a disservice by ignoring your needs. Now is the time to use your oxygen mask first, and by doing so, you will be more available to those around you, even from a distance. 

Communicate Clearly: Take advantage of the technologies available to you at this time. With so many ways to communicate, we need to make sure we are setting reasonable expectations with our co-workers and clients. It is okay to let your boss know that you are overwhelmed. We all are!  

Set Your Hours and Maintain a Routine: When possible, manage your time as you would when going to the office. For mental health professionals, like MFTs, this means keeping a similar schedule to the one you do in the absence of the current pandemic. For other professionals, try to mirror the schedule you kept before the quarantine. And if space allows, create a designated area to work in your home. 

Protect You Space: Having work overtake your home can feel bad—not because you don't like what you do but because it infringes on what usually is your personal space. Be sure to keep some part of your day sacrosanct for your own time. 

Take Breaks:  Just as you would do pre-pandemic, permit yourself to take breaks during the workday. Pushing yourself to be "on" all the time will only lead to additional exhaustion. Take time to eat, hydrate, and stretch. 

Be Kind to Yourself and Set Reasonable Expectations: Lead from kindness; no one has done this before. It is a new time, and the rules are unclear. No one expects you to be perfect. Do what you can and let yourself rest when you need to. Keep your expectations of yourself and others within reason. We are all adjusting! 

These are trying times for all of us. If you need additional support during the COVID-19 pandemic, please reach out to a mental health professional in your area. Telehealth services are available across the US and Canada. You can find support through the following sources: via the AAMFT therapist locator (AAMFT Therapist Locator) Psychology Today(www.psychologytoday.com), Good Therapy(www.goodtherapy.com).

AAMFT Sends Letter to Congress and NAIC About Telebehavioral Health Restrictions

AAMFT and many other national behavioral health organizations that are members of the Mental Health Liaison Group sent letters to Congress, the nation’s governors, and the National Association of Insurance Commissioners requesting that states lift restrictions on telebehavioral health for all individuals regardless of insurance and ensure payment parity with face-to-face therapy during this emergency period.

Read our letter to Congress here: Download MHLG Telehealth State Coverage Letter 3.25.20 FINAL House and Senate

Read our letter to NAIC here: Download MHLG Telehealth State Coverage Letter 3.25.20 FINAL NAIC

AAMFT Signs Letter to Congress About Funding for Healthcare Relief

AAMFT and over 170 other organizations urge Congress to move legislation forward that gives at least $150 billion in relief to states as they fund critical healthcare needs at the state and local level. In this letter, we strongly urge Congress to move legislation forward for direct aid to states for fiscal relief as they deploy their resources to address critical health needs and absorb the related economic crisis.

Read the full letter here: Download FUSA State fiscal and Medicaid signon 32320 430

Coping with Social Distancing: Tips for Managing Time, Stress, and Anxious Feelings

By now, most, if not all, of us are practicing social distancing until further notice. For those with kids, they are homeschooling while trying to balance remote work schedules. For others that may be alone or have no kids or family nearby, or have been temporarily laid off of work, this time is especially challenging.

We must all do our part to help reduce the spread of COVID-19. Social distancing functions as a means of harm reduction and in allowing time for tests and vaccine production. It is vital and requires effort. The timeframe on this remains unknown, and long periods of loneliness and worry can increase stress, anxiety, and depression. 

Social distancing, while crucial, asks us to suppress our evolutionary hard-wiring for connection. Nicholas Christakis, a social scientist and a public health specialist at Yale University, told Science. "Pandemics are an especially demanding test…because we are not just trying to protect people we know, but also people we do not know or even, possibly, care about." (bigthink.com) And yet social distancing will be a way of life for several weeks, if not longer. It is a test of enormous proportions, and we all need to help each other as much as possible from a distance.

Breathe…we can do this! Before hitting the panic button, try to think of the opportunities that still exist at this time for creativity, care (self and others), and compassion. We are fortunate to have more ways to reach people remotely than at any other time in history. We have tablets, laptops, and phones that function as mini-computers. We can use these platforms to support people outside of our social restriction circle. 

A helpful way to reframe social distancing may be to focus on social solidarity. It is a chance to reflect and expand our circle of moral concern. We are in a time of transformation, shifting away from an I-centric approach to one of collective effort and care. We are all in this together, and maintaining our emotional well-being matters. 

For Marriage and family therapists, social distancing is part of a systemic response to managing the spread of COVID-19. The discordant nature of it is such that we are helping the more extensive system, our community at large, by intentionally conducting life via isolation. But to repeat…we can do this! 

Here are some survival tips for managing life during this time: 

• Don't Panic: With so many sources of media, it can be hard to weed out unfoundedly pessimistic news. To fend off panic, one must prioritize reason and realism. One way to do this is to make sure you are obtaining information from reputable sources. Some good sites for this include the CDC's coronavirus page, your local health department's website, and the Johns Hopkins Center for Health Security. Other reputable news sources include New York Times Conavirus (free access during the outbreak). Do remember to set limits on how much news you consume each day. It is not helpful to keep checking; in fact, the more you do this, the more likely you are to make snap judgments based on how easily information comes to mind.

• Re-create Your Daily Routine: The sudden move to remote working and homeschooling has thrown routines off-kilter. For most of us, this can create additional stress and anxiety. Thankfully, we can retrofit our pre-distancing habits to our new social distancing way of being. If you are working remotely, try to follow a similar routine as you did when going to the office. Get up at your usual time, engage in healthy activities of daily living, and carve out a designated space to work. 

If homeschooling, set up a schedule that resembles what your kids have been doing throughout the school year. You can modify it, however, as you feel fit. For example, you can develop a schedule that incorporates routine and reward. Follow an hour of reading or math with a snack and an educational show. There is no specific right way to do this, but having a routine will make life a bit easier for everyone. 

• Be Altruistic: Research shows a strong correlation between philanthropic activities and improved health and well-being. While social distancing puts limits on our ability to engage in altruistic behavior, it doesn't eliminate it. 

One can offer to shop for a neighbor or relative that is elderly or has a compromised immune system. Another way to give is financial. If someone in your community is temporarily laid off, you can offer to drop off groceries or send a gift card to help offset some of the burdens he or she is facing. 

• Be Creative: Being socially restricted may provide an opportunity to engage in creativity. With the time at home, you will likely cook more. Find new recipes or have an in-home bake-off. 

Other creative outlets include – drawing, puzzles, knitting, crocheting, creating writing. You can find anything on YouTube, so don't be afraid to learn something new while you have time to do so. 

• Move it! At this time, we can still go outside for a walk and get fresh air. Take time every day to go for a walk or jog (if preferred) while maintaining a safe distance from others who may be doing the same. Getting fresh air and moving our bodies is one of the best things we can do at any time, and now more than ever. 

• Choose to Remain Positive: Social distancing will have taxing moments. Human nature leans into the negative with ease, so staying positive will take some effort. Marriage and family therapists often talk about the positive to negative ratio or “magic ratio” is 5 to 1. This means that for every negative interaction during conflict, a stable and happy marriage has five (or more) positive interactions (com).

During this time of social distancing, you will have ups and downs, and that is okay. Make room for the trying moments, and remember they are just that – a moment, not forever. Maintaining an attitude of optimism is more beneficial to your well-being than dwelling on negativity. Try to choose a healthy mindset day by day, and remember you’ve got this!

AAMFT Signs Letter to Congress During COVID-19

AAMFT and 87 other healthcare associations submitted a letter urging Congress and the Administration to implement measures to ensure access and continuation of behavioral health care services to all during the COVID-19 emergency and future national emergencies.

Please read the full letter here: Download COVID-19 and Mental Health SUD Letter

Couples and COVID19

Written by: Michele Weiner-Davis

Several weeks ago, I told my husband about my plan to shop for food and supplies in case the Coronavirus reached pandemic proportions.

He smirked and said something like, “You’re so predictable,” referring to my tendency to worry about dire outcomes. I’m just wired that way.

Not to be deterred, I took off to Costco and once there, filled my cart until I could feel the adrenaline stop pulsing through my body. Upon learning about my Costco mother lode, I became the brunt of my family’s jokes.

Fast forward to the last few days. No one is laughing anymore.

Especially not the couples in my practice.

I spent several hours on the phone today with a couple in crisis from California.

Married for 8 years, John, a physician, and Rita, a journalist, had not been able to stop arguing for three days. Their hostility was growing exponentially.

When asked what had been going on between them, it quickly became apparent that the issues identified were merely red herrings; something deeper had hijacked them emotionally.

And it was this.

John and Rita had completely different perspectives about the risk involved with the current COVID-19 situation. Because of his medical background, John felt that, while they should not panic, he and Rita should make immediate changes in their lifestyle to minimize risk to them and their two young daughters.

For John, this meant other than his work responsibilities, he and Rita should limit contact with the public- no socializing with friends and family, staying home as much as possible, stocking up on food and supplies from online sources, and following mainstream medical advice regarding regular handwashing and sanitizing surfaces at home.

Rita, on the other hand, while not oblivious to the health risks, believed that with diligence and sufficient caution, their chances of contracting the illness was slim. She didn’t agree with John’s plan to fully limit social contact, especially for their toddlers who had frequent playdates. Also, Rita was close to her parents and felt grandparent visits were a major bonus in their daughters’ lives.

During our two-hour call, Rita repeatedly asked, “When does the cure become worse that the illness?”

Tips to Support Mental Health Amid Concerns about the COVID-19 Pandemic

Managing fear and anxiety at any time is challenging. No one likes uncertainty, and with so many avenues to information, basic levels of stress can skyrocket. Remember that human beings are survivors. Anxiety is activated by the primal part of our brain, signaling us to fight, flight, or freeze. It intends to aid survival, and yet, as it sometimes functions, it leaves us feeling paralyzed, panicked, and riddled with fear. Remember that this is normal, and everyone will feel some level of anxiety and fear right now.

Given the seriousness with which we are receiving information about COVID-19 pandemic, it is normal to feel anxious. Facing concerns of the developing COVID-19 pandemic, marriage and family therapists, as well as other mental health experts, want to remind those with exacerbated anxiety, fear and depression symptoms some ways to manage their symptoms during this time of uncertainty.

• Honor Your Feelings: You will have anxious thoughts. Hold space for these thoughts as not to avoid, ignore, or suppress them. Give yourself permission to have anxiety as an appropriate response to uncertainty. Manage things in smaller increments of time, reminding yourself what you can and are unable do from minute to minute. This can help keep things in perspective. 

• Self-Care Matters: Engaging in self-care is critical right now. A short list of self-care items includes: sleep, balanced nutrition, exercise, hydration, as well as protecting and conserving our emotional energy. When our personal energy drains our ability to keep things in perspective becomes increasingly distorted.

• Maintain Social Support: Stay in touch with your social support system via text, phone, FaceTime, Skype—whatever is available to you. Pay attention to your sleep and nutrition needs. It can be hard to sleep well when we are a bundle of worries. Try to maintain a healthy routine including the things you typically do to support your physical and emotional wellness. And use caution by following current health and safety protocol while doing them.

• Check on Others: Helping others when we are worried can be a welcome distraction, as well as an action item to ease it. Take time to check in on anyone in your family, friend, or community group that is living alone.

• Consume a Healthy Media Diet:Just as you need to pay attention to sleep, nutrition, hydration as ways to manage your health, you must choose a healthy media diet. Seek information from reliable news sources only. Set healthy boundaries for checking in on the latest news to short, defined periods, and refrain from setting related push notifications on your device. In fact, it serves your interest to turn these notifications off. Appropriate information consumption can reduce anxiety and fear, or at the very least, give you a break from ruminating on the current COVID-19 climate. Here are some better-established sources when you do turn to the media coverage:

            https://www.cdc.gov/coronavirus/2019-nCoV/index.html

            https://www.nytimes.com/news-event/coronavirus (free access during the outbreak)

            https://coronavirus.jhu.edu/

• Live Reasonably, Do What you Can: Take the recommended precautions as outlined by Centers For Disease Control & Prevention (COVID-190) and other credible health agencies (see links above). Remain focused on the factors within your control, such as washing hands, covering your mouth during coughs and sneezes, avoiding non-essential travel, and practicing social distancing.

• Reach Out to a Mental Health Professional: MFTs and other mental health professionals are still keeping up with their clients. Many have moved to virtual platforms that offer telehealth to clients. If you’re noticing that your symptoms of anxiety (in association with COVID-19 or otherwise) are causing you significant distress or are interfering with your ability to function normally, reach out for formal mental health supports. You can find support through the following sources:  via the AAMFT therapist locator (www.therapistlocator.net), PsychologyToday(psychologytoday.com), and Good Therapy (www.goodtherapy.com). 

These are challenging times, and now more than ever, we need to work together in supportive and compassionate ways. From some of the most difficult moments come opportunities to grow. This is a time to redefine our communities in ways that will allow us to feel more connected, despite temporary social distancing.

5 Local and Global Things To Remember Now

Last Wednesday, working at my computer, I happened to catch Aiysha Malik, a Mental Health Officer at WHO in Geneva on Twitter doing a live Q & A about mental health and #Covid19. I know Aiysha from other projects at the UN level; I recognized the hallways and workspaces where she was filming, because I had worked in them, too. In the clip, which I encourage you to
watch, Aiysha talks about all the things systemic folks know and all the things systemic folks do, including the use of language to de-stigmatize, how to talk to children during the outbreak, and how to be reflexive in your self-care. Systemic family therapists often don’t realize all the ways we are recognizable at the global level. If you listen to Aiysha, you’ll see us, too. Indeed, Ms. Malik is one of many people I’ve met at the UN level who is intimately aware of the implications of applied systems thinking, and how families and family therapy are such a key part of any one person’s mental health.

As I watched and listened to Aiysha, I thought: I would love to see my fellow family therapists looking and listening and thinking about this kind of outreach, perhaps using it to augment their work during #Covid19, and then perhaps creating moments of their own, to be shared and exchanged for our learning. There are many things we cannot control at the moment, but also, many things that we can. We benefit in times like these to see and share important outreach and leadership between us, in AAMFT, from local and regional bodies, and within our own individual communities. No matter if our primary world is digital or analog, or our geolocation is here or there, or quarantine or isolation or six feet of separation, indeed we are all in this together, as the Director General of WHO put it in today’s situation report.

Providing Services During the Coronavirus Pandemic

The global coronavirus (COVID-19) pandemic has MFTs questioning whether they can provide their services through the use of telehealth technology, especially given the recommendations from the Centers for Disease Control and the World Health Organization to practice social distancing. While telehealth seems like the easiest solution to best protect yourself as the mental health provider, as well as your clients, it’s important to understand the complexities of providing telehealth services before making the decision to offer teletherapy to your clients. 

Top Items to Consider Before Offering Teletherapy During the COVID-19 Pandemic

Does your state allow MFTs to practice teletherapy?

• MFTs are legally able to provide teletherapy within a state if they are a licensed MFT or other licensed mental health provider in that state. However, some states do have requirements that licensees must meet before providing teletherapy, such as a certain number of hours of CEs on the subject. Therefore, please check with your licensure board for any state requirements pertaining to teletherapy before proceeding
• Some state licensing boards may have special notices or alerts regarding this very issue. It will be crucial to periodically check in with your licensing board because this situation is very fluid, and teletherapy policy may change at any time.
• Some state governments have issued emergency declarations that could impact whether or not MFTs can practice telehealth. Please contact your state’s licensing board or agency to find out more information on how an emergency declaration impacts your scope of practice.

Can MFTs provide teletherapy to clients who now reside in another state? 

• Some members are encountering situations due to the pandemic where their clients moved away to another state where the member is not licensed, or the clients can no longer travel from their home state to the member’s office in another state. In most states, you must be licensed in the state where the client is currently residing in order to provide therapy online to that client. Unless the government in the state where the client resides waives this requirement under an emergency declaration by the governor, or emergency rulemaking by a licensure board/agency, then this restriction would still apply.

Have licensure laws, or sections within these laws, been waived for the duration of the epidemic?

• The short answer is “no” so far. The current statutes and regulations still apply and remain in effect for the duration of this pandemic. Federal or state law still applies and is still enforceable. The only exceptions would be if the government waives a statute or rule under either an emergency declaration by the president or governor or other executive authority, or emergency rulemaking by a licensure board, or a court order.
• In some cases, the executive branch, whether the federal government or state governments, might not have the legal ability to waive certain requirements during an emergency. Congress and state legislatures also can push legislation that waives or amends certain requirements.
• Please be sure to contact your licensure board should your state government make any emergency changes to confirm how the changes may impact your scope of practice or your ability to utilize teletherapy options.

Will the insurance companies reimburse me for a virtual visit during this time?

• It’s important to check with each insurance company you are paneled with. Some insurance companies will only reimburse mental health providers for virtual visits after the provider has had an in-person visit with the client. Some insurance companies may change their telehealth policies in order to address the current crisis. The trade association for the insurance industry has a summary of actions by some insurers who have waived requirements in light of the virus.

Will my malpractice insurance cover telehealth services? 

• If you are insured by CPH and Associates through AAMFT, they have released a notice stating that the policy will cover telehealth as long as the services are being provided legally within the scope of your license.
• If you are covered by a different malpractice insurance company, you will need to contact them to find out if telehealth services are covered under your policy.
  
  

What teletherapy platform should I use?

• Members should use a teletherapy platform that is HIPAA-compliant. Regarding supervision, AAMFT’s affiliate partner, Motivo, is offering all members a free, HIPAA-compliant platform for virtual supervision during COVID-19.
  
  

What ethical issues apply to teletherapy?

• All AAMFT members are bound to comply with the AAMFT Code of Ethics. Standard VI of the AAMFT Code of Ethics addresses the provision of online therapy or supervision. In particular, Standard 6.1 outlines the steps MFTs should take before commencing therapy or supervision services through electronic means. In addition Standard VI, the remaining provisions of the AAMFT Code of Ethics also apply to online therapy or supervision.
• Besides the AAMFT Code of Ethics, your state’s licensure law might have additional provisions that apply when conducting teletherapy or supervision online. Many states have requirements that are the same as or similar to the AAMFT Code of Ethics. However, some states have additional requirements that apply to therapy or supervision through electronic means. Members should check their state’s licensure law or contact their state licensure board. For information regarding your state’s licensure law and licensure board, please visit our State Resource Pages.

I am a student in an MFT program attempting to complete my practicum this semester. Our university is now closed, and I have gone back home, which is in different state. Can I continue providing therapy to clients virtually in the state where the program is located?

• Regarding the ability of students to continue providing services online, this will depend upon several factors. One factor is whether the MFT program or university will allow the practicum to continue during the disruption. Some programs might not allow it, particularly if they are formally closed during this period. Another factor is whether this therapy is allowable under the laws of the state where the clients live, as well as under the laws of the state where the student is residing. You or your program will need to check with the licensure boards in these states. In addition, you will want to contact your liability carrier to see if providing therapy virtually from another state as a student would be covered under your liability policy.

What about for associate MFTs? Will my hours earned during this pandemic count towards licensure?

• As an MFT in training, the COVID-19 pandemic may have you worried about completing your hours of supervised experience in order to become licensed. Supervisors may also be worried about providing supervision while adhering to the recommended social distancing preventative measure. Some states already have a certain number of supervision hours allowed to be completed virtually. Again, given the fluid nature of this pandemic, it could be possible to see some of these virtual supervision policies change. Please contact your state’s licensing board/agency to determine if virtual supervision hours will be counted towards licensure.

AAMFT Resources

• AAMFT has several resources regarding the practice of teletherapy. Those resources, along with other resources that may be helpful during this time of uncertainty, have been compiled for your convenience here.
• For information regarding your state’s licensure and supervision policies, please visit our State Resource Pages. Please note: These pages were not created with a global pandemic in mind! Please utilize the links on your state’s page to access information directly from your state’s MFT licensing board/agency, because policies may temporarily change due to this crisis. Each State Resource Page features links to the MFT licensing board/agency.