Interview with Lisa Hutchison, LMHC

1. First, can you tell us a bit about your professional background?

I am a licensed mental health counselor for the Commonwealth of Massachusetts, who has been practicing psychotherapy for over 20 years. I have created  program for caring professionals, who want to prevent and treat compassion fatigue. I have taught various classes online and in person, in addition to being a national public speaker.
I am the Best selling Amazon Author of I Fill My Cup: A Journal for Compassionate Helpers and Setting Ethical Limits For Caring and Competent Professionals.  I also am published in 3 Chicken Soup for the Soul books and international magazine publications. Currently, I am an expert writer for CounselingSchools.com and a CEU faculty member writer for NetCE. 

After multiple publications, I further expanded my business to include writing coaching and teaching, to help others tell their stories and connect to the creative-therapeutic aspects of writing.

I have worked in various community outpatient mental health clinics, serving clients with substance abuse/addictions, depression, anxiety and other mental health concerns. In addition, I worked four years in an elder partial hospitalization program. One of the many groups I led was expressive therapy, in which I loved teaching creative writing.  My lifelong connection to spirituality became a part of my professional business in 2014, when I started my own business offering angel card readings and later spiritual coaching sessions. You can find my spiritual readings on my You Tube Channel, Lisa Hutchison LMHC.

Lisa Hutchison

2. Compassion fatigue (aka secondary trauma, aka burnout) is such a huge issue for helpers right now! When did you start writing about/working with compassion fatigue?

I started to notice my own compassion fatigue when I worked as a counselor for counseling agencies. Even though I did a good amount of self-care,  I would come home feeling exhausted. 

Deep down, I knew something was missing.  I was good with setting boundaries, I began instituting boundaries more and more. Despite this, I  still felt fatigued.

In 2014, I had a spiritual experience, which lead me to leave my traditional job and start my own business, incorporating my psychological expertise with my spiritual channeling abilities. I wanted to help others who are empathic find their own answers and feel better through counseling and angel card readings. Later on, I offered spiritual coaching sessions.

I knew I wanted writing to be a big part of what I offered. I began by writing a blog, putting out a newsletter and submitting articles. I tuned into my feelings and gut knowingness, which brought me to one publishing experience to another. 

3. Tell me about your books and resources on compassion fatigue.

I will go through the main three publications I have.

I wrote and published, I Fill My Cup: A Journal for Compassionate Helpers. I wanted to give my clients and other helpers who may not be into therapy, a tool to manage their personal energy. I filled it with helpful suggestions, writing prompts and space for the helper to journal their inner thoughts, feelings and observations. I wrote and NetCE published, Setting Ethical Limits for Caring and Competent Professionals. This is a continuing education course for counselors, although many other professions could find benefit in the information presented as well. I wanted to educate helping professionals on how to provide compassionate care ethically to those they serve without causing burnout. 

On my web site, I offer a free 10 page e-book called, Why Compassionate People Run Out of Energy and What You Can Do About It. In it, I discuss compassion fatigue, burnout and vicarious traumatization. This is a small introduction to these topics. Also, helpers can receive my free monthly newsletter when they receive this which is filled with tips for empathic helpers. You can find this here at http://www.lisahutchison.net at the top of the page. 

4. What can we, the helpers, do to take care of ourselves when it seems like “difficult times” are never-ending?

The most important thing helpers can do for themselves is to listen within and acknowledge whatever you are feeling. Reach out and find supports who can hold the space for your inner exploration and expression. This can be a friend, coworker, psychotherapist or coach. Find someone who gives you the tools to follow your own gut knowingness. Other people may prefer to connect to their intuition on their own and write out what they are feeling. 5. Tell me a bit about your Archangels course – what is this, and who can it help?

I am currently running a seven week Archangels course that is delivered to your email inbox. Once a week, you receive a video, which tells you about how a specific Archangel can help you, being an empathic helper. In these emails, I describe how you can connect to each angel by their unique signifiers, different exercises to connect with them, writing prompts, prayers and affirmations. I also offer 3 live zoom angel card readings for the class as a whole. This is for the empathic helper, who connects with spirituality, to rejuvenate, protect and restore their depleted energy. I created this to be self-paced because I know how busy we can get. There are times at night or during the weekend, you could listen to the video, do a writing exercise, practice affirmations, or speak the prayers and intentions.     

6. What other upcoming projects do you have going on right now?

I currently offer virtual psychotherapy, spiritual coaching sessions and angel card readings. In addition, I help others with developing creative writing skills through sessions and classes. I am writing a new continuing education course for NetCE for counselors. I also am in the process of writing another book, this time on spiritual manifestation and psychology.

Autism Database Updates

If you’re new around here, you might want to get caught up: here’s my letter to the North Dakota psychology board about the Health Department’s mandatory autism database, and here’s information about other states that have mandatory databases as well as steps YOU can take to protest them.

Infinity by Kuba Bożanowski

I was able to get a hold of someone at the North Dakota Psychological Association and learned that not a single mental health professional was consulted in creating the database, and everyone in the association spoke against it at the time. They shared serious concerns about privacy, eugenics, and ethics. And the government, which supposedly exists to serve the people and defend our rights, went ahead and passed the law anyway.

NDPA is in favor of me pushing back on this, but it sounds like they ran out of options at the time. I have reached out to the North Dakota chapter of the ACLU and am awaiting a response, since it sounds like this law would not hold up if challenged in court, but that requires someone to challenge it in court.

One rationale for the database is that it is modeled after a similar (equally unethical and terrible) database in New Jersey. Now, I have focused my energy on North Dakota because I’m licensed there and feel like I would have more pull as a provider, but I wonder if it would be more effective to focus nationally – if we could fight all the databases at once, that would be such a win.

Is this something the national ACLU chapter would take on? I’m figuring it out. Are you a provider who wants to push back on these laws? Are you not a provider but pissed off and wants to help? Let me know! Let’s do this together!

Some Thoughts on Mindfulness

Mindfulness,” in psychology, refers to activities and practices intended to bring your attention and awareness into the present moment. The aim is to be aware of your body, mind, and surroundings without judgment.

It is also a term that has been thrown around to the point that much of the original meaning has gotten lost. Employers promoting “wellness initiatives” (which is boss-speak for “don’t say we never did anything for you”) promote it as an antidote to burnout, and the “Wellness Industry” sells it as a cure-all for your mental health woes.

Photo by Monstera on Pexels.com

Misuse of “mindfulness” has gotten to the point that therapists are sometimes cautious about using the word. “Have you tried mindfulness?” has a similar feel to “Have you tried meditating?” or “Have you tried going outside?” It gets sold as a magical cure-all, which does a disservice to clients who might actually benefit from some mindfulness practices.

There are many valid circumstances in which a person might not want to be more in tune with their situation. If you experience chronic pain, mental health issues, or are, say, living through a pandemic, you might not enjoy becoming more in tune with the present moment. That is why mindfulness by itself is not only unhelpful, but can actually be harmful to bring yourself more into the present without any follow up or support to cope with that present moment.

In my practice, mindfulness exercises are just a first step. It’s a way to gather data that can help us tease out what needs and supports would be beneficial. It can help trauma survivors notice their triggers, or those who struggle with regulation start to notice a feeling before it gets too big to manage. It can help children learn what different emotions feel like so they can communicate effectively.

For some, mindfulness activities can be helpful on their own. Bringing awareness to the present moment can pull someone out of a flashback or help with reality testing. But most of the time, it is a starting point.

If you find mindfulness activities helpful, great! If not, that is okay too – no one solution is right for everyone. But if it has been presented to you as a cure-all, this is an oversimplification that does a disservice to anyone who might benefit from being more present and attentive to themselves.

Interview with Kevin Gruzewski, Recreation Therapy Consultant

Kevin Gruzewski is a recreation therapist who has worked with developmentally disabled adults as well as teenagers in the criminal justice system. I connected with Kevin through Amazon of all places! I was looking up my telehealth book, and under “Frequently bought together,” Amazon recommended Kevin’s book, Therapy Games for Teens: 150 Activities to Improve Self-Esteem, Communication, and Coping Skills. I figured, if some of my readers like Kevin’s books, I should let the rest of you know about him.

Recreation therapy is “a systematic process that utilizes recreation and other activity-based interventions to address the assessed need of individuals … as a means to psychological and physical health, recovery, and well-being” (NCTRC). Recreation therapy often refers to outdoor activities, like athletic games and outdoor physical activities, but it can also include creative and artistic activities, animal assisted therapy, and mindfulness or meditation activities. If outdoor activities are not an option in your practice, the book still has many resources that you can implement with your clients.

Recreation therapy can be great for building rapport, especially with clients who might not be thrilled about coming for therapy. It incorporates activities that make therapy enjoyable and often does not look like “traditional” talk therapy. The movement activities that recreation therapy incorporates can be particularly helpful for those struggling with trauma.

Therapy Games for Teens

Who doesn’t need more options in their toolbox for therapeutic interventions? Kevin’s book gives detailed instructions for implementing activities for a variety of presenting concerns. You can follow the instructions easily, but you can also customize the interventions based on the client’s unique needs, interests, and preferences. It is a great addition to any therapist’s library, especially those working with teenagers.

Kevin’s book came about from his blog, where he wrote about recreation therapy and shared resources for other therapists doing recreation therapy. (Sound familiar?) His website has some great resources and activities for therapists who want to make their therapy sessions more engaging and fun for clients. If you are looking for some free suggestions for your practice, check his blog out!

Currently, Kevin writes full time and is available for freelance work.

The Weekly Mews with Armani

Happy Caturday, friends! Armani is so happy it’s the weekend (though for him, every day is kind of a weekend since he doesn’t have a job).

Kitty on the floor

Armani has been less fond of being left alone lately, though when we come through the door he likes to pretend he didn’t realize we were gone. Vera runs to greet us and find out where we’ve been, but Armani stays on top of his scratching post like, “Oh, I forgot you even existed.”

But as soon as we settle in, he clings like he was abandoned. Poor guy. I guess I will have to keep working from home forever.

Kitty on the lap

No updates on Armani’s health at this time – we are still doing the low insulin dose and the special diet, which seems to be really helping him live his best life. He can currently climb everything he wants to sit on, and we are so proud of him.

Clinical Documentation in Therapy

Today’s guest blogger comes highly recommended by Armani. Sarah Isaacs (aka @Sheologian) is an excellent therapist and personal friend. Earlier this week, in the midst of coverage of a particular harassment case, news broke that the victim’s therapist had turned therapy notes over to her university. The university showed her private therapy notes to her abuser.

Outside of what is required in collecting payment and compliance with mandated reporting laws, what happens in your therapy sessions is supposed to remain confidential. There are circumstances where a therapist can be forced to turn over records. I do not know if this was the case or if the therapist could have done more to protect their client. I do know that I have been in situations where a judge ordered me to turn something over, and my choices were 1) listen to the judge, or 2) go to jail.

Sarah has a system to keep her notes legally and ethically compliant while doing the maximum to ensure her clients’ privacy is maintained. She was kind enough to share some tips.

Photo by Tirachard Kumtanom on Pexels.com

Documentation is a huge part of our jobs as mental health providers. We write treatment plans, case conceptualizations, coordinate with other care providers/do case management, talk through issues and stuck points with our supervisors, and also maintain the file for our clients in a timely manner.

The official record is a very sensitive document. It is to be treated with the utmost care and there are rules for its contents, availability, and storage which each mental health professional learns in their very first semester of their education. In my ethics class, we talked about notes and confidentiality for weeks.

The most important thing to understand about the file is that it is the property of the client. They may ask to see it at any time, and it should be provided to them. It might take a few days to present it to them depending on your EHR and style of documentation (it would take longer if you, for example, still use paper charting as opposed to being able to download it with a click).

There are some who believe that sharing notes with the client can be harmful and in that instance the therapist does have the right to obfuscate or keep portions of the notes back. I philosophically do not believe in this myself. The client/therapist relationship is not meant to be a hierarchical one but a collaborative one, and whatever is said about them should be known by them. Otherwise it is a relationship where the therapist is doing to, not doing with.

There are two types of notes in mental health – progress notes and process notes. Progress notes are required, official, and in the record. These are the notes that could be subpoenaed at some point, and the notes that the client is able to see at any time. If you work with insurance companies, this is the note that they require. This note includes: date of service, time of service, mood/affect of client, whether or not there was any suicidal ideation, what interventions were used, an update on progress towards treatment goals, and next steps. That sounds like a lot, but it really doesn’t have to be long at all.

Brevity and ambiguity of notes is a way I protect my clients. Even if I received a subpoena signed by a judge (the only type of records request from anyone other than my client that I would ever respond to) and my lawyer that is part of my liability coverage determined I must turn them over, what they would receive from me would be completely unhelpful on purpose.

You always document assuming that someday your records will be read on the stand in a court of law. All of us will be subpoenaed at some point in our career, and some of us may ultimately have to provide the requested documentation. If you write your notes the way that I do, your client’s privacy will remain intact.

Here is the basic progress note, with very little deviation, that I write in the file:

Met with client on date/time
Client was on time for therapy.
Explored, confronted, clarified, and interpreted client’s thoughts and feelings
Mood was euthymic, affect was appropriate, and suicidal ideation was absent
Progress towards therapeutic goals is ongoing
Next session is scheduled for (date/time)

Even if I provided three years’ worth of progress notes, my client would have nothing revealed about them.

Part of your informed consent should be about your documentation. I go over this being my method as part of the confidentiality and exceptions thereof in our first meeting. I emphasize that at any time they are free to ask to see my notes as it is their record.

You may or may not take little notes for yourself (process notes). Unlike progress notes, there is no requirement to do so. I typically jot down names of partners or people important in their lives and things like that. While a lawyer may request these, as they are not part of the official record they will only in the rarest of circumstances win and force your hand. For myself, once I have written it down I remember it, and I could (and likely should) burn or shred all of my process notes so that none exist.

Though they are not part of the official record you of course must store these – if they exist – with the same care as the official notes.

For my ethical obligations, that means an additional lock behind a locked door. For extra safety, none of my process notes have the name or identifying info of the clients, and I choose to never type them even in an offline document.

The things shared in therapy are to be assumed private at all costs. If ever you get a records request not signed by a judge, you may choose to respond or not. I don’t. I will only respond to a subpoena signed by a judge and only after calling the lawyers that are available to me who specialize in this.

I am thankful not only for my clients who trust me with their stories but also my internship supervisor who would return to me any progress note over 100 words and make me redo it, shorter. I was taught well, and I hope this information is helpful to someone else. 

How Vera Says “I Love You”

This post is inspired by all the kids I’ve met who do not show affection in a “traditional” way. I hope their parents can see and accept the way their children say “I love you” even if it is not the way they are used to.

Remember Vera, the cat who gets scared by strange things and has a special sensory corner in my house? The other day, I noticed something else that Vera does a little bit differently than the rest of our family.

When Armani, my husband, and I all snuggle up together on the couch, Vera prefers to sit in the chair across the room. She might smile at us, but she does not want to join the family cuddle.

Vera in her chair

When I’m working in my office, Vera comes in, lays on the guest bed, and watches me, but she does not crawl into my lap. She does not like being picked up, and if you pet her when she has not specifically asked you to, you might get nipped.

You might think that Vera is not a very friendly cat. But when I am under my blanket at night, she curls up on my back and purrs. When I come home after being away all day, she is often sleeping on one of my sweatshirts where she can get my scent all over her.

Vera snuggling my shirt

When Vera is ready to receive pets, she will nudge my hands with her little nose until I give her all the pets and scratches she wants.

Vera doesn’t say “I love you” the same way that the rest of our family does, but she says it in her own way. Maybe the way you say “I love you” is different from the rest of your family. That’s okay! I hope that they can learn to hear your “I love yous” and accept affection in the way that feels safe and comfortable to you.

Autism Databases

Last week, I shared my concerns about North Dakota’s mandatory autism database. If you missed it, check out that post and please help us report this unethical law to the Department of Justice.

Photo by Steve Johnson on Pexels.com

As I said in the post, I sent my letter to the North Dakota Board, Health Department, and Governor’s office. I later also contacted the North Dakota Psychological Association. The Board confirmed receipt of the letter but has not followed up with any action they are taking or feedback about how I am expected to follow this law and the ethics code at the same time.

I also tagged the American Psychological Association, American Counselors’ Association, and the National Association of Social Workers. I forwarded my letter to APA’s legal department. As I am writing this, I have not heard back from most of them. (Cue an image of the man from Caddyshack saying, “Well? We’re WAITING.”)

The American Psychological Association said they will “look into it” in response to one of my tweets. I asked them to keep me updated. Now, we wait (again).

The Governor’s office did get back to me, and they gave me the name and contact information of the individual in charge of overseeing the database, as well as information about the next legislative cycle (beginning January 2023) when I can request that the state legislature consider repealing this law. I have reached out Kodi Pinks, to the person in charge of the database. I have also told the Governor’s office that I am not able to ethically conduct autism evaluations in North Dakota until this is addressed.

Kodi responded to me and said that they are working on reducing how much data will be collected, and they are forming an advisory council to decide what this should look like. I volunteered to be part of that council – we will see if they are open to the extremely pushy woman being further involved in these decisions.

Change is a marathon, not a sprint. I am not known for my tendency to let things go. I can keep yelling about this for as long as I need to, and I encourage you to yell with me.

You know how you see a light come on in your car and take it to the mechanic for what you think will be a simple fix, and it turns out your entire engine was about to implode? It was brought to my attention that North Dakota is not the only state with a mandatory autism registry. I have not had the time to deep-dive each state’s specific laws, but they seem to vary in how much personal information is required. I for one feel like the only appropriate amount of personal information for the government to require from providers is zero.

If you are a psychologist, clinical social worker, counselor, therapist, et cetera, in the following states, YOUR state has an autism database:

  • Delaware
  • Indiana
  • New Hampshire
  • New Jersey
  • Rhode Island
  • Utah
  • West Virginia

You CANNOT ethically practice if you are legally required to report client information to the government based on the client’s diagnosis.

I am told that other states have “voluntary” databases, which I still find problematic, but I am first focusing my efforts on states that require providers to register autistic clients.

I can report each state’s law to the Department of Justice, and I can make noise about all of these states, but that will only go so far. I ask that anyone reading who is licensed to practice in one of these states demand that their licensing board and state organizations lobby to get rid of these registries. If you are not licensed in one of these states, you can still report them to the DOJ demanding they investigate the laws as unethical.

You can use my letter as a template. Copy and paste the parts that fit your needs, and just switch out anything that doesn’t (for example, if you aren’t bound by the APA ethics code, replace my quotes with quotes from your own code).

We have a duty to our clients and our field to demand that these laws be changed. Thank you to everyone who has sent words of encouragement and has already let their voices be heard on this issue.

Therapist Seeking Therapist

Good therapists have therapists. They don’t necessarily have a standing weekly appointment until forever, but between addressing how their value biases impact their interactions with clients, getting treated for their own mental health diagnoses (a LOT of therapists have at least one mental health diagnosis, even if we don’t feel safe disclosing it), and managing our extremely high-stress jobs, we often benefit from our own treatment. Plus, willingness to receive our own treatment helps reduce stigma about mental health.

But it can be hard to find a therapist who works with other therapists. It’s kind of like how they say medical doctors are the worst patients to have in hospitals – there are unique challenges to doing therapy with another therapist. When I step into a therapy room, my brain automatically goes into “work mode,” and I need someone who can help pull me out of that space and actually have a session for myself.

It is hard to find a therapist who specializes in your symptoms, is a good fit for you personality-wise, and takes your form of payment. That’s why therapist directories exist. But some directories have accepted kickbacks from certain online therapy providers known for some pretty serious ethical violations.

Jeff Guenther, the creator of Therapy Den was offered such kickbacks and not only refused to accept them, but created a series of TikTok videos about the practice.

I reached out to Jeff via Twitter with my issue, and he immediately (like less than an hour later) added “Therapists Who Treat Other Therapists” as a specialty over at Therapy Den! Granted, as I’m writing this, not many therapists had changed their profiles to reflect this specialty, but I love that it is available and am sure options will be available soon!

Therapy Den search feature: Therapists Who Treat Other Therapists

So if you’re a therapist looking for your own therapist, head over to Therapy Den. And if you’re anyone else looking for a therapist, head over there also because you can search by your specific issue, zip code, and method of payment through a directory that didn’t compromise its morals for money.

Updated PCIO Files Walkthrough

As you probably know, I use the PlayingCards.IO platform to play many telehealth games with my clients. They have made some updates to their website, so I have made a new walkthrough for how to use these games, with a special guest appearance by Armani. (If you’re looking for more telehealth games to play with your clients, check out my Teachers Pay Teachers store!)

Also – if you are having trouble with a game you have purchased from my store, please let me know. I am happy to talk you through any troubleshooting, and I want these activities to be as useful to you as possible.

Walkthrough video

PS: If you liked the WorkRobe I’m wearing in the video, use discount code DRAMYMARSCHALL15 and get 15% off your order with this link!

Happy telehealth-ing!