303: Are You Practicing the Way You Actually Want to Practice? With Shane Birkel

Shane Birkel (0:00)

I was really surprised with how many people were excited by the idea that they could come in and do a longer session.

SPEAKER_2 (0:10)

Welcome to The Couples Therapist Couch, the podcast for couples therapists, marriage counselors, and relationship coaches to explore the practice of couples therapy. And now, your host, Shane Birkel.

Shane Birkel (0:27)

Hey, everybody, welcome back to The Couples Therapist Couch. This is Shane Birkel, and this is the podcast that's all about the practice of couples therapy. Thank you so much for tuning in. I'm a licensed marriage and family therapist, and the goal of this podcast is to help you learn how to more effectively work with couples and possibly even learn how to have a better relationship. The episode this week is brought to you by Alma. They make it easy to get credentialed with major insurance plans at enhanced reimbursement rates. Alma handles all of the paperwork and guarantees payment within two weeks. Visit helloalma.com or click on the link in the show notes to learn more. On Friday, I did a live training, the live webinar. Many of you may have got the messages about that on couples therapy intensives. I want to thank everyone who joined. It was really awesome. And I got to connect with people through the chat and things like that. But afterward, I went back through and I want to look at the questions people asked and something stood out. Most of them weren't really about whether longer sessions can work because, and I started thinking about that, I think like when you've worked with couples before, you understand that having more time is a good idea.

And so, you know, I don't even think that I need to spend a lot of time, usually, justifying the idea that this is going to be a helpful thing.

There were questions like, what would I do for that long? Or how would I charge for it? Or, you know, how do I fit this into my week? Or am I trained enough? It got me thinking about a bigger question and one that isn't really about intensives at all. But how much of the way we practice is based on what we believe is most helpful? And how much is based on the way we learn therapy is supposed to look? So that's what I'm going to talk about today. And, you know, I think, you know, we all go to grad school, we all get our hours. We have political systems that are involved in deciding that it should be a 50-minute therapy session or something like that. I think a lot of times it's set up this way to help politicians and insurance companies and entities like that to develop plans where they can say, okay, if you have anxiety, then you need 12 sessions every week for 50 minutes. And there's like a clear prescription. And that's just not the way humans work. There's so many different situations. And as therapists, you all know this. I'm probably preaching to the choir. But none of this is bad necessarily.

A lot of healing happens inside the 50-minute structure. But most of us work that way. I still work that way a lot of the time. But I think we need to start thinking a little bit more outside the box, or at least I want to take this podcast episode to take a moment to take a step back and think more outside the box.

Just because the picture looks consistent, a session is 50 minutes. It happens once a week, often at the same time every week. You charge by the session. You build a caseload of a certain size.

All of these things. And again, that's probably how most of us are going to work most of our lives, and that's fine. But just for the sake of not staying stuck in a certain type of mindset, I'm trying to open up a bigger conversation. Because somewhere along the way, a lot of us stopped asking, what is the most helpful way to work with this particular person or this particular couple in what they need as an individual? Right? And we start asking, how do I fit this person into the way therapy works? Or fit this couple into the way therapy works? And those are different questions, and they can lead to different answers.

And Couples Therapy in particular, I think, is where it jumps out to me that this is a situation that is worth looking at. And a lot of you know the setup. A couple comes in, activated, maybe they just had a fight as they were coming into the office, and you spend the first part of this session figuring out what happened. You slow things down, you help them feel safe, safe enough to actually talk. And finally, something real comes up, something underneath the argument that's going to create a significant change for their life. And you look at the clock, and there's only three minutes left.