The Practice of Therapy

Gordon Brewer 0:00
This episode is brought to you by blueprint health. Blueprint health is a measurement based care platform for mental health providers. You can find out more about them by going to practice of therapy.com/blueprint health. And also this episode is brought to you by therapy notes therapy notes.com, the leading electronic health record system for mental health providers in private practice there who I use in my practice, check them out at practice of therapy.com/therapy notes.

This is the practice of therapy podcast with Gordon Brewer, helping you to navigate your private practice journey.

This is the practice of therapy podcast and you're listening to episode number 206 of the podcast Welcome everyone. Hope you're having a good week or weekend, wherever you might be listening to this. And if this is your first time joining us for the podcast, glad you found us glad you're here. And hope you'll take time to follow us on subscribe to us wherever you might be listening to your podcasts. So I'm really excited for this, this episode because I think it's a topic that we we throw around a little bit but I've run into a person, Kathleen Shannon, who has got a real passion for just talking about licensure portability. And it's something that we run into, particularly for those of us that might move around or be changing states or want to be licensed in multiple states. And I think this particular issue of licensure portability, came up a lot through the whole COVID pandemic and that we were recognizing that as we move to telehealth, and a lot of people were finding out that, okay, we can do do a good job working with people through telehealth, and then you just run into the hall the nuance of the people living in different states and being being a practitioner in different states, and how that works and how all of that plays out. So Kathleen has really tackled this topic. And so we have a conversation about this. And I think you'll find it pretty interesting just to listen to I know, one of the things that just kind of as a side note here where I live in Tennessee, one of the things that we're running into, and I saw a post today on Facebook through the Tennessee Marriage and Family Therapy Association, when Facebook page that there is a huge backlog of people getting licensed within the state of Tennessee, they just don't have the staff at the state level to process all the applications they had like, yeah, of course. Yeah, like like a lot of states, Tennessee has a combined board. So the profession LPCs. And marriage and family therapists and also Clinical Pastoral characters. Pin, clinical pastoral counselors, and also podiatrist are all under the same board. And so are the under the same administrator. And so they have like a backlog of over 400 applications within the state of Tennessee. And so people are just having trouble getting licensed for that reason. So anyway, not to get too far off on a tangent with that. And looking forward to hearing my conversation with Kathleen as we talk about this particular topic. But before we get to Kathleen, I'd love for you to think about next year. And so here's where I'm going with this. One of the things that I have learned in the time that I've been in private practice is the importance of having groups of colleagues that I can bounce things off of and also just have a listening ear, and also just being able to learn from them as far as ideas and really struggles within private practice and that sort of thing. And one of the best ways to do that is in the context of a mastermind group, or focus group. I like to call it a focus group, rather than a mastermind group. But I've got one starting in January of 2022. And I'd love for you to apply to that and find out more about that. And if you'll go to practice of therapy.com/focus group, you can learn more about that. I was going to start one in November of 2021. But my timing wasn't great on that, because I think we were all headed towards the holiday season. But I know as this episode is coming out, we're in the middle of the holiday season. But I'd like to invite you to maybe think about joining my focus group that's going to be starting in January,

again, is going to be a great way for you to just get feedback and consulting and all that sort of thing with me in a group setting. So again, go to practice of therapy.com/focus Group to find out more about that. And also, before we get to my conversation with Kathleen, I'd love for you to hear from more about our sponsors of the podcast, and that is blueprint health, and you can find out more about them by going to practice of therapy.com/blueprint health, and also therapy notes. therapy notes is the leading electronic health record system for mental health providers here in the United States, and they're who I use in my practice, so want you to hear more about them. You know, as your practice grows, the systems and processes you have in place will keep your practice running smoothly. That's why it's important to have an electronic health record system that is specific to mental health providers. therapy notes is a complete practice management system. With everything you need to manage patient records, schedule appointments, meet with patients remotely, create rich documentation, and bill insurance all right at your fingertips. Their streamlined software is accessible, wherever and whenever you need it. There are who I use in my practice. And then I mentioned that they are one of the top rated EHRs for mental health providers. Their support is also second to none. So be sure to check them out at practice of therapy.com/therapy notes. And be sure to use the promo code Gordon just gr do in and you can try them out for two months for free. That's therapy notes.com. And this episode is also brought to you by blueprint health. You know one of the best ways to serve clients in your practice is through measurement based outcomes. In fact, more and more third party payers, aka insurance companies are demanding measurable outcomes. And with more and more emphasis on good mental health. Having a way to measure your outcomes just make sense. Introducing blueprint, the measurement based care platform that administers scores and charts, hundreds of symptom rating scales to give clinicians deeper insights into treatment progress, ultimately, by helping helping behavioral health providers to grow top line, practice revenue, increased clinician satisfaction, and deliver more effective care. So be sure and check them out by going to practice of therapy.com/blueprint health. And by going to that URL, you can also get your first month free. Again, that's practice of therapy.com/blueprint health.

Hello, everyone, and welcome again to the podcast. And I'm so excited for you to get to know Kathleen Shannon Kathleen, welcome. Thank you. Yes. And so Kathleen and our kind of catching up before we started recording just on some of the common common connections that we have. Just to some degree is kind of a southern thing you kind of figure out who you know and who you have in common but Kathleen is located in a Black Mountain, North Carolina, which is just across the mountain for me, but Kathleen has a start with everyone. Why don't you tell folks a little bit about your private practice journey and how you've landed where you've landed.

Kathleen Shannon 9:48
So how I ended up where I did well been in private practice partially for about 21 years. I either was working for an agency or for another group practice, while I was building my private practice, I had a private practice out in Washington State. And then about eight years ago, I realized, you know, you really can't take me out of the south. So I came back here and set up my practice here, in addition to working for the Department of Veterans Affairs, and officially three years and some change ago, I decided, You know what, I just need to go full time, private practice, nothing, nothing else. So that's how I ended up here.

Gordon Brewer 10:33
Yes, yes. So yeah, I love I love hearing people's stories just about just kind of their journey and all of this, what sort of what sort of specialties do you kind of have or a niche? Do you kind of identify with,

Kathleen Shannon 10:48
um, I am, I primarily use a lot of neuro linguistic programming, as well as hypnosis. I specialize in treating anxiety, depression and sleep problems with a special special interest in people who have survived religious trauma.

Gordon Brewer 11:06
Right, right. And we were just kind of talking about some kind of faith, faith based or faith, things that we held in common in terms of our both of us are connected to the Episcopal Church. So I thought that was, that was pretty cool, just to kind of chat about but one of the things that I know for you, Kathleen, that you've gotten real interested in, and this is really kind of how we got connected through our friend, David Hall. And that was just around. licensure, portability, and just some of the problems people are running into is here, dare I say, post COVID. But we don't know for sure. But just people moving around more and moving to different parts of the country, and all of the things that came up for you and your practice around that.

Kathleen Shannon 12:00
It was, it was pretty, it was kind of scary, really, to be honest. Even though I got my degree in Florida, pretty much when I walked across and got the degree, we were on our way to Washington State. So even though I got my degree in Florida, to make sure that I met licensure requirements in Washington State, well, the thing is, they didn't even have any solid licensure requirements for all the states until 2009. Really. So if we had we had something, you could be a registered counselor in Washington, and you didn't even need a degree. I mean, really, my cat could have been a counselor really there for what it was. So when I got licensure, and then I came out here and COVID hit. And because I work with a lot of people who are either elderly, or I work with a lot of college students, both of those populations either had to go live with family, because school closed down, or they got to be older, and family was like, Mom, we can't have you staying out there, we need to make sure that you're taking care of so then they would move out of state to wherever they were. And some states for you know, if you can get this done in a few minutes, then it's okay. And you can get temporary license. And I thought to myself, no, no, let me just go ahead and get actual real licensure in the States. Well, that ended up turning into some sort of crazy situation, because I was like, so wait a minute, my degree is a core degree, not a cake grip degree I graduated 21 years ago, taker hadn't really gotten as much leeway, or headroom, I should say, probably a better term in the in the whole academic world until around 2009 to 2016. That's when they really kind of clamped down and made sure things happened. But, you know, I'm sitting here going, but I didn't need this out there. And this is well, I'm sorry, it's it stinks. But you're going to have to go back to grad school and I'm going, you've got to be kidding me. I've been doing this for you know, 1819 years at that point, you know, well, no, it was 20 years, because it was last year. And I was like, This is crazy. This is not so I was like, You know what, I need to go find out what, what are the commonalities that you need in every single state, in order to be able to have licensure in terms of a person who's been licensed for over five years. And I found that there were five things that you needed in each and every state, you make sure you got a lot of money, because each state wants a lot of money. By the time I added up, if I wanted to be licensed in every state and jurisdiction, it was like over $13,000 Wow, that's just insane. And then you know, you got some or every two years that you have to renew and then you've got some every years and every three years, you know, June 30 of odd years. I'm sitting There has got to be a better way. But I wrote it all down, got it all together. So as long as you got a lot of money, you can be licensed in every state. And if you're incredibly organized, and can make sure you get yourself renewed by that date, and let me tell you, I was, I was not smart, I allowed my Washington state license to lapse. In order for me to just kind of live, it's like, it's gonna be 100. And some dollars is like less than 100. Some dollars, I'm not even there. I don't even care. That was unwise, because now it's going to cost me like $191 to go renew, because I've got late fees and penalties. It's going to cost me more to renew than it would to get a fresh one. And so I was like, alright, that's kind of nutty. Exam, is this exam going to be good enough for every state? No, I have got for like Tennessee, I have to take not only the NC, but the NC MHC in order to be able to diagnose and do insurance and all that interesting stuff. So I decided I'd go take that exam thinking, well, at least we get the exams out of the way. Oh, my word. That was a hard exam. And I didn't pass and I'm like, Well, I gotta go with then it has to be three months until you can take it again, I'm like, Well, this is my got to figure out what I'm going to do. And then transcripts, I got to get it sent from here from their application, some were only online, some are only paper. And then of course, sending a copy of your license to wherever you need to send it to. Now, some states are going to say, Oh, you want us to send a copy of your license, that'll be $30.

Now, if every state did that, that would be $1,500, just to send a copy of a license that you can google. Right? So yeah, this can be kind of complex. And I just decided I need to have a one stop shop, because I can't be the only one having problems with this. And people started calling me and they said, What do I need for Tennessee? What do I need for Oregon? What do I need for Hawaii? What do I need for Puerto Rico? When I was like, Well, are you going to physically live in Puerto Rico? Well, no, I just need to get licensed there. I said, Nope, they're not going to give you one unless your body is there. So yeah.

Gordon Brewer 17:11
Wow, wow. And I know that you've been really just kind of collecting all this data and that sort of thing. So what what would you say that people that are looking at getting licensed in other states? What would be kind of the process? You would kind of guide them on with that? I mean, you know, I think there's, there would be a lot of compelling reasons to think about which state you'd want to be licensed in. So well, how would you approach that?

Kathleen Shannon 17:40
First thing is go ahead and take every single solitary exam, take the NC take the Nac Nac whether the state needs it or not. Because when you have both all states will accept it. So just go ahead and have them underneath your belt. Now here's the deal, the second you get the second one, go ahead and apply for licensure in Oregon, because you have to actually have taken that license licensure exam within the last 10 years. All the others don't care if you took 25 years ago. But just get both, like get both exams out of the way. And just that's the number one thing and figure out in terms of where do you really want to focus? Do you want to just stay in one time zone? Do you want to have the luxury of actually offering decent times to other people in other time zones, where you get to have a more free time during that time and your time zone? So it's just something to really consider but definitely at the first thing, take both exams, whether you need them or not. Because eventually you will.

Gordon Brewer 18:53
You're right, right. What would be next, at least in your mind, the things that a person should be prepared for when thinking about getting licensed in other states.

Kathleen Shannon 19:06
KCUR versus non CACREP degrees. So you would have to go get the list of either go to cake rip.org. Or you could go to their actual applications. And they say if it isn't cake rip most of them are okay, with if you can justify that you have taken courses that cover these areas. They're good. Some states like Tennessee, one course can cover two areas, which is good. Yeah, but some states are you can only have one for one, which is kind of I mean, for those of us who have degrees that are decades old, you know, we had pretty comprehensive things in each of our classes that overlapped by a fair bit. So just make sure that you look at your transcript and you go ahead and make sure that all the areas are covered in the event that you don't have a cakewalk degree. So make sure that you keep a copy of your syllabi, I've hermetically sealed somewhere fire safe, water safe and all that other stuff, because they just think it. I remember them telling me that in graduate school and I was like, that sounds odd, but I'll do that. And I've, I've kept all the paper copies for 20 Some years and troll them back and forth across the country a number of times. Not. I mean, it's Lord knows what all animals have walked across them.

Gordon Brewer 20:25
Right, right. Yeah, yeah, you are putting together a course, that should be ready around the first of the year, you want to say some more about that?

Kathleen Shannon 20:36
Yeah, there's going to be two different courses, there's going to be a course for graduate students who are looking for initial licensure. And for most states, it's either an associate or an intern or some whatever term that they have for it, it's not you're not fully independently licensed at that point. So that you can go ahead and find out what that state would need in terms of your obtaining licensure. Let's just say you're in an online program in Virginia, and you actually live in Georgia. So to be able to find out what Georgia would need versus what Virginia would need, even though the course was in Virginia. That's one, one course. And the other course is going to be available to people who've been licensed for more than five years, on how to either transfer or obtain additional licensure based on endorsement, meaning you have not the fortunate thing with Tennessee is that you have reciprocity with Kentucky. So that's a good thing. No other states really have that. But as far as being able to go from one to another with endorsement, as long as you've been licensed for five years, it's usually not that difficult to go ahead and get licensed in a different state. So there's gonna be two different tracks, one for the freshly graduated and going to get associate or intern licensure. And then the one for has been licensed for a number of years. I'm also considering having a group coaching program, for those who did not graduate from a cake or program on how to get licensed because that's going to be a special ball of wax. And it would be easier to actually sit down with people and say, Okay, these are the areas that you're going to need to cover.

Gordon Brewer 22:21
Yeah. And so, again, kind of going back to what we talked about a little bit at the beginning, kind of what was your mindset around trying to get licensed in all the states? Because

Kathleen Shannon 22:32
I just wanted, my mindset was only I need to be able to be there for my clients. I can't just go say, Well, go look on psychology today and go find somebody where you are. I needed to be able to at least for a minute, say Okay, let's keep up there. Who have you found out there that looks like they might be reasonable that you may take your insurance, because now you're out there or whatever. But I needed to be able to provide continuity of care. That was my only reason for actually even starting this thing, because I was, I hate to say it, I was selfish, that I needed to know for my own ethical backside that I was like I can't afford. That's just not you can't do that.

Gordon Brewer 23:12
One of the things that I've heard about recently is that some states and I think Florida is one is is that you can get kind of a special permission from their board to practice in their state with an out of state license. What else what other states have you run across that have kind of have that arrangement where you can get, I guess that permission

Kathleen Shannon 23:38
to telehealth thing with Florida? Yeah, the Florida telehealth one is relatively inexpensive until it's not. I think it's like 10 $20 you can get new pay for it every year. So there are so many stipulations around that that it is just not even worth the while. Part one is that when you have that you still have to have a registered agent in the state of Florida. In case you get some sort of whatever they have going on there and trying to follow the the whole rubric on what qualifies as a registered agent why you need one where to find one they have a list of them that you know that i Last I checked there were well over 700 You could choose among well then why are they all charging different fees and what's going on here and what's going on there and I thought to myself, and if you have this telehealth thing, you can not have a brick and mortar place in Florida. Also you can't let's just say you're going down to you know vacation in Florida. You cannot operate your telehealth license while on vacation in Florida to a person in Florida. And I just kind of thought to myself, I don't need this if then if then if then let's just get a legitimate straight up license with all the requirements because I thought that would be a whole lot easier. What if I want to retire to Florida? Which, by the way, Florida in 2025, you're gonna have to have a straight up Cakewalk degree, they're not even gonna look at anything else. But there that's going to be in effect in 2025.

Gordon Brewer 25:13
Right, right. Yeah. Well, it's, you know, I know one thing is, is that in my conversations with people across the, across the country, this whole licensure portability problem is hopefully, we're getting some more and more conversations, I think, with this, as we're coming out of the COVID pandemic, and all of that, just the focus on mental health has been much greater than it has been in the past. And I think maybe one silver lining to a lot of it is that there's less stigma around people seeking help for mental health issues, and, and, you know, just getting getting the help that they need. But I think it's, it's kind of hopefully kind of forced a lot of states to be more consistent with getting some consistency across the board with being able to have true reciprocity with licensure and, and that sort of thing, because I think, yeah, it's just the, the need is there.

Kathleen Shannon 26:21
It is, there it is that they have the counselor compact, that they're still chatting about that. They're trying to hopefully have something by July of next year. I don't know if they're going to have anything by that time, they have to get I think 10 states involved and everybody, but then it's only among those 10 states. So I'm just sitting there thinking I appreciate what you're trying to do. And I know trying to talk to 56 people who's gonna be representative of each state and jurisdiction. I mean, trying to get 10 people on a phone call is a act of God, much less that. So I just, I think in the process of trying to be helpful, it just got to be overwhelming for so many. I mean, we don't even have the same acronym in every state, because some people want LPC LPCC, LCPC lmhc lc MH, I'm just sitting here going, dear lord. Yeah, I've often thought to myself, why don't we just get a psychotherapy degree and be blessed with the wonderful blend of marriage and family therapy? With the wonderful notions and social work and Counseling and Psychology? Why not have some anthropology in there have a little bit of you know, religion, things like that multicultural stuff? That would be a true psychotherapy degree.

Gordon Brewer 27:38
Right? Right. Definitely. And I'm really appreciative of the work you're doing around this, because I think it's, it's something that we're gonna, you know, people are becoming much more transient, I know, just the whole COVID, you know, a lot of this is, is coming out of COVID. And that people are, are moving more, and that they're, you know, moving to other parts of the country, they're getting kind of moving out of the big cities and moving into more rural settings. And I know where we're located just here in the southeast, we're seeing a pretty big influx of people moving in just looking for differ, lower cost of living, all of that kind of thing,

Kathleen Shannon 28:22
then when you're moving even into this area, trying to negotiate whole Okay, so who do I see here? It would be wonderful with that course, that I'm hoping there can be that type of like a membership directory, where we can actually have Okay, so you're licensed here, and you're seeking license elsewhere? You know, I want to be able to refer to you because I have, you know, XYZ, I think that it's eventually where I'd like to see it.

Gordon Brewer 28:49
Sure. Sure. Yeah. Well, Kathleen, I want to be respectful of your time. And I'm so glad we got to have this cover conversation today. tell folks how they can get in touch with you and a little more about the upcoming course.

Kathleen Shannon 29:06
Well, the course isn't coming out to the beginning of the year. However, you can go to www dot L P see license info.com. And going there, and you can go click on the front page there and you can get the report on the five key things that you're going to need to be licensed in every single solitary state.

Gordon Brewer 29:30
If somebody wanted to get in touch with you. Otherwise, Kathleen, how could they do that?

Kathleen Shannon 29:34
You can drop me a direct email at Shannon rehab@gmail.com. Kathleen,

Gordon Brewer 29:40
I'm sure we're going to have more conversations in the future and hopefully, since we're geographically pretty close together as far as the world goes, hopefully get together for coffee one day.

Kathleen Shannon 29:52
I hope so to Gordon, thank you. Thank you

Gordon Brewer 30:09
Well, big thanks to Kathleen for joining me on the podcast and be sure to check her website out it's LPC license info.com. And there's be links here in the show summary in the show notes for that, and give you again, looking forward to her having her course coming out at the beginning of the year, if you're interested in learning how to better navigate licensure portability, and being able to get licensed in multiple states, I think it's going to be a great course that's coming out. And yeah, so again, thanks to Kathleen. And be sure and check out her things here in the show notes and the show summary. And also, I'd love for you to join me in the upcoming focus group. Go ahead and, and commit now to the focus group that's going to be starting in January. And again, you can find out more about that by going to practice of therapy.com/focus Group to learn more about that. And looking forward to getting started with people. You know, the one thing I will say about the focus groups that I've been involved in not only the ones that, that I've facilitated myself, but also once where I was a participant, I've developed just some really important friendships and, you know, professional colleagues through those networks. And so I think it's gonna be something that's really going to help you in your practice and really help you, as they say, level up in your practice. So be sure to check that out practice of therapy.com/focus group. And also, before we go, be sure to check out our sponsors for the podcast. So grateful to have them on board. And also just really feel like they're offering some wonderful stuff. And that's blueprint health. And you can find out more about them by going to practice of therapy.com/blueprint health. And if you use that link, you can try them out for one month for free. And then also therapy notes. And if you'll go to practice of therapy.com and use the coupon code just Gordon, when you check out you can try them out for two months for free. So be sure and check those two wonderful sponsors out. Also, again, thanks for joining me on this journey. And be sure and take time to follow us or subscribe to the podcast, wherever you might listen to your podcasts. I know I'm a big podcast junkie. So I've got lots that are following so but anyway, take care folks, and I look forward to talking with you in the next episode.

You have been listening to the practice of therapy podcast with Gordon Brewer. Please visit us at practice of therapy.com For more information, resources, and tools to help you at starting building and growing your private practice. And if you haven't done so already, please sign up to receive the free private practice startup guide at practice of therapy.com. The information in this podcast is intended to be accurate and authoritative concerning the subject matter covered. It is given with the understanding that neither the host guests or producers are rendering legal accounting or clinical advice. If you need a professional, you should find the right person for the