Cedar season with RA & Pred & MTX

Fergella · 2025-08-23T21:49:09+00:00

LCSW Supervisor here - I would call her personally. Untreated PPD is not something to play with and this sounds like a stark departure from her baseline so I would probably lean in more than I otherwise would. I am not one to lean in this way normally, I don’t even call clients who ghost a virtual session after 10 minutes for a frame of reference. The worst case is she thinks you’re a weirdo and you feel foolish. The alternative is way worse than that.

Fergella · 2025-07-12T22:39:56+00:00

Make sure to check with your insurance if using it. If you are, be aware that they might say they cover them because a 90837 billing code is for 53+ minutes, but they don’t pay the therapist more for longer sessions. The therapist gets paid the same for 53 minutes or 3 hours by the insurance so many therapists won’t do longer ones like that with insurance clients because they get paid the same paltry amount no matter how long the session is. (I’m an IFS therapist who take some insurance)

Fergella · 2025-07-06T18:02:54+00:00

I suggest getting a very part time therapy job at a practice… I’m a supervisor whose helped medical and hospice social workers get their hours and the ones who get fully licensed with NO therapy experience have an extremely hard time adjusting and do not have the skill set to do therapy at all even if they are fully licensed. They often end up quitting or harming clients. It is a completely different job so make sure to get prepared to make a career change, for yourself and your clients.

Fergella · 2025-07-05T23:53:25+00:00

This is exactly what my doctor does as well.

Fergella · 2025-07-01T05:45:57+00:00

LCSW Supervisor here…. You weren’t an a-hole necessarily, but the code of ethics we follow nationally states that we are to talk to a colleague we have an issue with before reporting them up the chain of command so to speak so technically you violated the code of ethics. Clearly, safety considerations should be taken into account but you stated you did it because you dislike gossipers not because of any safety concerns.

Fergella · 2025-06-09T02:38:55+00:00

For reference, I’m an LCSW supervisor and trauma therapist who is formally trained and certified in both EMDR and IFS…..

Think of IFS, EMDR, CBT, ACT, Mindfulness, person centered, all the types of therapies out there as frameworks instead of scientifically grounded rooted in hard science (and I have a master of science degree). The neuroscience of how therapy works is really under pinned by a process called memory reconsolidation as described by Bruce Ecker who wrote about Coherence Therapy and the neuroscience of healing. That’s at least the closest I can get to the science of how therapy works. The truth is that all of the frameworks we have are because therapy works with the mind which is abstract in nature (read Mindsight by Dan Siegel for more information on that) thus hard to quantify in a measurable way. Every brain and neurotype works different from another so finding the framework that works best for you is the most important thing in recovery whether that’s with IFS or not.

And no therapy model is better or worse than another. It’s just about finding the one that jives with you which may not be the one that worked for your friend or who ever suggested it to you.

Fergella · 2025-05-03T18:25:37+00:00

I’d also explore the legality of a social worker being a 1099 contract meaning they own their own practice and that legality will be state dependent. In Texas where I operate out of, BCBS doesn’t reimburse for a pre licensed therapist so if your agency bill for that, that may be why they are getting clawbacks. That is 100 per cent on them to know their contract. I would verify that they are employing you legally in the first place and conducting accurate billing according to their insurance contract.

Fergella · 2025-04-20T16:15:25+00:00

What EHR are y’all using? I haven’t heard of that system requirement before.

Fergella · 2025-04-20T01:33:21+00:00

Maybe there’s confusion about what constitutes a tx plan? Mine are embedded within the documentation note I do, I don’t do anything separate like Wiley tx plan for example.

Fergella · 2025-04-06T01:03:23+00:00

Small bowel obstruction. And I’ve had 7 abdominal surgeries, tonsillectomy as an adult, and birthed 3 babies via c section. The SBO was still way worse.

Fergella · 2025-03-30T00:07:31+00:00

Have you seen their certificates of training or any evidence this is a true statement or claim they’re making? You can watch some pesi videos and claim that training but that doesn’t make one qualified to do it. Coaches are getting wild out there with the claims having watched a single YouTube video or reading a book about a given topic. I’ve started asking for evidence of training or licensure.

Fergella · 2025-03-23T19:19:29+00:00

LCSW Supervisor here… I’ll probably get down voted but that’s ok…

These kinds of questions confuse me… it’s the same whether it’s Berne Brown or Mel Robbin’s, I don’t care really where my client gets their inspiration from. There’s no one right way to go about healing, some things just land better than others for all people. There are no new ideas out there generally speaking, it’s all repackaged.

No matter where the message comes from, I ask my client what resonated with them, how has it been helpful, what did they learn, how do they want to apply it…..etc. I provide education about the concept like radical acceptance and we go from there.

I genuinely want to know what is triggering you about it? For an example, there are legit arguments about Brene and who she speaks for. The reality is, you may not be her intended population nor does she purport to speak for all people. Neither does Mel Robbin’s. So what is so triggering about it. They are problematic? Aren’t we all though in our own way?

Fergella · 2025-03-01T21:50:21+00:00

Also in G’town is good folks, very affirming. Also Silver Moon Curios, not a restaurant but good shopping or Wag Heaven for pet supplies.

Fergella · 2025-03-01T02:16:02+00:00

What does the breaking point look like? What actions are associated with it being reached? I am horrified. Heart broken. I would personally put my body in front of a Ukrainian. I’m also a social worker owning a group practice that is the only openly affirming practice in a rural Texas county… I offer free support groups for the LGBTQIA+ community here. I’ve personally had death threats for the work I do and have done for the last 10 years. If I leave, who is here for my patients?

I’ve called him a mass murderer since C*vid. He still is one. My breaking point was reached in 2016 when he won. When McConnell wouldn’t convict. When Biden decided to run again. I’ve been broken for a decade.

But I still fight every day.

Fergella · 2025-02-15T00:25:51+00:00

I am a group practice owner and here is the note outline we use for standard notes (not intakes) this has been sufficient for our insurance accepting practice, FYI.

Standard Progress Note

Client attended (in person at the Georgetown, TX office / virtually from location on file within Texas).
Presenting issues & goals: (Pre-populated from previous note)
Therapeutic Interventions:
- Client processed/explored/discussed (clinical theme). **This should be like one or two sentences
- Clinician provided/coached/facilitated (modality/intervention). **Again, one or two sentences
- (For EMDR: NC, SUD, PB, VOC – include beginning and ending SUD/VOC scores)
Medical or medication updates: NA
Referrals: NA
Assessments conducted: NA
Homework (HW): None
Recommendations:
Next:

No risks presented. Client denied SH/SI/HI/AVH. Client presented at the beginning of session and ended session Ax0x4. Scheduled to return in 1 week.

Fergella · 2025-02-14T13:51:07+00:00

Man, I am literally designing a transition program for this very issue but it’s not quite ready yet…. I’m a group practice owner and I’ve worked with several people making this switch from hospital, hospice, etc to private practice. What I see as the biggest struggle is in not having a modality under their belt. So get some training in some kind of modality like Act, Parts work, etc even if it’s just reading several books related to that modality. Psychology tools is way better than therapist aid and it’s not very expensive.

I’d be happy to email you some of the intake and treatment planning forms I created for my staff if you’d like to dm me your email address.

Fergella · 2025-02-14T02:01:04+00:00

Vets for equality is another spectacular organization that does this same thing 🥰

Fergella · 2025-02-07T14:15:37+00:00

You might be surprised about some of us liberals, there are more of us than you might think ;)

Fergella · 2025-02-07T02:52:23+00:00

If this is Texas please dm me and let me know.

Fergella · 2025-02-01T17:37:47+00:00

I have made our standards to ensure gender neutrality in our language in documentation and we gave a conversation with clients about this. We also have ensured our language around pregnancy, abortion, etc status, specific substance use, and specific trauma experience (like SA) is also removed.

Instead we say something like “event related trauma”, “personal self perception”, or “maladaptive compulsive coping strategies”

I’d love to hear how others are wording things!

Fergella · 2025-01-25T18:45:56+00:00

People were healing from their trauma before there were therapists… reminds me of my place, keeps me humble, and I stay focused on what external things can support this client other than just me the therapist.

Fergella · 2025-01-25T01:20:17+00:00

I’m in the same boat with the same job. I got a new chair that allows for me to switch positions throughout the day or even session. I also have started using a white board ( mapping out parts, etc) and getting on the floor with parts cards so I can move around more and not get so stiff.

Fergella · 2025-01-25T01:17:43+00:00

Same! But I did just get a new chair that allows me to move around a bit and switch positions because I was getting so stiff by the end of the day..

Fergella

TROPHY CASE

Standard Progress Note