Session 306: Becoming A Therapist, Part II

Session 306: Becoming A Therapist, Part II

Dr. Joy: Hey y'all. Thanks so much for joining me for Session 306 of the Therapy for Black Girls Podcast. We'll get right into our conversation after a word from our sponsors.

[SPONSORS’ MESSAGES & CTA by Dr. Joy]

Dr. Joy: We've had dozens of therapists on the podcast sharing their perspectives on various topics, from friendships to meditation and even horror movies. But have you ever wondered what it takes to become a licensed therapist? Well, the road isn't paved in gold. More like a few years of school and thousands of hours of supervised practice. But don't fret; the second installment of our Becoming a Therapist series is for our community members who are therapists, sisters looking to enter the field, and everyone in between.

Joining me today are therapists Dr. Kimberly Applewhite based in Utah, and Dr. D’Andria Jackson based in Ohio. My colleagues and I got candid about our journeys and talked all things personal development, business administration, insurance paneling, and more. If something resonates with you while enjoying our conversation, please share it with us on social media using the hashtag #TBGinSession or join us in the Sister Circle to talk more in depth about the episode. You can join us at Community.TherapyForBlackGirls.com. Here's our conversation.

Dr. Joy: I'm excited for us to dive into part two of this conversation. We did part one of Becoming a Therapist several weeks ago, got lots of great feedback. Beginning therapists, people who want to be therapists were very excited and really wanted us to continue this conversation, so we're excited to have you join us today for part two of the conversation. Dr. Jackson, could you start by introducing yourself and talk to us a little bit about your educational background, where you practice, and what excites you about being a therapist?

Dr. Jackson: I am D’Andria Jackson. I have PsyD, I graduated from undergrad from Oakwood University, an HBCU in Huntsville, Alabama, and I received my doctoral degree in clinical psychology from the American School of Professional Psychology. While I was studying, I decided I was going to serve my country. I was an active duty psychologist for seven and a half years prior to launching into private practice. Since, I've been working independently and enjoying the space, getting to serve black women through telehealth therapy, and my practice is primarily based in Ohio.

Dr. Joy: And what about you, Dr. Applewhite?

Dr. Applewhite: I am a licensed clinical psychologist. I have a doctorate in psychology also, from Ferkauf Graduate School of Psychology which is associated with Yeshiva University in Bronx, New York. I attended New York University for undergrad and then went straight to graduate school from there. I received my degree in school in clinical child psychology, I have an interest in working with marginalized populations’ kind of complex cases. So most of what I've done since graduation has been with adults. I did post-doctoral fellowship at Boston Children's Hospital where I worked with adolescents and young adults there. And since moving to Utah where I currently reside, I've done mostly work with adults in a dialectical behavior therapy paradigm, which I love. It allows me to do a lot of skills-based work with people who live pretty complex lives. But still see kids from time to time and so identify as a child psychologist. I've also been able to build practice here to try to cater to the BIPOC community here out west. And so that's what I'm into. I also do some, I guess you could call it religious thought leading with the primary religious group out here in Utah, so that's a big part of my professional work as well.
Dr. Joy: Wonderful. Thank y'all both for that. So Dr. Applewhite, I did see online that you had a pretty cool presentation that I wonder if you could talk with us about. You did a presentation connecting ACT and DBT principles to Kwanzaa principles. Can you talk a little bit about that and what that looked like?

Dr. Applewhite: I can. First of all, I love what's called third wave orientations to psychotherapy. So much of what we've learned was developed (honestly) by old white people, and ACT and DBT are really no exceptions to this, except maybe they were middle-aged white people. But anyway, I think that from the language of especially what we call evidence-based treatment, so much of it has punitive language around it, and so much of evidence-based treatment was not tested on or developed with the experiences of BIPOC people in mind. And so I tend to think that third wave paradigms for treatment like DBT and ACT have the best potential for being able to incorporate a wide variety of perspectives because they both value the behavioral principle of contextualism that says that basically things don't have meaning unless you can put them in the context where they're relevant. And so if we're not doing relevant work, then it's not work at all.

And so I think that DBT and ACT both have a lot of orientation to values as part of the paradigm for understanding emotions, understanding the function of what our bodies are telling us we want to move toward. And so, there's so much wisdom in our communities and what African American culture has tried to develop from a context of colonialization and being taken from our motherlands, that I think that we have as a people come to an understanding of how important it is to anchor ourselves to the things that are most important. And when Kwanzaa was developed, it is a very values-based perspective that says, how are we gonna tend to our communities? How are we gonna develop the greater good of our people? How are we gonna develop purpose in ourselves? And so much of that resonates with the best parts of what I love about DBT and ACT.

The presentation that we did, and it was with a group of black clinicians that we have here in Utah, we were using Kwanzaa principles to help people develop an understanding of connecting to values. How you use that to develop into a purpose-driven life, how you use your values to evaluate different decisions or choice points that you're at, and how to define what hooks you. And doing that within a culturally relevant context, the realities of doing a lot of this work in predominantly white context. So, yeah, it's fun. I think the more you look at how values have been defined, even in these therapy paradigms, it's still pretty white and western centric, and so bringing in the wisdom of our communities was really meaningful to me.

Dr. Joy: Thank you. Sounds really interesting. So you used a term that I wanna make sure we have clarity on for people who may not be familiar. You talked about it as a third wave kind of theoretical orientation. Can you say a little bit more about what that means?

Dr. Applewhite: I can try. I'm guessing that the first wave of things in psychotherapy is probably what a lot of people think of when you're thinking about going to therapy. Like the psychodynamic Freudian, like it's all your mom's fault, ego drives and things like that - the basis of therapeutic work that psychiatrists were doing. And then from that came, I guess what you would call the second wave of what was popular in therapy, cognitive and behavioral paradigms. So looking at a lot of things in our society are built on behaviorism. Like this idea of giving kids dinner and saying you can have dessert afterwards is a behavioral principal. A lot of programs in schools like reward systems are behavioral, and so that second wave of what people were doing in therapy was just looking at how we can teach people to do stuff based on getting a better sense of what consequences would come or what would be the impact of their behavior. And then third wave psychology paradigms tend to take the behavioral aspects of things, but look at it really with what I think is a more holistic approach, and that people might develop strategies and ways of responding to things that were helpful in the context that they developed them, and the problems that people faced.

Growing up as a black girl in the South, I developed all these coping strategies to like not be seen by people, not look as though I was making trouble in school. If I had trouble with something, I didn't ask, and maybe those things were adaptive. But then you get to graduate school and those things are no longer adaptive. Because if you're not talking to your professors, they don't know what you know, it increases the likelihood that they're making judgements about you, especially if you're black. And so in this body, I'm like but what is going on? Because I had all these things that worked and now they're not working as well. Those are the things that third wave treatments tend to be better at because they look at context and they also look at how can you accept more of the things that you had learned? Accept more of the messages that your body's trying to send, and figure out from there what you want to do to commit to an action that's gonna be, in DBT we say more effective. Third wave treatments incorporate more validation, self-compassion, just really healing those things that you've brought with you. Honoring them while also figuring out how much of that you wanna keep, how much of that you wanna set to the side, how much of it you want to put in your pocket so that it doesn't affect where you want to go. In essence (that) is the message of what you would call third wave paradigms.

Dr. Joy: I appreciate that, thank you so much. Dr. Jackson, you mentioned being an active duty navy psychologist. Can you talk to us a little bit about the decision to go down that path and what does a Navy psychologist do on a day-to-day basis?

Dr. Jackson: The decision to go down the path of navy psychology was one that was influenced by a long family history of military service. My grandfather, my father and my aunt, my uncles all were part of different branches of the military. But I decided to go to the Navy because I am a daddy’s girl. Although the secret is I applied to the Air Force first and they changed their scholarship requirements as I was going through the process. So I said, okay, I guess I'll be on a ship somewhere.
And so I decided to apply to the Navy, in part because they offer what is called a health professions scholarship program. And as you all know, obtaining a doctorate in clinical psychology is no inexpensive feat, and I wanted to set myself up for success in the future in addition to the pride in terms of military service. So I decided I would apply. And as life had it that I was the first recipient of that particular scholarship in 20 years. They hadn't given it for so long, they opened it back up while I was looking, and so I went through the process and I was commissioned.

As a commissioned officer, you go through officer development school, which is not exactly like bootcamp, but you do that training and then once you finish learning how to be a naval officer, you report to your duty station for internship. Much like other internship processes, ours is a year long for training at the predoctoral level. And then after you finish your predoctoral training and get licensed, you're then assigned to whatever billet the Navy needs. Needs of the Navy come first, and it really depends on the billet that you're in what type of job you do. So I have friends who are operational psychologists, who have done tours on aircraft carriers. I was a hospital psychologist, so I saw active duty personnel. Sometimes their beneficiaries like their spouses. We don't see children typically in the outpatient environment unless you've specialized as a child psychologist. I also saw retirees as well. Veterans, not typically through our system unless they are retirees.

And so much of the day, as an active-duty psychologist in a hospital setting, is doing what we do in private practice or in a hospital sort of service center. You just see clients, you provide evidence-based therapy, whether it is grief psychotherapy, cognitive behavioral therapy. I ran a DBT group for a while so much of what Dr. Applewhite was saying sounds very familiar to me too. And that was pretty much what we did. We had little adventures here and there, of course, as active duty service members, just like you're voluntold to do. Some of those things you can talk about and some of those things you can't. But it's great exposure and it was phenomenal training. And while I was on active duty, I had the privilege of being able to spearhead some telehealth work. That was before it was really all that popular, it was really new, nobody wanted to dabble into it very much, but I was able to dip my toe in the water. And once I got exposed to that, I absolutely loved it, which was a steppingstone to where I am now. I was also given the privilege of being able to provide supervision for predoctoral training students or predoctoral interns coming through the Navy pipeline. And that was a wonderful experience as well, being able to make a mark on the community and shepherd baby psychologists into becoming credentialed and licensed, full-fledged psychologists.

Dr. Joy: And what would you say for people who may be interested in following your footsteps? How would somebody go about applying for like the Navy internship? What do they need to do?

Dr. Jackson: You've gotta reach out to a health professions recruiter. They're going to be different than the typical recruiter who's trying to bring you in on the enlisted side. They are specifically looking for professionals who either have their degree (so you can come in already degreed and fully licensed) or if you're looking for the scholarship program, I believe each branch of service, not the Marine Corps... Navy, Air Force, and Army, all three of those branches of service do have scholarship programs and they also have internships. So if you wanna go through the scholarship program, you gotta contact one of those recruiters early. If you wanna just come in as an intern, you're supposed to apply through the APPIC program. And then if you wanna come as direct to session, you just talk to a health professions recruiter and you've already gotten all of your credentials taken care of. The beauty though, of coming in as a scholarship student, at least when I came in, was that you didn't have to go through the APPIC process.

I know a lot of people have gone through that sort of very expensive, very stressful process, waiting on match day. The benefit at that time was that the specific sites for scholarship students, because they are tied to our career and our contract, are not specifically available to other students applying through APPIC. The other beauty is… it sounds like a Navy commercial. The other beauty is they pay you while you're in school. So not only are your tuition and fees covered, they give you a little bit of a stipend while you're in school so it provides a little bit of assistance. And then once you become active duty, you get all the great benefits of healthcare and life insurance and a great paycheck. Once you really get licensed, great paycheck. Those are all the wonderful things about participating in a military specific internship.

Dr. Joy: Got it, thank you. Something we didn't get a chance to get to in part one of this conversation was of the personal development piece that is required to become a therapist. One of our community members wrote on Instagram at “@Jump For Joe,” she said I definitely didn't expect the healing it forced me to do in places I thought were already healed. It has made me a more attuned human so that I'm able to properly show up, not just for my clients in the therapeutic space, but also for myself and loved ones. I'd love to hear from both of you a little bit about your own personal development and like what kinds of things have you learned about yourself or had to attend to in your work as a practicing clinician?

Dr. Jackson: Well, I got a lot of feedback in internship. I was a fixer when I first came in, and so I just wanted to dive right in there and try to give my clients the answers as opposed to accompanying them on the journey of building insight and developing that sense of self-awareness, and that mindfulness of what it is that they're dealing with, and helping them put those puzzle pieces together. So on the outside, I was kinda like, I see this and let’s do this, and we can add this, and we can do that. And that was sometimes not helpful for my clients in internship because they didn't learn from the process. So I had to learn to hush myself in session and I also had to learn to monitor my nonverbals. I think that was really another one for me because my face will speak before I have an opportunity to, and with all my black girl energy that I was trying not to bring to the military space (cause it didn't seem like a warm, welcoming environment for that), that used to be a challenge for me. I also, upon embarking on treating trauma, had to learn to work through my own stuff that I thought was healed but was not, and especially in the context of providing manual based therapy like cognitive processing therapy or prolonged exposure. Those kind of things can really have an impact, especially once you start doing it regularly with multiple clients. And so sitting with that and working through your own stuff, getting your own counselor and continuing to see your own counselor is so important in the process of becoming a therapist.

Dr. Applewhite: Yeah, I agree with so much of that. And I was thinking about how when I was in graduate school, you think you made it, right? Especially like on a doctoral level, you're like, man, I've gotten an American dream or whatever and done what I came to do. And I can remember clearly a time where we were talking about the idea of stereotype threat. I went to NYU, they were doing a lot of that work at NYU, one of the leads on that was still a professor in the Steinhardt school, so I was familiar. But then I learned that the other person, Claude Steel, was a black man. And in my head, I thought that Claude Steel was a white woman. I guess I had the Danielle Steel books in mind or whatever, so that was the first thing. And then at the time that I was in graduate school, Norm Anderson was the CEO of APA and he is also a black man who graduated from North Carolina Central University.

And you know, I mentioned I'm from the south, but I'm from North Carolina specifically, and I went to boarding school right down the street from NCCU and didn't really seriously consider going there because of really all of this internalized racist stuff that I had growing up as a black kid in the South. And so when I realized that, and I noticed my surprise about that, hey, these are really successful people and they're black people and they grew up similar to me. I was like, oh crap, what am I assuming about myself and my own likelihood of being successful in graduate school if it's really this surprising to me that there's black people out here doing this? And to think that not everybody that gets to graduate school is gonna have those emotion skills to be able to pinpoint something like that. And so, yeah, as long as it's undeveloped, realizations like that are really jarring and difficult.

And then when you get into kind of your passions. When I've gotten into my passions in things that I feel strongly about, caring for black youth, tending to racially stressful and traumatic events in the community, and then you have people kind of devalue those things. People that you think should know better because they're all in the mental health fields. It continues to bring up things that (like Dr. Jackson was saying) really do require you be in your own work, like that you have a space to process those things. One of the reasons that I like being a DBT therapist so much is that there is a little bit of room… Well, there is lots of room in the model to be more self-disclosing because in DBT, a lot of times people have experienced invalidating environments and that's where they learned a lot of the ways that they are coping with the world, and so it's important to be genuine in appropriate ways. And so then I really like being able to be genuine and expecting that the type of relationships I build, people will call out what seems like it's therapy interfering and give me that chance to process it. But that I don't have to put on certain types of language or put on a front to be a certain thing that I'm not.

But yeah, you really do learn a lot of treatment paradigms so, you know, practice the skills on yourself. And it's all kinds of things like practicing skills of self-compassion, emotion regulation. I can't come into work tired, not having eaten, and yet I have these realities, right? I have two kids at home, I have all of these things that I'm doing in the community. And so really, I have to practice the skills to be able to do what I'm doing on a daily basis. And then to be able to share that with clients when we're working with skills. It's like, man, you might wanna call BS on a lot of this because the implementation is difficult and I'm doing it, like we're doing it together. So yeah, you really do learn so much.

Dr. Joy: I really appreciate you sharing that, Dr. Applewhite, and I think that that is important for us to talk a little bit more about, like this internalized racism and prejudice that we grew up, most of us, (or at least all of us talking here today), grew up in America, right? And so there is no way really for us to not have in some ways internalized what the world tells us black people are and who we should be. And so I wonder if you can talk a little bit about what kind of work should therapists do to even examine where those biases and those internalized messages exist for themselves, and what does it look like to really challenge some of that?

Dr. Applewhite: Dr. Jackson, you said you were a Navy commercial and now I'm like a DBT commercial. So in DBT paradigm, and I'm sure there's other paradigms that break this down, but I just really appreciate the parts work that DBT does around this. You think about all the steps to having an emotional experience and it's so much about like what you see, how your body takes it in, what experiences have you had that make you interpret it certain ways? What is the interpretation that you give? What does your body say? All of these things make an emotion. And so understanding that and being able to deliver that message on a daily basis has really given me a lot of power to name my own experiences. So in 2020 when George Floyd was murdered… And we were one of the first places in our area to go completely telehealth and then we stayed telehealth for probably 15 months almost exclusively but then, on occasion, we would come to the office for things.

And around June 2020, I just did not want to be around people and I couldn't explain it. Like I didn't wanna leave the house. It didn't feel like fear, but whenever I thought about going to work and being around people, my stomach would hurt and I couldn't think about talking to anyone. And so I was like, what is this feeling? A lot of times when I have a feeling that I don't understand, I go to the worksheets. So these worksheets break down, like they put the emotion family is at the top, and then they have all the synonyms for the emotions right underneath that and then they have prompting events for emotions and then like interpretations (which is basically like when you think something is happening and it sets off that emotion and then it has all the biological changes in your body and stuff.) And so when I feel some type of way, cuz I'm used to saying like, oh, I feel some type of way about this, then I go to the sheets and I just look at the biological changes and I say, okay, I have at least three of these things that might be happening. And then I flip to the next page.

So I always go to all 10 sheets. I don't rule any emotional experiences out because, yeah, there was a lot of fear around that time, but what I discovered was that what I was feeling was closer to disgust.
I like a lot of food and so I don't feel disgusted very often, except you about rats and like environmental things. But racism is one of those things that elicits disgust, and it was something that I had not labeled before. But it helped me to understand why I didn't want to be around people. I didn't wanna be around people that would remind me of things that happened. Cuz you know how, especially the fair complected people will do, they'll be like, oh, are you okay? Like I just wanted to know if we could do… You know, just kind of in a vague way.

And so I had some stomach pains around that. But also it kind of takes me back to being a little kid growing up and just fundamentally not wanting to feel like I was different from people. And how hard it was to be reminded that I was having a different experience from other people, that just brought on a lot of pain and also disgust and not wanting to be around people to contaminate folks with that. And so that's something I can check because my experiences and how I see the world are not like the poison that is causing racism. It's other things. Like racism illicits its own form of disgust but then there's so much going on with me where I'm like, I don't want to burden people with this. If I let people into what's going on, that it'll put people in a bad mood, it'll like tamper the spirits of things. And so really applying emotion identification skills and then regulation skills after that is one part of the work that I do to bring clarity to myself. And really have compassion for like, oh, my body knows things that my brain hasn't quite caught up with yet. And just appreciating the wisdom of this grand design that is our bodies, I think is pretty cool. I can nerd out about emotions and functions all day, so...

Dr. Jackson: If I may chime in. I always recommend looking at our schemas. Those concepts and beliefs and ideas that we have that are shaped early in our lives and continue to shape the way we respond to the here and now, and even the way that we look at the future. I like to encourage my clients, and I even do with myself, explore my schemas when those kind of things come up. Whether it's race based or anything else, to kind of see how my history is at play in the present moment, or how a client's history is at play in the present moment. And I think for a lot of people… I'll just speak for myself. In the context of internalized racism, I had to look at my own unrelenting standards and how those were shaped by early life experiences in terms of messages that were overtly given to me. You have to be twice as good to be considered equal. Or you don't have the luxury of being mediocre. Excellence is its own reward.

Those kinds of messages that were given to me to show up in a very white world made it something that I internalized in terms of my own expectations. And that put a lot of pressure on me and I would kind of engage in perfectionism, or I have to be just this way, or I have to show up in this way, or I have to be prim and proper, and I must use the king's English instead of our vernacular. Those kinds of things came to be a lot more suppressive and exhausting. And once I realized that my own unrelenting standards got in the way of my ability to show up authentically in spaces, I was able to work through that because I was able to connect how my past was functioning in my present. And then I was able to take power back and say, mm-mm this is how I wanna handle this in the future. And so I think schema work can also be very helpful when we're looking at those deep-seated beliefs.

Dr. Joy: More from our conversation after the break.

[BREAK & CTA by Dr. Joy]

Dr. Joy: Dr. Jackson, you said something earlier that I wanna go back to around realizing that you were showing up as a fixer in your sessions. I think a lot of black women probably can recognize that because in a lot of ways we are socialized to be that. In our circles, in our families, in our communities. So what kind of work did you do to try to not overstep that boundary with clients? Like what does that look like to kind of pull yourself out of that fixer role?

Dr. Jackson: The best feedback I got from a supervisor who was also a black woman was to be curious. Instead of trying to jump in there and fix the issue, be curious about where your client is in this moment. Ask lots of questions, clinically appropriate questions, but ask lots of questions about where they are, what they're feeling, how they're experiencing that, what that came from, how that makes them feel, in order to get a better understanding of where they are in their journey towards developing insight. And then where you can drop little nuggets, provide a little insight, that's when you chime in. But only after the client has kinda come to a space where they're ready and they can understand and they're able to digest that information.

Dr. Joy: Dr. Applewhite, something else you said that I wanted to go back to as well. You made a comment around I feel some type of way. Like being able to kind of not distinguish what was going on. And I feel like, again, that is something the black community uses. Like I feel some type of way about this. Do you feel like that kind of language distracts us from actually understanding what our mind and body is processing?

Dr. Applewhite: I think it's all about kind of decoding the story. Like not letting it stop there, but just using that as a basis for exploration. Because if I didn't know that, oh, I feel some type of way, then I wouldn't know to explore that to give myself time. But then, yeah, there are so many situations where somebody might recognize that they feel some type of way but then just go on about their lives. And I think that that's where the research comes in that by the time black people end up in therapy, we're worse off than other people that come to therapy because we're not using these observations that we're making as the jumping off point for further examination. And of course, it's understandable because all these systems, even the mental health system… For sure, psychology is guilty of a lot of things that would make it so black people would not feel comfortable. And yet there are so many of us out here trying to do this work. And a lot of good people of different cultural backgrounds too, trying to do the work.

And so I feel like there is so much wisdom in the ways that I've learned to articulate my world because of being black. It's not cuz of being a psychologist. If anything, being a psychologist has helped clarify how wise my family was. But it's about just figuring out how much of that and into which context I want to take it. And like Dr. Jackson was saying, when you come across a pattern of thinking or a pattern of behavior, just looking at it and figuring out what you want to do with it, but you don't have to discard the wisdom of it just because it doesn't come in some conventional form.
I don't want the people that I see to sound like therapy pros. Like I don't want them to come out with all of this jargony language and ways to describe things, even though inevitably I have things, people have things. But I want to help people feel like they can access their own wisdom, and that includes a lot of the things that we've learned from our families and from our culture.

Dr. Joy: You both have referenced this kind of family thread, which I think is really interesting, but I also think is indicative of the work we are doing in the world. I think we have come through these very formal training programs and are figuring out how to manipulate it and present it in ways that are actually a much better fit for the communities that we want to serve. I wonder if you both can share some of these like family lessons that you’ve realized showed up in your formal education, even though maybe we called it something different.

Dr. Jackson: The power of positive thinking was very explicitly talked about in my home, and so a lot of times, while I do see that there are problems with cognitive behavioral therapy, especially for our culture, I think that kind of provided a springboard for me into not believing everything that I think. Taking some time to evaluate some of these thoughts to see how effective they are, how effective they are for this situation, for this moment, for how I'm feeling. Is it gonna extinguish the way I'm feeling, help me cope with the way I'm feeling, or is it gonna perpetuate it? And so in my family, there was a lot of redirection towards, there's nothing you can't do, only things you haven't learned yet. Or opportunities to stretch yourself and it's okay to fail. While there were some high expectations that were set, there was also compassion and grace and empathy and lessons taught when you did skin your knee, when you did fail. And the importance of self-acceptance was also there. I think as I got older, there were more conversations that were had around it's okay to be who you are and it's okay to embrace the differences and the uniqueness that you have that you add to the world because that's a beautiful thing. And so a lot of empowerment, a lot of affirmation, a lot of positive thinking was part of my household experience.

Dr. Applewhite:Yeah, I was thinking about that too in the last few years, really the last decade, when you have like viral takes on songs or whatever. And say you wanna change a nursery rhyme to something hip hop or something gospelized, it will always have affirmation. Like it'll always have some message about growing into being what you can be, you know. And I'm like it’s all black culture. Another thing I often share is there's a video by Northwest Tap Collective and it's a tap dance to Hell You Talmbout by Janelle Monae (it goes through the names of people that have been lost to police violence.) But this video that the Northwest Tap Collective did is all generations of every shape, every size, of all these beautiful black people just doing this dance. There's kids, there's elders, there's men, there's women, there's all kinds of people, and they're doing this tap dance to this really painful song. And so much of that is what I take from my family culture too.

My grandma before she passed was the mourner in the family. So whenever somebody died, she would come like wailing up and down the aisles, just such a full bodied expression of grief. For background, I grew up and still am a part of The Latter Day Saints community, so I'm Mormon. And so there probably are, maybe your family still have mourners in them, but in my religious culture, it is very much not a thing to have people that openly express their grief. And in fact, it is already like in my religious context, usually we like to package it and say that it's okay. And so seeing those aspects of what my black culture brought into my experience was really meaningful for me. When you look at the research on racial socialization that's come out in the last few years, and we understand that there's all these types of strategies that people can employ to cope with a racially complicated world, and my family was like “check boxing” the list. You know, they were preparing us for the possibility of bias. They were instilling pride in our black heritage. But then they also have a mix of these other things, like Dr. Jackson was talking about. You can be anything you want to be, those you would consider colorblind messaging. Or sometimes things were not about race, and they didn't make them about that, but having just the weight of these things.

Being like, can you feel pride in who you are and can you be prepared for what comes next, we now know from the research leads to better outcomes for our children. And so with the way that research is hopefully going and stays there, and looking at the strengths of what comes from black communities, I think we're only gonna find more and more things that all along we've been doing well and that we can make sure get passed down through the generations. Along with other things that in this context can be looked at. Like do we need to hide things from everybody? Do we need to incorporate so much pain on our bodies when we know that things are taking a toll? Is black don't crack really true, or are we just cracking on the insides? So there's things to be examined, but I still think there's so much wisdom that comes from our families and from our culture.

Dr. Joy: You both also administrate your own private practices. And so there was a lot of questions after our previous episode around accepting insurance, being paneled with insurance. What would you want clinicians to know about getting paneled with insurance? Like what steps do they need to take? What kinds of things do you wish you knew before you started the process?

Dr. Jackson: It takes a long time.

Dr. Joy: Right, a deep breath.

Dr. Jackson: It can take a long time. I think sometimes upwards of 120 days to be credentialed with some insurance panels. The other thing to consider is you're not gonna know what your reimbursed rate or your contracted rate is gonna be until you actually go through that entire process and receive the contract. And so it can be kind of difficult if you don't already have experience, being paneled with another agency or another practice with one of those particular insurance panels. It can be really difficult to know and base your business plan on how much income you think you might derive. Copays. Copays are a wonderful thing because it makes healthcare accessible to our clients, and that's one of the reasons that I decided to go ahead and be paneled with insurance. Is because I wanted to work with a specific group of people, I wanted to work with black women, and I wanted to be accessible to black women who needed help.

And no knock on anybody who decides to be private pay, but at the time when I started my private practice, I felt that was really important. Copays come in, the reimbursement from the insurance company can take a little while longer. They're supposed to provide those reimbursements to you in a certain period of time, but they don't always get them there. And you have to be your own advocate. Keep really great records and be willing to, in addition to doing your clinical practice and your clinical notes, be willing to get on the phone with these insurance companies and wait for a while. It's inconvenient sometimes, I will acknowledge that, but I do think it's worthwhile from the standpoint of providing accessible care, especially at a day and age where it's hard to get in with someone and the economy is rough, and people are spending five, six dollars for eggs now and toilet paper and all kinds of things. So for me, where I can find ways to be affordable and accessible, I opted to do that.

The other thing that I would want or would have wanted to know ahead of paneling with insurance companies, make sure you have your NPI numbers and your EIN numbers so that you're not giving out your personal information. Of course, the NPI number is something you have to have, but that the EIN is so important because you don't wanna give your social security number out to these insurance companies or for your clients to have access to when they're trying to look up your information for your practice. That's really important. And there is a difference between a solo NPI number and a group NPI number that you'll need to be mindful of as you're establishing your practice too, if you wanted to expand.

Dr. Joy: Can you tell us where do we go to get an NPI number or an EIN? If somebody's listening to this conversation and they're like, what? What is this? Do you have to pay for this? Where do you go to get this?

Dr. Jackson: I'm sorry I cannot remember the name of the website, but there is an NPI registry website. Where you go online, you put your information in, make sure it is the official NPI registry website. You can do these things for free. You don't have to pay someone else to do them for you. That is more convenient for some people if they don't wanna put that kind of time in, but you can get that NPI number with that registry. And the EIN number is something you have to obtain from the IRS.

Dr. Joy: Perfect. Yeah, we'll make sure to include the links to all that in the show notes for people who want to start that process. What about you, Dr. Applewhite? Do you accept insurance in your practice?

Dr. Applewhite: I do not. I actually work in group practice and it's a little complicated because previously I did work at our local inpatient hospital, and I am still a PRN employee with them. So technically, I am paneled on insurance and they do it for me, which is nice. But here I am not paneled on insurance and our company does not take insurance. And that has been a really difficult thing for me coming from systems that were just more equitable in that way from the hospital, and then I was in college counseling, so it was hard. The reason why our group practice has decided not to do this is because a lot of times the reimbursement rates (kind of what Dr. Jackson was alluding to) are not equitable to the work that we do. Basically, the system is not for any of us. The rates are set by, in essence, people who don't value the work of mental health professionals, and so the rate tends to be lower. Especially for the work that I'm doing here where it's mostly DBT therapy, which means I'm around the clock for my patients and doing what I can to keep them out of inpatient hospitals. So in essence, we are what would be considered an intensive outpatient placement, but we're doing that from the ground, and so it's just hard work that for some people would not pay off if we accepted insurance, is what I have been told and what I can understand kind of from an intellectual standpoint.

And I think in Utah, very few of the black providers here take insurance, if any. And so it's come up in the community where there's some people that are really angry about this and they're like, how can you say that you're for the people when you're not working to make yourself accessible? So first of all, all graces. It's nice if you can recognize that, again, the system doesn't work for any of us, and so we're all just trying to do the best that we can. It's not about money for me, but more about balancing my way of life. So in order to give clients the care that they deserve, it's nice to work at a place that pays me enough that I can protect my time, so that I can go to continuing education things without having to reschedule or cancel on clients and those type of things. That I have time to receive supervision during my workday. And so I've come to realize that those things are also ways that I can give back to the community as long as I'm explaining that to people.

But the other way that I can give back to the community is by enhancing my ability to give scholarships to people. So as soon as I got here and realized that we weren't gonna do insurance, I'm like, okay, well I can do this work on the sides. Like I can go do outreach events and people can pay me to do stuff. Can I give you that money? Well, no, that's illegal. But then we figured out how we can offer CE services (continuing education) to other therapists that then goes into the pro bono fund that we have at the center. And our pro bono pot is not necessarily meaning that people get free therapy, and it's also not totally income based. It's just if you cannot afford to pay but you want to see a licensed clinician, that money is there. And so that's something that I've worked to develop at the practice that I'm at to kind of counter the effects of the system not really working for any of us. And so I would say, if you're thinking about setting up your own practice, just know that there are options that you can use.

I feel like in psychology, they teach us to have kind of multiple streams of income anyway. Not for income, but just cause we're so busy, right? We do so many things like assessment and whatever, but then when we go into practice, you only will often do one of those things. And so you're like, oh my gosh, where did all the things go? And so then you end up with these streams of income and revenue. So there's ways to be creative. Some of my friends also, you know, they get on third party providers that provide employee assistance benefits to companies and so the reimbursement rates tend to be fair, but then you're not dealing with insurance still. And I think from what I've said and what Dr. Jackson said, I hope that it's clear, that like every decision that you make is complicated. It's just a different set of complications, and it's about figuring out what you're willing to deal with to follow that value.

Dr. Joy: More from our conversation after the break.

[BREAK and Dr. Joy’s CTA]

Dr. Joy: It's a running refrain when I talk with other therapists about this, like there's so much we don't learn in grad school about actually either operating a practice or even being in private practice. I know there's probably so many things, but what is one thing that you feel like you did not learn in grad school about either being in a private practice or owning your private practice that you would love to share with other people, that you've been able to kind of figure out on your own?

Dr. Jackson: Establishing a business plan. And I can't even say that I figured that out on my own. I'm blessed to be married to a man who has an MBA so I've harvested that knowledge from him, and he's also in finance. But there's so much about stepping into the space of running your own practice that you have to be knowledgeable about business plan and marketing strategies and marketing analysis, and SWOT analysis so that you can recognize what it is that you want to do, how that aligns with your values, but also how it makes business sense. I hear Dr. Applewhite saying that it just didn't make good business sense and the systems not working for all parties. I absolutely agree with her on that. And so having a solid business plan, understanding your business model, identifying how you can work into your business plan these alternative streams of income so you're not grasping at straws. I think it's so important and it's not something that a lot of academic programs are offering. Once clinicians get out into the space of establishing their own practices, a lot of times we're like clueless and don't even know where to start. And then once we get a little bit of taste of that information, it's very overwhelming in terms of all the things that need to be accomplished and the boxes that need to be checked. So I would say establishing a solid business plan is necessary to know.

Dr. Applewhite: I hope that people coming through grad school now, their training is different but I feel like the importance of technology was underemphasized in school. And of course, in this pandemic and post pandemic world, it's become more important than ever to be flexible to the needs of clients and use technology. The older I get, and I'm 34, but I try to see teen clients, and I don't know what's going on with them because technology has just advanced. And, you know, I tell people I had kids in graduate school, so my knowledge of pop culture is kind of limited and perhaps dead. It's limited to like the time my first kid was born. All of my music knowledge is mainly from before 2014, like it's just dead. But then when you're working with clients, there is a need to stay relevant and stay connected to what people are talking about. Like it's come up that TikTok has advanced, or I don't know if you call it advanced. It certainly has put out there a lot of talk about mental health. Some of it is accurate, some of it is effective, some of it is not. You got kids running around thinking they have DID and you're like, what? DID is only in like, I dunno, 0.5% of the population or something, like what's the prevalence of that?

Or, you know, people say AHD is this, ADHD is that. And I’m like maybe you’ve got some other things going on. Maybe you need an evaluation. But as long as we're kind of constrained to offices and not regularly engaging with technology, then we won't be prepared. Then the next pandemic or that kind of event will come around and you won't know what to do. Like Dr. Jackson was doing telehealth before telehealth was cool, in essence. Before that, you know, all kinds of shade was like, “oh yeah, telehealth didn't work as well,” even though the evidence was there that it did. Or like, oh, you're gonna be disconnected from this, that and the other if you go telehealth, and then we all had to do it. So some of us were able to continue to grow and develop by being connected to technology. And sometimes I think we can fool ourselves into thinking we only have to be connected to the work, but the work is technology. We’ll get left behind if we're not keeping up.

Dr. Joy: These are both such great points. I feel like we could spend a lot more time on both of the things that y'all have said, cuz I think that there is a lot there. But I do want to wrap up with one final question for you both. What kinds of professional organizations have you either participated in or been a part of that have been the most helpful to your evolution as a therapist?

Dr. Applewhite: I joined the local Psychological Association when I moved to Utah. That was a suggestion from a colleague when I moved from Massachusetts to here cuz I'm like, what is Utah? What am I gonna do? And they're like, well, you join these state psychological associations to understand what are the issues of people that are working in your community. And so then that's a good way to not only network, but just understand what you're getting into by seeing the types of events, the types of issues that people are trying to address. And so I've joined UPA. I’ve remained a member of American Psychological Association, though I think in the pandemic I tended to be less active, or even since moving to Utah. Because when I was East Coast, it was easy with APA being in DC.

I did attend Association of Black Psychologists once when I was here, and Association of Black Psychologists is interesting. Some of them are far along their path of decolonizing themselves and I am not quite that far along. And so it was almost like a baptism by fire situation that they have done so much important work historically in blazing the path for black psychologists to exist that I think that every black psychologist or person interested in working with black people should take a look at the work that ABPsi has done. And then I also have tangential connections to the Society for Research in Child Development, which also has done a lot of great work to grow out Black psychologists. They have a strong history there. And so those are mine.

Dr. Jackson: I would echo state associations and APA, I think those are beneficial professional organizations. But where I've really found a lot of useful information is connecting with other professionals who look like me. And so I found a lot of the online clinician support groups like Black Girl Clinician Collective is one that I'm a part of, Clinicians of Color is another one that I'm a part of. These are useful organizations that I found have helped to provide opportunities for consultation, provide opportunities for just connecting with your colleagues and building a sense of community. Opportunities for CEU trainings. I also have been part of business boot camps, so while the professional organizations I think are really beneficial, for me where I am at this point, I found that creating community and being able to connect with other people who see the field of psychology and the work that we're doing from a similar lens has been really useful to me. And I've been able to find that more online than I was in the larger organizations.

Dr. Joy: Great points. Thank you both for sharing that. So we do have to wrap up, even though there's so much more I know we could talk about. Dr. Jackson, can you let us know where people can find you online? So your website as well as any social media channels you'd like to share?

Dr. Jackson: Absolutely. You can find our website at www.epiphanypsychotherapy.com. I know it's long! And you can find me on Instagram @Dr.DJackson.

Dr. Applewhite: You can find my information on our group practice website, which is UCEBT.com. It stands for Utah Center for Evidence-Based Treatment. I'm also online, when I can figure out how to do it, on Instagram and Twitter as @ApplePSYD.

Dr. Joy: Perfect. We'll be sure to include all of that in the show notes. Well, thank you both for spending some time with me today. I really appreciate it.

Dr. Jackson: Thanks for inviting us. It's a pleasure.

Dr. Applewhite: Thank you.

Dr. Joy: Absolutely. I'm so glad Dr. Applewhite and Dr. Jackson were able to share their expertise with us for this episode. To learn more about them and their work, visit the show notes at TherapyForBlackGirls.com/session306 and keep your eyes peeled for part three of this fantastic conversation. Also, don't forget to text two of your girls and tell them to check out the episode right now. If you're looking for a therapist in your area, check out our therapist directory at TherapyForBlackGirls.com/directory. If you wanna continue digging into this topic or just be in community with other sisters, come on over and join us in the Sister Circle. It's our cozy corner of the internet designed just for black women. You can join us at Community.TherapyForBlackGirls.com. This episode was produced by Fredia Lucas and Ellice Ellis, and editing was done by Dennison Bradford. Thank y'all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take good care.