Enlightened Practice Podcast
The holiday season is nearing, the frenzy of gifts and preparations is growing and these variables can affect your practice. Our hosts share their strategies for this particular time of the year to ensure patients and clients get the care they need without, as clinicians, getting to the point of becoming resentful or burned out. We hope you enjoy this new episode of the Enlightened Practice Podcast.
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Transcript of the podcast
Ken: Hi Kari, welcome back to the podcast.
Kari: Hi Ken, how are you?
Ken: Good, thank you. It’s great to be together again. And today we are fielding a question from one of our listeners who is asking for a strategy for surviving the holidays and how to think about that from a clinical perspective but also practice management perspective. I think it’s the first go around in private practice for this listener. So, first holiday season is coming up and it’s pretty good timing for us to be thinking about nuances that the holidays bring up for us and what special accommodations we need to make and our scheduling or that sort of thing. So, why don’t we dive in and talk about it? I’m curious what your experience is in holiday seasons past, and how the holidays affect your practice.
Kari: Yeah, that’s such a great topic to talk about. In my experience, the holidays have been a mixed bag. I would say for the most part, the pattern is that the practice usually slows down because of people’s holiday plans and travel as well as potentially my own holiday plans and travel. But there are also some cases in which mental health issues can escalate around the holidays because there can be more stuff going on in clients’ lives that can be more triggering or activating, such as being around certain family members or something like that. And so it can be an interesting time where you might notice a decline in clients, but you also might notice more acute issues that need to be handled. And then you’re also balancing all that with your own holiday schedule. And so there’s a lot to think about in terms of how to handle all of that. How to schedule backup care? For example, which we can talk about and how to set boundaries if that is part of your practice. And I can definitely go into the details of how I’ve done some of that, but I was also curious to hear from you just if that’s similar to anything you’ve noticed around the holiday time?
Ken: Very similar. How did you know? It’s probably all of us have experienced this kind of interesting duality where especially around the end of the year holidays, it seems like every client or patient is on a different schedule and they’re off from work before the holidays or after the holidays or during the holidays. So, it can make for a real checkerboard schedule to look at on the calendar. And when I was first starting out in practice, I wanted to see as many people as I could other than on the major holidays. I didn’t want to take vacation then because that was when everybody else took vacation. So I realized, well, I don’t need to take vacation just because everyone else does. However, when all of your patients or clients take vacation, then you may or may not want to take vacation, but it doesn’t really matter, that’s a really good time to take some vacation.
And so as the years went on, I just started to take vacations along the same time that everybody else does. So, that way I wasn’t in the office with long breaks in between patients or clients. I just didn’t feel productive in that atmosphere. So, I do around the holidays if I am working, try and bundle and move times around so that way I can see a few folks back to back to back and then get a real half day off. How do you handle some of the scheduling challenges?
Kari: Yeah, now that you mentioned that, I had a couple holiday seasons where it was a similar experience where I decided to work the week of a major holiday and the schedule was so slow and with long breaks. And I remember at the time thinking to myself, I don’t want to do that again, because it felt exactly what you said. It felt unproductive. And so now what I do is I, based on what is best for me and also aligns with some major holidays that I can anticipate, a good chunk of people probably want travel as well. I take a full break whether or not I’m going out of town, or if I’m just sitting around my house, or whatever it is. You know, just depending on what has happened that year and how many other breaks I’ve taken. I would take anywhere from one to even two weeks around some of the holidays.
And in that case, I’m pretty strict about making myself totally unavailable. And then I offer backup care for people that would want help during that time. So, that could be anything from another provider to going to the ER, or whatever it might be that would be the kind of help that they would need. I’ve tried doing it so that I’m kind of on call and for my practice that doesn’t really, first of all, that doesn’t happen that much. So, the client would need to reach out because of an emergency, but it also doesn’t work because the reality is if I really am on a vacation or a break, I actually can’t be on call. So, it’s not what’s really in the best interest of the client. So, I set making sure I’m setting up backup care, taking full consecutive days off, and giving clients plenty of notice that that will be happening so that for whatever potential issues they’re anticipating dealing with over the holidays we can actually spend some time preparing them from a clinical perspective, so that doesn’t feel potentially as like daunting for them to go through without a therapist.
Ken: That makes sense. For medication patients, it’s a little slightly different in that they still run out of their meds and haven’t requested a refill far enough in advance. And so having this I think speaks in a different kind of way to the value of having backup coverage that you really trust and that you have good arrangements with your colleagues. I’ve covered holidays for other colleagues knowing that they’ve covered for me. And that if you really want it to be a vacation, then have really good coverage and then you can put your mind into everything other than work and really take advantage of the time. This is what we talk with our patients and clients about is getting into good psychological space, and we need to do that for ourselves so that we can be available for them when we are on. And it seems much easier now than when I was in training or starting out to just take calls anywhere in the world.
I mean, unless you’re camping off the grid, there’s really nowhere that you have to have coverage for, but you really should have coverage and really trust them, really know them because they’re going be taking care of your patient and you’re going hear about it. After you get back, you get a report card on your colleague and you want to be that kind of good colleague as well when you’re taking a call for them. So yeah, I like your point about really trying to hold to not being if you’re off, you should be off. And you should make it really clear though, how they can get care. I mean, I remember my first year in private practice and I think on Christmas day got a call from a teenager I was seeing whose parents are divorced and arguing and it was just a miserable Christmas for her. And of course I talked with her and the, the crisis passed, but it did make me think about that I wasn’t with my family at that time while I was helping her, and that really made me think about how can I have good boundaries here so that our patients and clients get the care they need, but that we’re not sacrificing ourselves to the point where we become resentful or burnt out.
Kari: Yeah. And I found that probably 98% of the time clients completely understand vacation time and or sorry, holiday time or yeah, vacation time, whether or not it’s around the holidays. And are, you know, supportive almost right of us taking a break. And for the few that maybe are more acute or need more acute care, I think then it comes down to planning and preparing and it’s still from a clinical perspective at least can be a good experience for a client to figure out how to bridge a gap without a regular check in from a therapist and, and or to know where else to get help from because yeah, we might not always be available even if we in theory are around. So, I see a lot of value in taking the, these breaks for us, for our clients, and all of that kind of stuff.
And then it just comes down to making the logistics work. And I think as people are in practice longer, you do start to figure out that there are rhythms where people really go away most often. And I think from a financial perspective, it makes the most sense to try to time your holidays or vacations around that. So that these would be clients that you wouldn’t see anyways because they’re either on vacation, you’re doing it on their vacation time basically. So, I think that’s just something to pay attention to as you spend a couple of years in private practice, if you notice those rhythms to really try to time it so that you’re not seeing clients when you’re away that you probably wouldn’t have seen anyways because they would be away too. Is that makes sense.
Ken: It does. And it makes me think about some strategy that new grads or those who are new to private practice can think about. I think one of those is, don’t wait until the holidays to start talking about the holidays with your clientele. I typically, for Thanksgiving, I start talking about it with my patients in late October and checking in with them on what their plans are and then I say, well, we’re at it, do you happen to know what your plans are for the end of the year holidays? I mean, many of them already know and there’s no harm in asking earlier and it starts to plant the seed for them. That change is coming in from a clinical perspective if it’s going to be very hard for them to endure us not meeting, I’d much rather know about it in October than mid-December and we can start practicing building skills, or talking about strategy, or whatever we need to do to help them, whether the absence, and if that’s going to be an issue.
It’s probably part of what we’re working on in terms of attachment, or coping skills, or other kinds of really important clinical elements. So, I look at the holidays as an opportunity to almost make the therapy go a little bit faster. Really it’s a forcing function. Another thing that I tell my therapy patients who are actually going home for the holidays is that even if it’s painful to do that, it often fuels our work in the new year and they can bring back if nothing else, good material for us to be processing. And to have that kind of course they’re there. They should be present in that first person sense, but it’s also if they can approach it with a third person sense of, oh, okay, that could be used in our work. I guess that’s second person or he’ll like hearing about that story that kind of thinking. Then it helps to decrease the sting and hopefully allows them to tolerate whatever pain there might be around the family in a different kind of way. What kind of advice do you give to your clients?
Kari: It really depends on what the issue is and what we’re working on because sometimes it could be as concrete as they’re worried about having a panic attack on a plane flying home and that could be the stress. And then sometimes it could be more complicated as in how to handle complicated family dynamics. So, the advice would vary a lot depending on that. But I mean, probably general advice it would be similar to yours, which is take notes on what happens and let’s talk about it when you get back. And it definitely helps to disengage a little bit from the intensity of whatever situation they’re going through, which can help to get through it. And then they know that they have the support waiting for them on the other side. So, that is definitely probably the number one thing I would say is, whatever happens just document it, write it down so we could cover it when we get back. And I think that that helps people for sure get through it.
Ken: I like it. From a medication perspective, I would say review, but between October and the end of the year, make sure you have a really good plan with your patients about the refills. There is every year somebody who has run out of meds on some variant of Thanksgiving Eve, Thanksgiving, Christmas Eve, Christmas, New Year’s Eve, New Year’s, and I feel for them it’s not a good position to be in and I don’t want any of any prescriber to have to feel that burden to have to break the frame from their own life to have to take care of refills on times when you don’t want be doing that. So, I have some of my med management patients get a three month supply, so I’m making sure I’m doing the math, make them count the meds at times if that’s useful.
And we want to make sure that you have full medication coverage through into the New Year. And for the folks who I’m seeing monthly, it’s really easy around the holidays to get busy and don’t schedule a follow up and then, lo and behold they’re out of medication. So if it’s a patient who’s stable who you’re seeing monthly, perhaps add in an extra refill on the medication that you’re sending in just so that way if they don’t come back in December that you’re not getting a call on Christmas Eve that they’re in a medication crisis and just to check in. It’s easier with therapy patients we’re seeing weekly, because you can spend a little time of the session getting into it, with meds patients you don’t have quite as much time and it’s a little harder to plan out logistically because it might be a month or three months out before you see them again. But really want to make a strong effort in mid autumn I would say, October early November to really hammer out that schedule for the holidays.
Kari: That’s helpful for me to hear as a non prescriber because a lot of my clients are on medication, so that’s helpful to hear as a thing that I could also be reminding people to check in with their psychiatrist.
Ken: That is great and I would be very happy if all the therapists that I shared clients with would help in that process too, because it’s not good for the treatment team when that happens. And it’s of course even worse for the patient, her/himself. So, never want to see somebody in that position. It just takes that kind of really a proactive thinking and it either just doesn’t occur to people, they don’t realize it till they’re in that scenario. Certainly for patients I see who have ADHD or other executive functioning challenges, that’s part of why they’re seeing me in the first place. So, I think it’s a wonderful opportunity to work with them on long term planning and have it be in real time. It’s always nice when the work can be in our relationship as well and not just in their own lives. So, lots of good lessons for around the holidays. Any other advice or strategy for new grads that you can think of?
Kari: I think, the only other thing I could think of right now is that, going back to talking about starting to notice patterns in the year definitely one of the patterns I’ve noticed is that while there can be a slow down around the holiday time, there’s often an increase from the New Year. So, I would definitely encourage people to take a break because there’s a good chance that there’s going to be a new wave of people that want to be seen in the New Year.
Ken: That is a great point. And even our current clientele often have lots to process about the holidays. I sometimes see a blip in terms of people asking for a second session, so that first week back after the end of year holidays can be really packed. So, I like what you’re saying, take the time that you deserve and get your energy back and then you can spend it all in the New Year.
Ken: All right, well thanks Kari! It was great chatting about this with you as always.
Kari: Yeah, helpful to think about as we get there.
Ken: That’s great. All right, well I’m looking forward to chatting with you soon again.
Kari: Sounds good.
Ken: Take care. Bye.
Kari: You too. Bye.