[Transcript] Episode 433: Intersections of Accessibility & Technology in Therapy Practice

 

Evan Dumas

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton, and we are Person Centered Tech.

 

Liath Dalton 

This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and Electronic Health Record system to support you in growing your thriving practice. Therapy Notes is a complete practice management system with all the functionality you need to manage client records, meet with clients remotely, create rich documentation, schedule appointments and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user, go to therapynotes.com and use promo code PCT.

 

Liath Dalton 

Hello and welcome to Episode 433: Intersections of Accessibility and Technology in Therapy Practice.

 

Liath Dalton 

I am so honored today to be joined by Emily Decker, who is a therapist and group practice owner and current PhD candidate, focused on the intersection of accessibility within therapy, although I’ll let Emily speak more directly to the full dissertation and area of focus. Emily also identifies as multiply disabled herself, and so has both a direct experience and a professional experience, that’s the focus of her therapy practice. So I’m really excited to have you share your insights with us around this topic, Emily, welcome.

 

Emily Decker 

Thank you so much, Liath, it’s good to see you. It’s good to be on the podcast. Thank you for having me on to talk about something I’m very passionate about and that I hear very few other people talking about publicly in this professional space.

 

Liath Dalton 

I think there’s not a kind of comfort or fluency in this area yet, and so hopefully this conversation will help make people feel a little more comfortable to start having those conversations and knowing what questions to to be asking and how to incorporate that in their practices.

 

Emily Decker 

Sure, I mean, that’s that’s my hope. Research and my personal experience are pretty clear that the biggest kind of driver of stigma around disability is just a lack of familiarity and comfort with the topic. So my goal with this is to be approachable and to, you know, be a source to answer some questions and also bring up topics that I think are discussed often within spaces for disabled counselors that aren’t necessarily brought to the general field, outside of those spaces.

 

Liath Dalton 

Is there something from sort of your origin story of what led you to this point in time, and the the path that you took to get here, that you would want to share with folks at the outset of this conversation? Like what questions you started asking that seeking those those answers or having those direct experiences made this become your focus?

 

Emily Decker 

Yeah. So I’ll start by saying I’ve been disabled since birth, even though I didn’t always know it. I was late diagnosed with ADHD. Diagnosis is kind of a loaded term sometimes within the community, it’s more of an identity for a lot of us. And growing up, I always felt like I was different, and felt connected to other people who felt like they were different for various reasons. I’ve worked with, you know, disability for a long time, professionally.

 

Emily Decker 

Even from my my earliest jobs, when I worked as a tutor in college, they noticed I had a knack for working with students with learning disabilities, and would sit me with them, and I’d work with them, and just kind of came naturally. Probably because in some ways, I’m, I have been part of that community for a long time, like I said, even before I knew it. When I went into my master’s program, I studied clinical rehabilitation counseling at Portland State University, and I was part of that first cohort that intersected kind of Clinical Mental Health and Rehab Counseling, which had been considered so separate.

 

Emily Decker 

And I was really fascinated to talk with classmates the year before and the year, the year I am in, and the year after me, from clinical mental health, who had had exposure to disability only in my year and later, most of the time, versus the experiences of people in earlier cohorts, where that was, there was less of a focus on that. It was more kind of, rehab is where we talk about disability, we don’t talk about it anywhere else. And just as I continued my clinical work, I have focused on seeing clients with various forms of disability, and then I also received a pretty life changing diagnosis of a significant neurological disability the day after I got my acceptance into my PhD program with full funding, and one month before the start of the COVID 19 pandemic.

 

Emily Decker 

So there was a lot of learning about who I am and who I have been, and kind of grappling with, you know, professional identity and how we provide the service, how we show up for people, and the narratives that we have around health and wellness and safety, even within counseling spaces.

 

Emily Decker 

You know, I’d spent a long time working with people with health anxiety, for example, but a lot of health anxiety literature is geared toward people who are healthy and have health anxiety. And there’s very, there was very little out there, and still is very little out there, around how to approach those topics when somebody you know has significant disability and is in serious potential danger from some of these things that we take for granted.

 

Emily Decker 

And a lot of us experienced some of that during the COVID 19 pandemic for the first time. This feeling of, oh, I might feel, I might be unsafe if I leave my house. That’s a feeling a lot of my clients lived with for a very long time. And I actually found in my practice at the start of the pandemic, a lot of my immunocompromised clients said they felt normal during lockdown, in a way. That people weren’t giving them weird looks for, you know, washing their hands or wearing a face mask, something that’s, for some people, they’ve had to do for decades.

 

Liath Dalton 

Wow.

 

Emily Decker 

So I, the more I kind of worked in this field, the less representation I saw in a lot of the kind of resources I was searching for, and the more I kind of, the more research I did around best practices and what we know about disability in the counseling sphere, the less I saw was present.

 

Liath Dalton 

Would, what would be a good example of that that would really illustrate it kind of one of on a visceral level, for folks?

 

Emily Decker 

We have no idea how many disabled counselors exist. There has not been a survey of that. The closest representation we have is that CACREP asks students to self disclose their disability status for incoming incoming grad students, but there’s no data about how many of those students finish the program. What we do know is that the CDC says 27% of adults are disabled, but. I’m going to look up the stats. I’ll double check it. Maybe you can edit if I get it wrong, but I’m pretty sure it’s less than 3% of incoming counseling graduate students in PhD or master’s level identify as disabled. So 27% to 3%.

 

Emily Decker 

I’ll also note that 10% of all graduate students identify, or 10% of undergraduate and about 5% of graduate students identify as disabled. But the fact that it’s less than that for counseling is concerning. And when I say we don’t know how many disabled counselors exist, that’s because the CACREP entry surveys that they do is the last time I’ve seen in a counselor’s journey any kind of survey around disability status in practitioners.

 

Liath Dalton 

Wow.

 

Emily Decker 

Inn the field as a whole. Yeah.

 

Liath Dalton 

That’s stunning.

 

Emily Decker 

Yeah. And that was a major barrier when planning my dissertation, because it’s hard to know if you’re getting a representative sample, if you literally don’t know how many disabled counselors exist.

 

Liath Dalton 

Has there been any sort of shift? I mean, I would say, from my vantage point, I increasingly have seen a lot of discussion from practice owners in in the kind of past year, maybe, in particular, around having received their own diagnoses and realizing how that has impacted them, and talking about it more on a personal level, or on a business owner level.

 

Liath Dalton 

So I know one of the things that that you’re focused on is looking at how the kind of what the connections are between personal identity as a disabled person or a person with disability and a professional identity in the helping profession, and how to to navigate those multiple identities and where they intersect, and how to manage that, kind of, appropriately. With with air quotes, right?

 

Emily Decker 

I, I’ve definitely seen an increase in discussion around that, in clinician spaces, somewhat in in group owners, group counseling ownership spaces. Most of what I’ve seen has been directed toward neurodiversity. And a lot of times, neurodiversity and neurodivergence have been pigeonholed as just or kind of isolated to autism or ADHD, when in fact, there’s a wide variety of neurodivergence. Psychosis, for example, is considered neurodivergence. Bipolar disorder.

 

Emily Decker 

But when a lot of people talk about neurodivergent affirming practices, they’re talking specifically about ADHD or autism, and even then, I still see practitioners who, when challenged, will, about their perspectives of employees, who maybe say they aren’t friendly – they show up and they do all the things we ask of them, and they’re creative, but they seem very like they have a flat affect, and they’re very like they don’t come to social events and don’t make eye contact. And, they’re, you know, when confronted with: That sounds like a neurodivergent person to me, they’re sometimes saying, yes, they are, and they’re not a good cultural fit for our practice because of that.

 

Liath Dalton 

Which is concerning on on multiple levels. So how, because I know you, as a group practice owner and clinician yourself, who also does supervision, that you both have the clinicalfocus of working with disabled folks, but also have really focused on creating a accessible culture and like a neurodivergent affirming culture within your practice, right? So what are some of the the ways that you have gone about creating that, and that other practice owners listening could think, ah, that is, is a way that I could address this and start to be responsive to this real present need more effectively?

 

Emily Decker 

Yeah, so one of the things I started with was really interrogating my definition of professionalism. And what actually started that was a colleague who, right after graduation with my master’s cohort, they were offered a position, and my colleague is a wheelchair user, and one of the listed requirements of the position was the ability to walk 20 feet unassisted. And this was a job providing counseling, and it was just kind of a boilerplate copy and paste from some something somewhere.

 

Emily Decker 

And it’s worth noting that it’s it is technically illegal under the ADA to have your job descriptions include things that are not actually part of the job description. And so my colleague who interviewed great, they were so happy to hire her, were really kind of surprised when they learned that the person they loved and wanted for this job could not be hired because the job description said they were required to walk 20 feet unassisted. And it took two or three months for this organization to go through the chain and change the job, the official job description requirements.

 

Emily Decker 

So this is, this was, this was somebody who really wanted to work, was excited for the job, was perfect for the job. The job wanted, my colleague, and they had just set up this barrier unthinkingly. Nobody caught it, nobody thought about it. They were just like. Yep, this sounds – like, I mean, I don’t, I don’t know the particular background of this company, but that’s often how it tends to happen, right?

 

Liath Dalton 

Mhm.

 

Emily Decker 

Is we just, we have these things that we think of as standard and as standards, and we don’t really question them. Even looking at things like when you renew or get your license in Oregon, it’s been a little bit for me since I renewed it, so I don’t know that they still require this question, but I know another organization I just applied to did require this question. And it asks you to disclose if you have any disabilities which may or may not influence your ability to practice, even with reasonable accommodation. And there’s no talk about kind of what they’re going to do with that information, how it’s used.

 

Emily Decker 

And you know, what does that mean? Does that mean, if you need glasses to read, do you have a disability that requires an accommodation? Is that going to increase my liability rates? You know, there’s lots of unanswered questions that even if you call and contact the organization, they’ll often just say, you know, this is just the form we have to have people fill out. So because I’ve come across that often in my in my career as a both as a client and as a clinician, there are a few things I’ve done to make my practice more accessible. I’ll talk about for clients first, but for clinicians and supervisors, that’s important too.

 

Liath Dalton 

Yeah, absolutely, if we can can speak to both areas and and kind of places of vital application, I think that would be wonderful.

 

Emily Decker 

So one of the things that’s important to me, as a client, is to never make phone calls if I can help it. Honestly, as a professional too, I hate them, they’re awful. I think that plays a part in neurodivergence. But I, I know when I was looking for counselors, I felt really stuck by how many counselors required me to make a phone call and leave a voicemail. So I, on my own website. I have multiple options for people to schedule an appointment, including text message, text. There are ways for people to sign up for either a consultation or a full intake appointment, if they’re like, I don’t want to do a consultation. I still will talk to them and make sure that they’re good fit for the practice and kind of go over, you know, some of that information in our first session.

 

Emily Decker 

I make sure that I have my fees as clearly posted as I can on my website. It’s as clearly posted as I can, because the laws and regulations around insurance and accessibility of care can really clash sometimes.ometimes.

 

Liath Dalton 

Mm, mhm.

 

Emily Decker 

I make sure that my website has high contrast between the text and the background. The number of times I’ve been to a counseling website where it’s very beautiful, light blue text on white backgrounds, I can’t, I can barely read that sometimes. I make sure that all images have alt descriptions for somebody who’s using a screen reader. And, yeah, I so I just try to make things as literally accessible as possible. When I say literally accessible, that’s because we often use the word accessible to talk about affordability or availability, but when I’m talking about accessibility, I literally mean the ability for people with disabilities to access and use that

 

Liath Dalton 

Right.

 

Emily Decker 

website.

 

Liath Dalton 

Right and to establish care without having there be undue barriers, thathat would not be a barrier for someone who isn’t disabled. So, you know, being mindful of, does my practice website, like that sort of hanging shingle, right, that’s the way most prospective clients are first going to have contact with the practice and is kind of the first sense of, is this going to be a fit or or not? Is this a safe place for me, is this an acceptable, accepting place for me, that is acceptable? And so having that reflected from the very start seems seems so vital.

 

Liath Dalton 

And I imagine, you know, that there are a lot of ways that practices can also speak directly to that, in their content and copy. Like how they name the frame of what it is they do and how they work. Are there any sort of do’s and don’ts in in that area that you see? Because, I mean, maybe we need to even take a step back, though, from talking about accessibility and first define disability more explicitly, because I don’t think that’s that’s a given as to what exactly it means and what that means in the context of a therapy practice, right?

 

Emily Decker 

Yeah, it’s true. And I’ll start by saying it is a tall order to define disability. There are over 20 different definitions of disability within the federal government alone. So even when you’re talking to a government official and you talk about disability, it can mean something wildly different. So the definition that I see most commonly used, and that I think is most salient to our work, is that from the ADA.

 

Emily Decker 

So the ADA, the Americans with Disabilities Act, says that a disabled person is somebody who experiences impairment or difficulty functioning in one or more major life activities. And it doesn’t explicitly, I don’t think it explicitly defines what these are, but they tend to be things like relationships, working, taking care of yourself, physically, those kinds of things. So it’s somebody who has difficulty in one or more areas, but also somebody who who has a history of difficulty in one or more areas, or who is perceived as having difficulty in one or more areas.

 

Emily Decker 

And I think those last two are really important, because that means ADA regulations also apply to people with a history of disability. So somebody who has cancer in remission, they still have protections under the ADA, even if they don’t currently have cancer. Some of those protections can be things like, you know, a reasonable accommodation to miss work in order to go to screenings for cancer, because that’s important, to make sure it’s not coming back.

 

Liath Dalton 

Right.

 

Emily Decker 

And also, people who are perceived as having a disability. This is important too, because there are a lot of people who might be seen as having a disability that don’t identify that way. I work with a lot of wheelchair users, for example, who have set up their life in such a way that they can do everything they need to do. They can reach everything they need to reach. And they may not self identify even as disabled, as long as the environment is set up for them. But because they’re perceived as a person with a disability, they also have rights. Another example of this is the Deaf community. Big D Deaf. They tend to identify as a cultural and linguistic minority rather than as a disabled group. And to say, you know, we’re different. That they compare the difficulties that they face, maybe, to people who don’t speak a dominant, dominant language, where they they have their own you know, they have their own culture and language and identity.

 

Liath Dalton 

But if they are perceived by others or by the majority as being disabled, then that is something that is within the context of the protections of the ADA, whether or not there is self identification.

 

Emily Decker 

Yes, you’re protected, you’re protected whether or not you self identify. And that’s that’s important. I’ll also note that mental health and disabilities count under the ADA. So almost all of our clients legally count as disabled people. The last criteria in almost every DSM entry is clinically significant impairment in one or more major life domains. That’s the definition under the ADA. We don’t often think about that, but so much of our time spent with clients, we’re, we’re evaluating the extent to which they’re struggling in one or more major life areas.  We’re actually evaluating for disability when we do that.

 

Liath Dalton 

That’s, I mean, on the one hand, seems so simple and and self evident and kind of like, of course, yes, that’s, that’s kind of the the crux of it. But then I think there, as someone who, this is certainly not my domain of of expertise or or study, which is why I’m so glad to have you here. But my perception is that there is a lot of tendency to categorize into different like subsets of disability, and to perhaps even, like there are greater stigmas for for certain categories of disability, or even some in in our general society might view particular types of disabilities as more significant or problematic in a in an othering way, right? That seems pretty, prevalent, as a society at large.

 

Liath Dalton 

So I’m curious how that kind of then filters into the therapy space. If people are like, well, I work with disabled clients who have physical disabilities or who have this particular subset of diagnoses, but don’t really think of all of my clients that meet the criteria technically for being disabled, because of the impact and impairment caused by their mental health struggles and diagnoses on their their life, aren’t really thinking of that as being somehow legitimate disability.

 

Emily Decker 

Yeah, I mean, honestly, that’s that’s a kind of internalized ableism that a lot of us, even within the within the disability community, grapple with too. Those questions of, am I disabled enough, or does this count as disabling enough to be part of this group? In terms of when we when we see clients, there are absolutely counselors who work with disabled people. Sometimes we don’t know it. You know, we have clients who might have a history of traumatic brain injury that we don’t ask about or even know how to assess for. And sometimes that’s not within our scope of practice to know or do, but they’re still there. They’re still in the room.

 

Emily Decker 

Disability, like any other kind of identity marker, it just depends on the person, how relevant that feels to their their situation, their whatever they’re coming into therapy for. I’ve worked with clients who come to me and we have standard talk therapy, but they come to me because they know, or at least hope, that I’m not gonna make puns about their wheelchair use, unless they do first, because humor is a huge part of coping. They know that I’m not going to use their lap as a table and place things on it for safekeeping while we go back to the office. They know that I’m not going to ask if they’ve tried yoga or a special diet or, you know, basic sleep hygiene things, or if they say they’re having more symptoms, I’m not going to say, you know, have you gone to your doctor? Because that’s a given. And there tends to be an idea in our society that if something is wrong, you can go to a doctor and fix it. And we know that that’s not true for mental health. We know that if somebody’s depressed and you say, have you talked to a counselor, that doesn’t mean they’re not depressed anymore.

 

Emily Decker 

But we tend to have this idea that if our clients in chronic pain, or if a client has migraines or is nauseous all the time, or whatever it is that happens, we seem to have this idea that if they go to a doctor, it will be fixed. And that is not necessarily the case. I work with many people who have chronic illness and have, they’ve been to all the doctors, right? They have sometimes been across the country visiting specialists to try and figure out how to, how to manage. And that’s what it becomes about. It becomes about managing. It’s not about, not about caring. It’s about just living with chronic pain. Sometimes it’s living with uncertainty.

 

Emily Decker 

My own disability, my neurological disability I was diagnosed with, this can be significantly impacted by things like heat. So for me, when it’s hot out, I have different symptoms than I do when it’s not, and it can be hard to predict those symptoms. Even things like listening to your body. Sometimes that works for me and sometimes it doesn’t. There’s no you know, size fits all. And a lot of the, a lot of the experiences of disabled people in counseling, when they come and seek me out, they’re not necessarily even looking for counseling about their disability. It’s more that they want counseling that doesn’t make assumptions about them, that doesn’t call them inspirational for getting out of bed, but does call them inspirational for coming up with a new way to store their cane in their backpack. That makes so much more sense and makes me so happy. And it’s like, that is fantastic, that is really that is really smart, right? Where we can celebrate the ways that they’re people are showing they’reiving their lives well.

 

Liath Dalton 

Right. So there’s a huge difference between having a practice that is, you know, focused on being affirming and a safe space for the disabled, but not, the clinical focus isn’t the disability itself, necessarily, right?

 

Liath Dalton 

And looking at the whole, whole, whole person, rather than just the label of disability or like, oh, that’s not what we’re going to tackle, okay, let’s compartmentalize that elsewhere.

 

Emily Decker 

And sometimes it is.

 

Emily Decker 

Yeah, looking at disability as a as a facet. You know, something that came up, and a lot of counselors who work with people across the disability spectrum, probably saw this with their clients during lockdown, that there was a lot of isolation and a lot of loneliness in their clients, and that’s an extremely common experience for a lot of disabled people. I continue to work with people who are immunocompromised. I’m immunocompromised. I can’t offer in person therapy safely at this point in time. And you know, when I see a client who’s lonely, and you know, even if it’s not explicitly related to their disability, we take that into account when we’re talking about like, ways to safely make friends for them and reach out. You know, a lot of times the things that are recommended, like virtual groups, sometimes those don’t work for that person, right? Sometimes it’s about creating and forging the community we need, and figuring out how to do that ourselves, because there aren’t pre-existing spaces for us, right? And –

 

Liath Dalton 

So it’s a kind of a example of to meet the client where they are. Sometimes you literally have to create, or co-create that space with them.

 

Emily Decker 

I also say, too, my dress code is, please wear a top. That is it. That is the entire dress code of not only for myself and my clients, but for my practice, is, you know, please cover the basic skin you would cover. But if you show up in a bikini, I’m not going to be mad, right? Because I want you to show up as you are, not as you need to be. You know, I think a lot of us during the pandemic had that experience of, you know, sweat pants on bottom, or not comfy professional clothing on top. How freeing did it feel to be able to show up and be taken seriously while also being able to keep yourself comfortable and accommodate your needs radically?

 

Emily Decker 

Yeah, and going to that kind of idea of interrogating what professionalism means. I also interrogated the idea of what’s needed for therapy. So one of the things I say to clients is, you know, it’s important to have the video on for at least five seconds so I can, I can do the mental status exam portion of it. But I say, you know, beyond that, if you need to turn off lights, if you need to lay down, if you need to have the session from the bathroom floor, or, you know, with your therapy dog lying on top of you, or your service animal, go for it. Like we don’t have to be sitting. We don’t.

 

 

Yeah, right. And I think, and I was just gonna say it is that, was that just contained to the pandemic?

 

Emily Decker 

Not necessarily. Yeah, it’s something that I still practice to this day, and in this very moment, I think I have PJ bottoms on, technically. Yeah, so just this idea of kind of what, what counseling has to look like. You know, sometimes I have clients who, maybe have, for some reason, they’re having a hard time talking. And rather than canceling session outright, I’ll ask what they would like to do. Do you want to, do you want to get on Zoom and use the chat box? Do you want to email? You know, I talk about confidentiality and all these things with my clients, and then put it in their hands of what do they want therapy to look like, and what do they need therapy to look like?

 

Liath Dalton 

Yeah, which is what the whole purpose of the profession supposed to be. Yes. Yeah, that’s supposed to be a core tenet of it, and I think it can be easy, without knowing what questions to ask or what resources are available, to become more informed and recognize the, you know, implicit biases that we have just by virtue of growing up in in this culture. How, how to start approaching these things with more intentionality and heart as as well and bringing the therapist’s own human connection to to these pieces and ways of relating.

 

Emily Decker 

Yeah, and to be clear, there can be valid reasons for having a dress code, for requiring the video to be on at all time, for all these different things that I kind of challenge within my practice, there are valid reasons to not do those things. But there’s also a need for some people to challenge those things, and some people to offer an alternative, and to offer a practice that can look more accommodating.

 

Liath Dalton 

So you’ve spoken really beautifully about some of the ways that you have created that and manage that on an ongoing basis, right? It’s not just a, you set this up and then it’s good to go. It’s incorporated into every aspect of how the ongoing operations and interactions within the practice and within the clinician client relationship are cared for. But how, how have you kind of managed that? Conversely, as the business owner and with your with your team of the clinical team and supervisees and and with your admins as well.

 

Liath Dalton 

Yeah.

 

Emily Decker 

So there are a few things that I’ve done with that. One, even just from the kind of recruitment process, I make it very clear in the description of my company and on the front page of the website that we are disability affirming. We affirm all kinds of things. I think, all of our clinicians, you know, everybody associated with the practice identifies as queer in some way, like we are a safe space in a variety of ways. But I really emphasize disability affirming as kind of the core tenet of my practice, this practice, I should say, because I see it more as a collaborative space.

 

Emily Decker 

In terms of kind of like, yeah, the the application process, I, for one thing, did not require resumes or cover letters. People were welcome to submit them, but I didn’t require them. The big part of that, the biggest part of that, was just because I couldn’t confirm that the uploading tools were accessible. So if I made it a requirement, it would mean that if screen reading wasn’t working, people who use screen readers couldn’t apply. I asked people when they would like to interview. I gave them options. I also gave them, in addition to times for interviews, I gave options about format, if they preferred to do you know email, or if they preferred to have questions in advance so they could prepare. That’s a really important accommodation for a lot of neurodivergent folks.

 

Emily Decker 

So a lot of it comes down to Universal Design, which is a principle that I think first started in education, with Universal Design for learning. But the kind of premise behind Universal Design is to implement the most common and easy to implement accessibility features as baseline. So for example, one of the most common  accommodationsaccommodation requests is for extra time on tests. So when I’m teaching, I don’t time my tests. They’re untimed. They’re all untimed.

 

Emily Decker 

So the goal is to create a space where success doesn’t depend on things that can be barriers for people, with disabilities in particular. So I offered a lot of that. When it comes to my employees and their their working day to day life, we’re a telehealth only practice, and they get to choose the hours they work. I tell them, if you want to see a client at one in the morning, and they’re willing to come, go for it.

 

Emily Decker 

A thing that’s often touted for the importance of work life balance is to like not communicate after certain periods of time, which I think is fair, in practice, if you have a body that is reliably available during work hours. And for myself and for some potential supervisees or clinicians, that’s not the case. For me, some of my most productive hours are 2am to 6am, just depending on the day, you know. Or if I have a migraine during the day, I might work that night.

 

Emily Decker 

So one of the things that I have set up with my employees is I say, first of all, you are never expected to reply to anything outside of your work hours. Second of all, these are the communication tools that we use, this is how to silence notifications during specific hours, if you want them. Let’s set that up together if you want to, so that if you want to only, if you want to only be available Monday through Wednesday, noon to 7pm because those are your good hours, then go for it. If you don’t want to work five days a week, that’s fine.

 

Emily Decker 

I don’t have a productivity requirement for my clinicians explicitly, but I do have a break even number, which is a number of sessions that it takes for the practice to break even. And because of telehealth and because of low overhead, that tends to be a fairly low number that feels doable, and that helps my clinicians not feel like they’re letting people down. Because that’s a huge feeling that happens for disabled people. We often get the message that we’re not earning our keep, that we’re not contributing enough because we’re not contributing as much as everybody else. Or, you know, feeling like they’re being so generous with their their pay, am I actually earning that, when I feel like I have to work twice or three times as hard for the same thing? And sometimes that can come about even from getting feedback, like this doesn’t look like 10 hours of work. Well, something that can very much be 10 hours or even more of work. So there can be this, this inherent kind of tying of productivity to value. And I am very transparent with my clinicians about, you know, what they’re what they’re bringing into the practice, and how I’m reinvesting that in opportunities for all of us, the continuing education or resources, I’m always having, asking questions about accommodations and what people need.

 

Liath Dalton 

I love that approach, and I’m kind of connecting that to what you said about the test and not having the tests be timed at all, not just that people can ask for the accommodation of for them, in particular, not having it be timed. And so there seems to be this very kind of crucial link or distinction between accessibility, meaning that accommodations are available by by request, and designing something, I mean, and I guess this is the Universal Design component, designing something to have as many of the kind of feasible potential accommodations already baked into it, so that it does not have to, only that the available accommodations aren’t only utilizable by special request or by demonstrating need and making a case for it, right?

 

Emily Decker 

Yeah, and that is such a huge common experience of disabled people. Soo often, you know, when you’re signing up for an event, it says, contact us if you need accommodations. And that is one, an extra task to do, that, two, is not guaranteed to be accessible.

 

Emily Decker 

I have a I have a colleague who is Deaf and uses TTY relay, and that usually when somebody does that, the person who picks up the phone hears, you know you’re talking with somebody who’s Deaf and is using this relay service. And more often than not, someone will just hang up as soon as they hear that.

 

Liath Dalton 

That’s heartbreaking.

 

Emily Decker 

Just literally hang up. Yeah. So sometimes it’s, you know, the way to contact the place for accommodations is not accessible. I’ve also had it happen when I’ve attended sometimes conferences or events that they require a doctor’s signature for specific accommodations. Which then means, not only do I, that means I also have to make an appointment to see my doctor and pay a copay for them to sign something that says, Yes, this person needs, I don’t know, a wheelchair ramp or something.

 

Liath Dalton 

It becomes an additional Disability Tax.

 

Emily Decker 

It does. It becomes a different barrier.

 

Liath Dalton 

Time and energy and just allocatable resources in sort of every way that those resources, which, you know, are limited resources, but, like, I only have one spoon. I don’t have the spoon to be, I don’t have multiple spoons to be able to request the accommodation and go through the process of what that sounds like, and then get the proof, and, you know, all the all those pieces.

 

Emily Decker 

Yeah.

 

Liath Dalton 

So it’s, I think, if we aren’t even kind of cognizant of how that is present and apparent in what would otherwise seem like maybe a simple or straightforward thing, it’s so impactful. And I can see all the areas where those kind of accommodations available statements seem completely performative and dismissive as well. And I’m not saying specifically within therapist practices, I’m talking more generally. But then you have to also think that if people’s typical experience interacting with that or responding to accommodations available inquire or here’s the process for how to utilize them. If they have had that dismissive or discounted reaction, they’re going to then maybe be more likely to think that discussion of accommodations around accessibility within a therapy practice are also performative, right?

 

Emily Decker 

Yeah, and that’s where I think that actively talking about accommodations, being the one to broach the subject as the person in power is hugely impactful for making your practice more accessible. To be the one to ask the questions, because so often for us, it’s treated as an afterthought. It’s treated as a, if we’re even considered at all. I have colleagues who use wheelchairs, who’ve been invited to speak at conferences that do not have ramps to the stage. You know where it’s like you sought me out, and you’re still not even doing basic consideration, right?

 

Emily Decker 

So when even that happens, it can be hard for us to even broach the topic. And the number of clients that I’ve had who express relief when I go over the quote, unquote rules of things. Where I’m like, you know, you you don’t have to get out of your pajamas. You don’t have to, you know, wear makeup. You don’t, there’s, you don’t have to do a lot of these things. There’s just this huge sigh of relief.

 

Liath Dalton 

Right, freeing them from that expectation and to show up as as they are, and, and be heard and held in regard, it’s a poweful thing.

 

Emily Decker 

It is powerful. I just, I hope it is, and to be clear, it does take effort to do that. It’s not, you know, when you’re, when you have more kind of open, less restrictive practices, like my cancelation notice is, you know, no charge or penalty if it’s a medical related issue. I don’t require 24 hour,s because I don’t even get 24 hours notice when I when my body’s going to do something. Like okay, I guess today we’re going to be laying down with the lights off, sometimes with five minutes notice, is what I get. But having, having that as a practice does mean it’s it’s going to be harder to, you know, have 30 sessions a week. I don’t in general, but just when we have more limited.

 

Emily Decker 

It takes a lot of energy to, you know, have intake paperwork where almost nothing is required, where people can choose not to fill it out, maybe because they don’t feel comfortable doing that. Maybe because, you know, I work with clients with dysgraphia who have a hard time writing or reading, or who don’t have accessible typing equipment and would prefer to just say it. And so it does take more work for me as a clinician to come in with somebody who I didn’t have a consult with, who scheduled an intake, who didn’t fill out any intake paperwork, aside from the like privacy practices, it takes a lot of effort for me to go in there and meet them where they’re at and create space for them. It does. For me, it feels worthwhile.

 

Liath Dalton 

I’m so, so glad that you are who you are and do the work that you do and are helping others in like community to consider these things and hopefully be bringing it into their work, both as a clinician and a human being and as a leader like, especially in the group practice space, I think that’s that it is an opportunity for leadership skills to be developed in this area and for there to be care given to to how this is like nurtured within, within therapy practice. So I’m I’m very, very grateful.

 

Liath Dalton 

There are so many more questions that I have for for you, but I am excited that we are going to be getting into, or you, I should say, are going to be getting into a very specific area of application around accessibility and therapy, and specifically related to teletherapy, you know, another domain of your expertise. So wanting to share with folks who are listening now that an upcoming CE presentation that will be a legal, ethical CE presentation Emily is going to be presenting on, Can You Hear Me: The Legal and Ethical Role of Accessibility in Anti-Oppressive and Neurodivergent Affirming Teletherapy, and that’s going to be both live and recorded.

 

Liath Dalton 

Speaking of accessibility, what, is there anything you would share about that upcoming training and how that connects a little bit to the conversation you and I’ve been sharing today?

 

Emily Decker 

Yeah, so our conversation today, I think, has included a variety of topics. There’s a lot to talk about, and there’s a lot that can be mystifying about just even the first basic steps for accessibility. The laws tend to feel and seem really scary, and research says like the number one barrier to providing accessible accommodations is fear about the law, fear about the ADA, fear about the repercussions of it. So my goal with this training and with our podcast today has been, and will continue to be, to try and demystify some of that, to give resources, to just help you at least feel like you’re putting your best foot forward and doing your due diligence. Because if you’re, if you’re, you know, doing something as what’s considered basic in the ADA, as you know, providing descriptions of your images. If you’re doing that, you’re already ahead of the curve, and if you’re not, there are some really, my goal is to make things pretty easy and approachable, something I learned from Roy, I think that was really the ethos of this whole company, has been to demystify the mystical and and help us do great work with with our clients, help them, help them, reach us, and help them and us feel better and more comfortable about things that are scary.

 

Liath Dalton 

That’s a perfect way to put it. I was going to say in the sort of like purpose statement of the CE program, I think, where it would very much have described it to be oriented around exactly that, demystifying the mystical and then equipping people to, to actually navigate, to understand and to navigate what was important for their practice and and their clients.

 

Liath Dalton 

And so it heartens me, especially just kind of as the you know, a continued purpose of PCT is to steward Roy’s legacy and the values that he founded PCT on the basis of, and clearly, like you, as a former student of Roy as well, are also out living that in amazing ways in your professional and academic work. And so, speaking of intersections, I’m glad to have that, you know, circle back to to PCT, and find find that to be tremendously meaningful.

 

Emily Decker 

Of course, and and in Roy’s honor, there will be memes in the presentation,

 

Liath Dalton 

Will there be cute kittens or puppies,  at some point?

 

Emily Decker 

There will definitely be a cute puppy. I like to use my dog as a slide transition when we’re talking about heavy or complicated things, so there will be a puppy. Yeah. And I also plan to talk about accessibility, not just for clients, but also for clinicians and supervisors, at least a little bit, because disabled people are not just clients, right? We’re also practitioners, which is something we also forget about in this field. So I hope it’ll have something for everybody. I know the topic can sound dry, I’m gonna do my best to make it engaging.

 

Liath Dalton 

Oh, I have, I have full confidence that it will, will be engaging.

 

Emily Decker 

Good.

 

Liath Dalton 

I mean, it’s, it’s, let’s be, let’s be honest, though, it is less dry than HIPAA at face value, right?

 

Emily Decker 

It is. But I got my first training on HIPAA from Roy, and it was very entertaining.

 

Liath Dalton 

This, this is true. He did, he did set a high bar. Well, to the good folks listening along right now you can check out in the show notes, will be a link to the training, which will be available both as live and recorded. And then I will also link to how you can connect with Emily directly, because Emily does consulting and supervision in the areas that we’ve just been discussing today. So if that is something that you want to avail yourself of, there are means to do it. So do check out the show notes and thank you again, Emily, so much for your time and for your care.

 

Emily Decker 

Of course, thank you for the platform and you know, giving voice and attention to this topic, it’s much appreciated.

 

Liath Dalton 

Absolutely.

 

Liath Dalton 

All right, folks, stay tuned for our next chat, and thanks for joining us. This has been group practice tech. You can find us at personcenteredtech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast, or click podcast on the menu bar.