Episode 85: Tearing Down The Mental Health Industrial Complex [featuring Elizabeth McCorvey]

Show Notes

Many aspects of the mental health field as we know it are systemically based and built on values sourced from colonialism, white supremacy, and Christianity.

As a result, there is often a lot of secrecy around the practice of therapy, and it can be very difficult to access for certain communities.

If you want to change the level of care and inclusivity in your therapy practice, as well as build more community, then this episode is for you.

In this episode, I talk with Elizabeth McCorvey, equine therapist, college counselor, anti-racist and anti-oppressive trainer and consultant.

Top 3 Reasons to listen to the entire episode:

1. Understand in what ways therapy is the opposite of community and how that shapes actions, ideas, and biases around the mental health field.
2. Learn ways to limit and tear down the oppressive structures around race, identity, ethics, community, and more in the mental health field.
3. Understand the importance of setting clear boundaries around how you support and show up with clients so that you yourself are not harmed as the healer.

It's important to understand and shape the care you provide to clients around boundaries based on honoring your authentic self, as well as do the work to really understand the communities you serve.

More about Elizabeth:

Elizabeth McCorvey, LCSW, is a psychotherapist in Hendersonville, NC. She is faculty at the HERD Institute in FL, where she helps bring therapists and horses together to support the healing process of their clients. She also works with college students at UNC-Asheville, and has a semi-private practice where she sees clients for mental health therapy. Elizabeth is a passionate advocate for anti-oppression, equity, and dismantling the mental health industrial complex, and frequently facilitates workshops for therapists on the subject.

You can find out more about Elizabeth and read her blog at www.elizabethmccorvey.com.

Upcoming courses: www.elizabethmccorvey.com/supervision-for-lcswas

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Transcript

PATRICK CASALE: Hey everyone, you are listening to another episode of the All Things Private Practice podcast. I'm your host, Patrick Casale, joined today by Elizabeth McCorvey. She's an LCSW here in Western North Carolina, and an equine therapist, college counselor, anti-racist, anti-oppressive trainer, and consultant. 

And we're going to talk today about tearing down the mental health industrial complex and whatever else comes up. So Elizabeth, I'm really excited to have you on and have this conversation.

ELIZABETH McCORVEY: Yeah, thanks so much for having me. I think it's funny being on a podcast about private practice, and also, talking about my desire to burn down the system, but I think they also go hand in hand.

PATRICK CASALE: Yeah. So, you know, when I ask people like, what are you passionate about talking about? I want to go in that direction. And you sent me the blog that you recently wrote, and I read that, and I think it makes total sense. And I want to kind of explore what's fueling the fire there, so to speak. 

And also, you know, I know you have a small, like, semi-part-time practice, I think you mentioned. So, I'm interested to hear both sides of the coin of like, the need to change a lot about what we're doing and I'm also working in this industry that I'm also actively trying to change pretty significantly too.

ELIZABETH McCORVEY: Yeah, yeah. So, what fuels that is rage, my rage against all of the systems and all the ways that we are, I think, that psychotherapy is actively working against the things that we say we're trying to dismantle. Like, we're actively contributing to the problem, is what I mean. 

So, I said to someone last week, and I was kind of joking, but then I was like, "No, I'm actually kind of serious." I said that the opposite of psychotherapy, the opposite of therapy is community, I think because I think we've created the system. And by we, I don't mean like individually, I mean, societally, with, you know, the morals and values of white supremacy, Western structure, has created the situation where the therapeutic thing is going to a secret meeting in an office with someone who is not necessarily in your community, that you can't say hi to on the street, and then, doing all this healing in private, when we are communal creatures, and we're social creatures, and the way past all of the bullshit structures is not going to be being separate from each other. 

And I think that it's tough. Like you said, I am also working against the field or I'm working in the field that I say I want to dismantle. And I think that for me, right now, psychotherapy is like a necessary evil. And I think that it's not ideal. And it's what we have. And it's not working. And I'm actively frustrated with it constantly. And it's what we have. So, it's a lot of both ends.

PATRICK CASALE: Which is like a wonderful therapist saying of both can be true. 

ELIZABETH McCORVEY: Oh, my God, yeah. 

PATRICK CASALE: Yeah, I have too many examples of that. Yeah, this is a very nuanced conversation and it's definitely very layered. So, you mentioned some frustrations. And in your blog, you mentioned a couple of those things, too. And I want to know, like, what really jumps out when you're thinking about, like, the frustrations with the field, the frustrations of the direction of where mental health therapy is going. And also, just the fact that like, we are working in a system that was created really via the colonialism and Christianity, honestly, in a lot of ways. So, there's a lot of harm that's not even being done intentionally, but still being done based upon how research has been structured, how funding has been structured, etc. 

So, we all know not everyone has an equal share of access to care and individual therapy certainly feels very privileged for people to say, like, I know, you mentioned in your blog, like I get to spend $150 an hour to go talk to this person in private, in secrecy, and like, have this conversation, but then that's the end of it, and then we move on, and I think that feels really challenging for people.

ELIZABETH McCORVEY: Mm-hmm(affirmative). Yeah, yeah. So, there's this great graphic that I came across, maybe it was when I was doing an REI training, the Racial Equity Institute. So, the graphic is… and you can Google it, it's called the octopus of oppression. And it talks about the ways that, like, colonialism, patriarchy, white supremacy, capitalism, like all of them intersect to create kind of the system that we have now. 

And I think about that a lot when I think about the role that psychotherapy plays in upholding the systems of oppression. So, you asked what jumps out at me as one of the things that really sticks with me as I try to do this work? Actually, the thing that's popping out it surprises me. The thing that's popping out right now is diagnosing, like, which we all know is, well, maybe we don't all know, I personally find problematic in so many ways because I think that diagnosing can be so supportive for people. I think it's really wonderful when people are able to find like, oh, this collection of things that I'm experiencing has a name, and I can understand myself better through that lens, and it's wonderful. 

And the way that we use that as a means of access or a means of restricting access is really terrifying. Like, when I think about the amount of power that I have as a psychotherapist, like, it really scares me, it feels so uncomfortable, it feels so uncomfortable that like not knowing a person who walks through my door, just by virtue of them being my client, I then have the power to give them a diagnosis that they don't agree with, that they could be sent to a hospital for, that they could be traumatized by, that just is then attached to them. 

I don't work with the police, but I could call the police and say like this person is a danger to themselves. And the police would believe me because of the credentials that I've paid for. And that's just a scary amount of power to be given to an individual person, I think. So, I don't even remember what your question was. But let's just say that [CROSSTALK 00:07:18].

PATRICK CASALE: I like the thought trains that you're going off on. So, I agree. I think there is such an imbalance of power in the therapeutic relationship, and, you know, when it comes to diagnoses, especially, right? Like, we're talking about stuff that can follow you around for the rest of your life. And if you're going to get life insurance or going to do something down the road, you might be denied care because a therapist 20 years ago gave you X, Y, and Z diagnoses because they've met you for 60 minutes. And we're unable to take into consideration every single fucking factor that's contributing to how these symptoms are presenting. 

And then, that can certainly dictate how you go through your life if you're thinking, "This is my diagnosis now, this is a part of my identity, this is who I am, this is why I perceive the world this way." 

And I think there's so much fallout that can happen from the inaccuracy, from the misdiagnosis, from the lack of necessity even to have that formal diagnosis in place. And that's a really frustrating place to be.

ELIZABETH McCORVEY: Right, right, especially, when we want to support clients who have insurance and we have to diagnose them. I know that what I do in my practice because I do have a private practice where I do equine-assisted psychotherapy. And I don't take insurance for that. But I also contract with a small general practice hospital in Hendersonville. And so, I do have to diagnose there. 

And I'm sure lots of therapists do this. Like, I'll start with an adjustment disorder, and then, I'll talk to the client about what do they feel like resonates? But I don't ever give anybody a diagnosis that… Ever? I want to say 99.999999% of the time, I don't give anybody a diagnosis that they don't agree with because even if I like see it so clearly, it's so obvious to me, I'm still not living in their body and it is not fair for me to wield that power. That's not power I want.

PATRICK CASALE: Yeah, no, I completely agree. And it really needs to be a collaborative approach in that regard, and so often, I think, we're just trying to check the boxes for insurance and then we don't even have the conversation with the client half the time about what we've diagnosed them with. And that doesn't feel fair for me to feel like the client doesn't even know, you know, what's going on to their record or what's happening behind the scenes. 

But there are so many of those instances in mental health therapy where you could talk about how this is not a fair playing field, and how the therapist has all this power, and how do you balance that out, especially, in society when it's constantly being thrown around like, "You need to use these evidence-based practices, you need to do this thing, you need to approach this client from this way." And in reality, very little of the time are we taking cultural consideration into place then.

ELIZABETH McCORVEY: Oh, my gosh, don't even get me started. Well, you invited me here, so do get me started. My culture on confidence. I do a lot of anti-racism consultation, and I do a lot of anti-racism, like trainings and workshops. And so, one thing that I'm doing a lot of recently is anti-racism consultations, specifically, using equine therapy as a modality. And that's really fun because, you know, a common theme for people, especially, people who don't know horses, is like, I don't know what the horse wants, we don't speak the same language.

And I remember asking a group… I did a group with a bunch of coaches one time and they said that. And I said, this is like my golden question, you know? Sometimes when we ask like the perfect question it feels so good. I said, "What if we assumed that we don't know anything more about our clients than we do about these horses because we are?" And they all went, "Oh." Which is also my favorite moment because [CROSSTALK 00:11:16].

PATRICK CASALE: Right, that does [INDISCERNIBLE 00:11:17] really good. You're like, "Yeah, that was the right one right there."

ELIZABETH McCORVEY: Yeah, I nailed that. That was an excellent question. [INDISCERNIBLE 00:11:23] go home. But I do believe that because I think that if we go in assuming that we don't know any more about our clients than the information they are giving us in that moment, then we can go in with some open mindedness about what kind of support we can offer them, from a much more culturally informed standpoint.

For some reason, I'm thinking about, I worked with a client who was of Asian descent, or is of Asian descent, and she was talking to me about her family, and feeling unable to like disconnect from them, and unable to like, develop her own sense of individuality. And like for a second, I like flashed to being back in grad school, and I was like, "Oh, a meshment, you're a mesh. You need to individuate, you need to, like, figure out how to put some separation." 

And then, I had to check myself because that's a pretty colonial mindset. And that's not in alignment with, like, what her cultural needs are. And if I were someone who didn't have the lens of providing culturally responsive therapy, then I could have given her a label that didn't fit, that wasn't accurate, and my whole treatment would have been different, and it would not have been in alignment with who she is or what she needs. 

And so, really checking myself on what lens am I coming from? And when you say, like, evidence-based practice, like evidence by who? Like, who decides? Still maintaining an awareness of that, and the humility to say, like, A, I have to check the amount of power that I'm welding and B, I need to be aware of where my clients are coming from because it's not where I'm coming from.

PATRICK CASALE: Absolutely. And I fear that too often that we are not doing that as a whole, in the profession, and especially, in a profession dominated by white people in general. You're doing maybe a cultural diversity class in grad school and you're saying, like, yeah, check the box, and like, yeah, these are my beliefs. Like, words are nice, but like, is the action really there? Is the learning there? Is the continuing education there? Is the training there? 

And I moderate a Facebook group that has about 8000 therapists in it now. And I can tell you just from having to be a fly on the wall in a fucking Facebook group, like we are so far away, in terms of bias, and just the racism, transphobia, homophobia that comes into the mental health space, and it's really appalling, but I guess it should not be shocking.

ELIZABETH McCORVEY: Yeah, yeah. It's scary. it's scary. The amount of unchecked power that there is, I think that was my point when I wrote that blog because I was, like, on fire when I wrote it. I was furious. I didn't even know it was [CROSSTALK 00:14:16].

PATRICK CASALE: You got energy while I was reading it. So, I think you got where you wanted to get out of it, I imagine.

ELIZABETH McCORVEY: Yeah, for those of you, if you're interested, the blog is on my website, elizabethmccorvey.com. and then you can click through and find the blog. And it's just this like, I was about to say it's just like rage fueled rant, but it's not. It's really well written. And it's concise. It's very clear. What I'm saying is very clear. 

And I think I was really trying to ruffle some feathers, but actually, by saying things that I don't think are that controversial. But I think grad school prepared a lot of… or underprepared a lot of us in terms of working with cultural competency, but like, also, over inflated the ego of what help means. Like, people say like, "Oh, I just want to help people, I got into the seals because I want to help people." 

And that's really noble, I guess. And I say this in my blog, that if you don't have a cultural connection with the communities you're trying to help, you're just colonizing them because when you go in with no knowledge of the community, and this idea that you even have the tools, the qualifications to help a community that you have no relational connection to, that's extremely unfair to that community because now they have to teach you, and now they have to hold your hand while you make all of these mistakes. 

And actually, that community probably has a really excellent idea of what they need. And also, they probably have people that are tapped into resolving the issues that are in their community. And so, if you want to support that community then maybe you need to go in as a volunteer, maybe you need to go in as, assuming that you are in someone else's home, that you've been invited, if you've been invited, that's another question, have you been invited? And if you don't have the relational connection with them really examine, like, what is your drive to be in this community? 

I think that so many of us because of, like, colonial teaching, and like, you know, public education, or private education, like so much of it looks like, "Oh, there's some like poor people over there who need help." When actually, a lot of these, like, poor people, I'm putting on in quotations, like people of low socioeconomic status have better budgeting, better awareness of their finances, a better sense of what's coming in and out than many of us in positions of financial privilege do. So, all that to say, we really have to check ourselves.

PATRICK CASALE: Yeah. And I think that that checking balance process has to be continuous, that's not a one-time thing. It's like, you have to be evolving in this profession constantly. And you have to be learning, and you have to be seeking out the information, like you said, it should not be someone else's job to teach you. I think you should really be showing up trying to do the learning and do the training, do the consultation. 

If you're spending money or resource in this field, paying people that are parts of these communities to help with consultation and training, and really investing in people's successes, and really ensuring that you're hiring experts to come and talk to you, or talk to your group practices, or help you with consulting and training for ongoing learning. I think it's really, really crucial and another thing that gets missed.

But I'm trying to think about what you wrote in your blog, something that stood out to me, and I wish I had it pulled up. But it was something about a client not seeing eye to eye or saying something that felt really harmful for you as the helper and saying like, "I can't help you or I can't do this here because that's going to harm me. But we can work on A, B, and C, right? Because that's what I'm here to do." Can you kind of elaborate on that a little bit?

ELIZABETH McCORVEY: Yeah, yeah. So, I think it's within the last two or three years I've really doubled down on my commitment to myself in the therapy room. So, I am not a blank slate therapist, I have never been, I am incapable. I am opinionated and I am brassy. Like, people know that coming into work with me. And if they don't, they figure it out really quickly.

PATRICK CASALE: I think that you put on your like bio, like, I think you put rabble-rousers, loves stirring the pot. I was laughing when I was reading it today. I wanted to get like a quick overview again. And I was like, these are good answers. I like this a lot.

ELIZABETH McCORVEY: Yeah, I love problem, I'm going to be a problem for you. And so, I'm really committed to honoring what my needs are in the therapy room because what I really believe in is, I don't believe in psychotherapy as a long-term solution to community wellness, but I do so deeply believe in the power of relationship and relational healing. 

And then, I believe that in order for people to be healed in a relationship, I have to also be honoring myself as a relational component of what's happening in the room. 

So, the client I named in the example is not the only client it's happened with where I feel I have struggled with somebody who's like untangling their own, like, racism, for example, or untangling their own, like this particular client in the blog, untangling their own phobia. 

And in these two examples, they're doing it in a way that I would then have to go and seek out my own therapy for it because it was hurtful and they come from, you know, privilege and power is layered. So, just because I'm the therapist doesn't necessarily mean I have all the power. I have a lot of power. But if it's my word against the word of like a cis white man, then I don't have a lot of power. Like, you know, in a situation where there was like a he said, she said, they said situation. 

And so, I think that there are so many ways that relationship can be healing, and I am never going to hurt myself in service of someone else's healing. I'm not going to put myself in a position where somebody untangling their own racism that there's going to be an ongoing situation where I have to support them as they try not to hurt me. 

And I'm of the belief that like I'm just a step on someone's journey, and maybe their next step, and next therapists, or next healing opportunity will be with someone who can hold that. But if that's not me, then I feel fine with that. I don't feel compelled to support somebody on every single step of their journey. And it's not possible. It's not possible for me to do that. And it's unfair for me to hold that kind of expectation or standard of myself because there are lots of skills that I don't have. And it's a scope of practice question, too, I think. 

Like, am I in the position to support someone who is needing EMDR, for example, I'm not trained in EMDR. And if they're choosing not to get EMDR, they really want to see me for lots of reasons, great. There are lots of things we can process and maybe you still need EMDR. And that's okay. And maybe you're not getting to unpack your racism with me. And maybe there are other ways that we can connect that would still be able to feel supportive and healing. 

PATRICK CASALE: I love that. And I think that's such an important point. And I think this is so missed so routinely where, one, I see a lot of therapists who feel like, I think they've gotten into this field to heal themselves through the work that they do. And I think that it's really unhealthy really quickly. I think that we assume we have to be these blank, robotic slates, like you mentioned, that you're not and I've never been either. And I just think that it's really hard to have an authentic healing relationship when you're bracing all the time for what's coming out of the other person's mouth because you're saying to yourself, "But I have to endure this, like, I have to tolerate this, like, I have to absorb this."

And that's when you go home, and you're like, "Well, am I drinking myself, like, into a stupor today?" Or like, "What am I fucking doing to deal with this?"

And I had a situation like this in reverse in a lot of ways where client was just using a lot of racist terminology over and over, and I just was like, "You are harming me because you're harming my wife, you're harming like, the people in my life, my in-laws. Like, I can't hear this anymore. And I just had to be done with it." 

And I was willing to endure that for so long until I realized, like, why am I sitting here allowing this to go on because I feel like I'm obligated to? So, I think, like, we can still have this relationship, this helping/healing relational relationship because we were able to be honest about what we are going to and not going to talk about, and not what we're going to tolerate in this room. 

And it's such a messy profession. You know, we're dealing with people, we're dealing with all of these disadvantages, suicidal, you know, lack of resources, in general, and you're trying to show up and be your best self, but like, you're a human being as well. And you're impacted by the work that you do. So, how can you do that if you're not really in authentic, genuine relational connection. And really, like you said, there are therapists out there for everybody. You're going to be a blip on someone's journey, people are going to have 20 fucking therapists in their lives, and that's okay. 

And I've always been of the mindset that I'm working myself out of a job since day one. Like, first time we meet with someone, I'm working myself out of this job that I don't expect to be there long term. So, I think there's a lot of changes that have to happen in this profession. And I'm glad that we're seeing more people start to really speak out about what they think is the direction that we need to go in. 

I still think it feels really complicated to say, like, I'm in this profession, but I also want to burn this profession down, but I think that's really how I feel a lot of the time as well. And I think that a lot of therapists feel that way. 

And I'm wondering, like, the preventative there, like what's preventing people from actually expressing, like, "Hey, this is the issue that I think I'm seeing or that isn't really being addressed." Because you're right, like, community and relationship is healing. But if we're doing so in secrecy, or shame, or stigma, or we're kind of elevating it on a place where not everyone has access to be able to take place in these secret meetings then what are we really doing?

ELIZABETH McCORVEY: Yeah, we're supporting people who are able to have access to it. And I guess what sticks out to me and what you're saying is, and I want to highlight that we are also, therapists also, you know, are being harmed by this system. Like, it's not serving anybody. It is serving us more than others because we have the credentials and the position to be able to make money and in a system of, you know, capitalism industry that has capital.

But it's not… I mean, I think the reason that we're still in it even though so many of us know this isn't working is because we also have to survive and so, it's this like, endless loop, like irk. And that's why I feel like it's going to take something major. Like, I think people in power are going to have to give up some power, but they're not just going to hand it to us on a plate. I think we might have to demand that. 

And so, then when I get really, really into it, I'm like, "All right, everybody, we have to give up our licenses, and we have to stop doing this." But that's like not maybe going to happen. 

But I do think… and I said this in the blog, like, I do think that if people had food assistance, housing assistance, supportive community, access to resources, access to medication, access to gender-affirming care, like, I would lose 90% of my caseload. And I would love to lose 90% of my caseload. And I wouldn't even need that 90% because I would also be cared for in those community ways. 

But I don't think that that's going to happen quickly. I don't think that it's going to happen in my lifetime. But I think it is what's needed. I think a lot of folks talk about decolonizing the mental health system. But for me, the mental health system was built on colonialism. So, I don't think there's any decolonizing it. I think that what we'll do is put a bunch of band-aids and stop gaps, and then people in power will say, "Okay, well, we did it. We moved an inch, so you should be satisfied." And then every 20 years, they'll say, "Well, we moved an inch." Even though that inch was like 100 years too late. And I think it'll just keep creeping, creeping, creeping and always be behind because it serves people in power for us not to have access to these resources. So, I think it's going to have to take something big. 

But then, also in my blog, I mean, I want it to be like a big revolution, but I actually also believe in tiny revolutions. And so, I think practicing therapy in a way that I feel is ethical and relational is also a tiny revolution. So, when I say like, I don't work with police, I truly don't work with police and I let my clients know that right away. I also won't work with hospital systems unless my clients want me to. And I told them that right away. 

So, unless, and I tell my clients this, like, unless you tell me that you're going to walk out of here and walk out into traffic, like, if you told me you're suicidal, like, let's work with that. If you tell me that, like, you're going to do a bunch of drugs and fuck yourself up, like, let's work with that. But like, I am not going to involve a carceral system that is harmful for you, also harmful for me if we can figure out ways of community care that are more supportive for both of us because I matter. Like, if I'm going to call the police, like I am also in danger, then. 

PATRICK CASALE: Absolutely. 

ELIZABETH McCORVEY: And I'm not willing to do that.

PATRICK CASALE: And I think that circles back to what you mentioned before being so important of also taking care of yourself in the therapy room. And I think these tiny revolutions actually make a lot of sense because, like you just laid it out, it feels so insurmountable sometimes to say this is what we all need as a society and then we say, do we really think we're going to get there in our lifetime?

But what I think is that we are starting to see more and more tiny steps and more and more people who are truly aligning themselves with their actual values and beliefs, opposed to like, "I'm a trauma-informed therapist, and I'll walk alongside you, and do all the stupid fucking things that we say we're going to do."

But in reality, like really aligning with, you know, pay what you can models, and anti-racist practices, and really, all of the things that come with doing the things differently than sounding boards, evidence-based care, this is how this has to look, this is how this profession has to operate, this is how we have to speak, this is how… you know there's so much gatekeeping, and there's so much colonialism there, and there's so much bureaucracy, so like, just smashing that down seems pretty fucking ideal to me.

ELIZABETH McCORVEY: Yeah, and it's more sustainable too. I mean, like I said, I would love everybody to, like, decide that they're going to give up their licenses, but that's not possible, or sustainable, or it's not also not a fair thing to ask of people when our licenses are… it is what puts food on the table. 

But I do believe that, like, in my own circles, and my circles with my friends, with my clients, like I am doing something different. And somebody said, I don't remember who, probably at Building Bridges or Rei, someone said that, like the revolution and liberation was never supposed to solve the problem. The intent was always for it to create new problems. 

And I love that, I love the idea of creating new problems. I was talking to somebody who was trying to figure out how they could see an equine therapist, who was trying to figure out how they could see a client who was offering to work off their sessions by, like, mucking stalls or doing something. And of course in our codes of ethics that's like a huge no, no because it's super racist and says that bartering is not the ideal choice, even though bartering is an acceptable choice in many, many countries. 

But what that brought up for me was like, okay, so maybe they do muck our stalls and maybe that is a dual relationship. But that's also like a new problem. Like, yes, a new problem, let's solve a new problem. And then that offers opportunities for both the potential client and the therapists to like, step into a relationship together, and troubleshoot all of these issues that might come up and figure out like, what could this actually look like in a way that is ethical, and sustainable, and culturally informed, and supportive, and that supports people in meeting their needs. So, I love the idea of creating new problems and I create a lot of them.

PATRICK CASALE: I love that. I mean, I love that, and I love that exact image, and that process too because, you know, we love to throw the ethical word around. And I think that if I really examined ethics, if we were to say, oh, if you're going to muck stalls, and you're going to get care, and support, and relationship in return, and the alternative is to say no, and you get no care, no relationship, and no [CROSSTALK 00:32:10]-

ELIZABETH McCORVEY: Right, and that's an old problem. We have that problem, we know that problem. Let's make it [CROSSTALK 00:32:14]-

PATRICK CASALE: Yeah, that problem exists. We don't need to recreate that fucking problem. So, if we can prevent that problem, or we can eliminate that problem then why not? I always think about it as like, which decision does less harm here? And which decision ensures that somebody can potentially get the healing, and connection, and relationship that they need even though they may be cannot afford to pay for it out of pocket, or whatever the case may be? I think we create a lot of these issues for ourselves in this profession too, and it's just one of those things that really frustrates me to hear that term getting thrown around constantly, like, "Oh, that's an ethical violation. Oh, this is…"

And again, like you said, now, this is more of a racism-based problem, this is a lack of cultural consideration-based problem. Like, these are not actual problems. They've just been instilled in this profession based on supremacy culture. 

So, again, I think there are lots of cool things that can be done. And I love that you just named that and these revolutions, creating new problems. I really like that, that's going to stick with me.

ELIZABETH McCORVEY: Yeah, right on, right on. I love that. Yeah, and I think what we get into then is like because there are only so many stalls. Like, I can't have a caseload of people who are all mucking stalls. But that's also a new problem. Like, okay, so I do have a couple, I don't actually but like, you know, in theory, like maybe I have a couple who are doing that. And maybe it's part of a relationship where I say, like, I actually don't have that need right now. I wonder what else we could figure out because I want to support you? And then, of course, I have lots of, ideally, of course, then I have lots of other clients who are paying my full rate or paying above my rate so that they can support people who otherwise wouldn't be able to pay for that. 

And so like, I want to create new ways of doing things because I've splintered off from the way that we've done things forever. 

PATRICK CASALE: I love that.

ELIZABETH McCORVEY: And actually, I guess, I should say, it's not the way we've done things, it's the way that, like, the people at the top of the bell curve have done things. There are lots of people at the margin who have actually solved these problems. And they don't have the access, or the privilege, or the voice to be able to say like, "Oh, actually, we solved this. We just need you all to get on board." 

PATRICK CASALE: Yeah, absolutely. Well said. I really love that. And I think that's really a wonderful way to look at how this profession and how these relationships can work. And that sounds like, when you say that, you know someone who's paying more than my rate to offset the cost of someone who can't, that sounds like to me like community [CROSSTALK 00:34:52]-

ELIZABETH McCORVEY: That's community, exactly. 

PATRICK CASALE: …well-being of the collective instead of just the few. And I think that means you've done a really fucking fantastic job, if that's the way you're conceptualizing, or that's the way that, you know, your clients are showing up as well because it sounds like everyone is invested in the common cause.

ELIZABETH McCORVEY: Yes, yes. Exactly, exactly, exactly, exactly, yes. I was talking to someone about… I have a friend who's always harassing me about raising my rates because if I don't have a rate that is at market value then I'm devaluing. Sure you've heard this like, like you're devaluing the profession by not having your rate at… and I get that, and also I get to decide what has value and money is made up of. 

And so, I love the idea of being able to offer people with means can do more so that people that don't have the financial means don't have to step up as much. But the value is the same. Like, the value of the work that I'm doing, like $5 has the same value as 500. It's all on the eye of the person who is putting forth the capital. 

PATRICK CASALE: And I hate that fucking conversation in this, you know, like the charge what you're worth conversation because like, how do we ever truly quantify that anyway?.

ELIZABETH McCORVEY: You can't.

PATRICK CASALE: Yeah and I could talk about that all day. But like, you can't. So, exactly, the value is in the eye of the beholder. If the $5 client and the $500 client both get the same value out of what they're paying for, I mean, I think it really doesn't make a difference whatsoever. 

But we are a profession that loves to, like, challenge that notion too of like, "No, charge what you're worth, and don't let the insurance panels take advantage." Which I'm totally on board for. But there is another side of it too where it's like, "Does any of this really matter, or are we just creating this construct for ourselves again?"

ELIZABETH McCORVEY: Yeah, yeah. And I get it too because I think we do deserve to be just, you know, "Deserve." But we do deserve to make what lawyers make, or what doctors make, and they don't have the same dilemmas because their profession is valued in a way that ours isn't. I want everybody to get their bag. And I want us to really examine like, what could be out there for us to offer to meet people's needs in a different way. 

And I think that therapists are constantly having this conversation, which I appreciate about our profession a lot. I think that we are able to see those nuances in ways that other professions don't have to, and money is made up, and everybody should have access to resources, and we should have universal health care.

PATRICK CASALE: Boom, that's a good mic drop moment right there. Well, this has been fun, Elizabeth. This is the first time Elizabeth and I have met, and I've really enjoyed this conversation. So, I just want to say thank you for coming on and just making the time to talk about this and sharing this too because I think it's so valuable to have people thinking differently, not only in this profession, just in general about what life can look like because we are all in this together. And there are ways for us to support each other, and connect, and build each other up instead of trying to drag each other down. And I really, really appreciate your perspective on all of this.

ELIZABETH McCORVEY: Yeah, yeah, I'm really delighted that we got to meet this way because I would love to, like, talk about, like, that's what I prefer. There's a… it's sort of a joke, but not really, when I meet people I can't do the like, "Oh, what do you do? How's the weather?" Whatever. I like to just go in and be like, "What's your trauma? Like, let's talk about that." 

So, I love the idea that like, we just got to know each other by talking about, like, some really good deep shit.

PATRICK CASALE: Oh, yeah, I mean that that, for me, feels much more value-aligned and that feels more authentic. I do another podcast with Megan Neff, who's also an autistic ADHD psychologist. And every time we get on I'm like, "Megan, how's your day looking? And how was your weekend?" And she goes, "Can you stop fucking asking that?" I'm sorry Megan, it's so ingrained.

ELIZABETH McCORVEY: It is.

PATRICK CASALE: It is, but I really do love the deeper, really more meaningful conversations. So, I appreciate you being willing to come on and just be really authentic, and really real about what's happening, and just your passions right now, and what's going on for you. 

ELIZABETH McCORVEY: Awesome, thank you. 

PATRICK CASALE: And for those of you who want to read Elizabeth's blog or any of the stuff that she's created, please tell the audience where they can find that information because you've got some really great writing out there and some really good content. And I think it's valuable to start following people who have voices, who are willing to take up the space, and willing to think differently, and I will have all of the… head cold, all of Elizabeth's information in the show notes as well.

ELIZABETH McCORVEY: Yeah, yeah, thanks. Yeah, you can go to my website to find out what I'm doing, where I'm at. I've got some resources out there, like, that I've written for people to access if they would like it, the blog is up there. 

I've started offering some supervision for LCSW-A's. There is a process for, again, because I don't choose to be in relationships where I'm going to be hurt, there is kind of like a Google form that someone would need to fill out in order to work with me because I only work with people who are coming from an anti-oppressive lens. 

And I'm also doing some equine-assisted supervision. So, if people want, like, to work with me on term or just kind of a one-off to do supervision, but there's a course there in examining your relationship with your client, and caseload, and issues like with the support of a course. That's probably not the most distinct way to explain it. There's a lot that goes into equine therapy. I got a lot of tricks, but it's a lot of fun. It's way more fun than sitting in an office and doing it. 

So, if you're interested, please reach out. Also, if anything I said was like upsetting and you're mad at me and you want to send me an angry email, I love those. So, please do that.

PATRICK CASALE: I read some of your posts when you had some of those from the Psych Today article that you wrote.

ELIZABETH McCORVEY: Yeah, yeah, that person was really angry. 

PATRICK CASALE: Person was really angry and nasty.

ELIZABETH McCORVEY: They wrote me a four-page, full page, like single-spaced page to tell me how unattended they were by me, to tell me how I didn't trigger them.

PATRICK CASALE: Sounds like you're doing something right, if that's the case, so…

ELIZABETH McCORVEY: Yes. 

PATRICK CASALE: Thanks again for coming on. And all of Elizabeth's information will be in the show notes for everyone to have access to. And if you're in Western North Carolina that sounds like a pretty incredible offer. I mean, consultation with a horse there. That sounds right up my alley. So, I appreciate you making the time and coming on to talk about this today. 

ELIZABETH McCORVEY: Yeah, absolutely. Thanks for having me.

PATRICK CASALE: And to everyone listening to the All Things Private Practice Podcast, new episodes are out every single Sunday on all major platforms. Like, download, subscribe, and share. Doubt yourself, do it anyway. We'll see you next week. Thanks, everyone.