Show Notes

In today’s episode, Hannah Ciampini, licensed clinical social worker and EMDR therapy Intensive therapist, will share how to manage fear with providing intensives in your private practice, specifically as it relates to ethics.

Hi Hannah, welcome to the show. I’m so glad to have you here today.

Hi. Thanks for having me, Kayla. I’m super excited to be here.

Hannah, before we dive into today’s episode, please introduce yourself, where you’re from, and tell us a little bit about your practice journey.

Sure. So my name is Hannah Ciampini. I am an LCSW. I am living in Florida and licensed in Florida and Alabama in the States.

And I currently run an EMDR and Brainspotting intensive practice. So I got started doing this. It’s probably been two to three years ago now. I went out on my own. I started like many therapist group practice model. And after a little while was like, okay, it’s time to branch out, start my own thing.

And started making those moves. And within the first year, started learning more about intensives and was like, this is what I want to do, this fits my clients and their needs and what we’re working on so well. And so I really just dove headfirst into building an intensive practice. And I am in a smaller area, so I think a lot of times when people hear Florida, they think of Miami or Orlando where Disney is or things like that. And I’m in a very small area, so I really had to get great at marketing and learn how to really network and get my name out there so that I could build intensives in my area. And now I get to help other therapists do the same. So now I’ve started a coaching business where my goal is to help other therapists build intensives in their practice no matter where they’re at.

Amazing. So I know that there’s some listeners who may not have heard of Therapy intensives before. So can you tell us what they are and how they work?

Absolutely. So, intensives, sounds fancy, but they’re really just anything longer than the traditional 60-minute session. So 90 minutes and up is considered an intensive. Some therapists never go past the 90-minute mark. And you’ll hear the word extended sessions thrown around a lot, when people talk about intensives, they’re all pretty much the same thing. It’s just those longer sessions, and really the goal with intensives is that we’re offering the client more time to work on whatever it is that they’re coming in for in that day, versus spacing it out into these 60-minute chunks.

So intensives is just a fancy way of saying that we’re going to meet for a chunk of time instead of breaking it up into little segments, and we’re going to work on as much as we can during that chunk of time.

Oh, I love that. So I know some therapists have to feel a little uneasy when they hear about therapy intensives. Where do you think the fear of intensives come from? And then I also hear some therapists think that it might be unethical to provide intensives in our practices. So can you tell us where you think that this fear might come from?

Absolutely. And if you are in a therapist Facebook group at all, you will see people talk about intensives and then there will be a thousand comments going back and forth on if they’re ethical, if they’re safe, if they’re good, you know, all the things. So it’s always a huge debate, and I think part of that is the newness of intensives. They aren’t a super familiar way of doing things. So for a lot of therapists, they’re just learning about intensives and the idea of them just sounds scary. I think we’ve been structured and taught that minute sessions once a week is just how you do therapy. That’s just it.



So when you hear about a longer session, it feels like you’re breaking a rule in some way. Like, no, this isn’t what they taught me in grad school. This isn’t what the elder therapist taught me. But the ethics of therapy aren’t really about the length of the session. So, they’re more about providing that care and practicing within your area and your niche and what you’re competent working with and ensuring that the client is getting the best service and you have their wellbeing in mind. That’s really what we want to focus on when we talk about ethics. The length of the session really has nothing to do with it.

But I think a lot of therapists over time have just built this idea around. That’s what we do is a 60-minute session and anything past that is greedy or unethical.

You know, it makes me think of a couple things here. First of all, you’ve mentioned Facebook groups in way we identify what’s ethical and what’s not. More times than not when we’re thinking about professional ethics. It’s about looking at our ethical codes of conduct, and I’m going to speak about Canada because I’m not very familiar with the American ethical codes but there isn’t anywhere in our ethical codes of conduct that says a therapy session needs to be 50 minutes. This is totally something that, I guess by design, we’ve just assumed to be correct because that is how it’s always been. But when we’re using the word ethical or ethics in a professional context, it’s really important for us as practitioners to really, again, look at our ethical codes and ask like, is there something here that identifies of being ethical or unethical? Because I do see the word ethics thrown around a lot in Facebook groups, and I do feel that it’s more based on someone’s personal ethics versus our, say, social work or therapist ethics that we’re looking at.

The second piece of that, I could actually challenge and say that sometimes a 50-minute session could be unethical if it’s not providing the services that a specific client or in cases of couples and families that they need. I don’t know about you, Hannah, but I’ve had so many sessions that it’s like. Do we really stop here? Actually, I should still be talking to you. There might not be a danger. There may not be a reason for me to extend it, but it just feels so. I’m going to use the word ethics, right? It just seems so unethical to just end at the 50-minute because we’re literally just getting into what it is that we need to get into.

So again, going back to what you are mentioning, I think that it’s important for, again, us as therapists to critically analyze our ethical codes of conduct and identify for ourselves is something ethical or unethical.

I always give one example. I always see people say that it’s unethical to charge clients in therapy. And it’s so funny because there’s literally, at least, again, I’m going to use Canada as an example. There’s no standard of practice or ethical codes that says we cannot charge our clients.

Yes, absolutely. And it same in the States. It’s not in our code of ethics that we can only provide 53-minute sessions. That’s really an insurance thing. And that’s what I tell so many therapists that I work with, is we have this number in our head that we can only provide 53-minute sessions because insurance will pay 53-minute sessions, not because that’s actually what’s best for the client. We’ve just all been kind of trained that that’s what you do, because that’s what their insurance will take.

But people that are working at insurance companies are not clinical at all. They are not in the mental health field, and they don’t know what’s best for your client. So just because they decide that that’s what they’re willing to pay doesn’t mean that that’s always what’s best for your client. And I think a lot of times. With that, we get this fear of like, okay, well if I do try to extend it a little bit, how do I know if this is even good for the client?

And like you were saying, you have to decide, even if you’re doing traditional 53- or 60-minute sessions or intensive sessions, you have to decide what’s best for your client. And a lot of times, I do EMDR, and when you get into trauma work, especially you run out of time quick.

And there were several times where I would be in a hour long session with somebody and we would really start getting momentum going in EMDR and then all of a sudden the session’s over and I’m having to wrap things up and like, okay, well I know we just got somewhere really good, or I know that you’re really in deep with something right now, but let’s contain it. I mean even EMDR as a modality itself. It’s recommended to go to at least 90 minutes. So, it’s like when you start breaking down these things, the 53-minute model was never really designed with clients in mind or with us in mind and what we’re offering.



I love that you brought that in because again, sometimes we think about how things. Were or are, but not where it comes from. And in Canada, our insurance is slightly different that we don’t have those same time limits. But I do know that in the US you have these codes, that you charge and then they’re based on certain times. And if we look at where it comes from, its insurance companies. Again, not our standards of practice or a code of ethics. So I love that you touched on that.

 And you also mentioned about the different rates and what people will charge. And I know that that’s something, that I see quite often, it’s like increasing the rate. Of course, you’re going to increase the rate because it has more time that you’re spending. And that might also go into some concerns of is it ethical for me to increase my rates for the service that I provide? So I’m curious your thoughts about that, especially if we tie in, say the US insurance structure into all that.

Definitely. I think a lot of times, especially here in the states where we are dealing with the insurance game so much and how they structure things and all the codes and all the different aspects of it, people get really scared to up their rates, even if they’re not doing intensives, even if they’re just upping their individual private pay rate. People get really scared because again, that ethics word gets thrown around. I will see therapists in Facebook groups say things like, you’re not a real social worker, or your heart’s not really in the right place if you’re willing to charge your clients out of pocket, no matter the amount.

And so then when you start talking about upping it, they really freak out and they’re like, that’s not very social work, like of you. It’s almost like used as a weapon. Like, oh, well you’re not being a good social worker or you’re not being a good therapist if you’re willing to charge your clients X amount of money.

And again, like you were saying earlier, it’s not in our code of ethics anywhere that we can’t charge them, that we’re not forcing anybody to pay anything that they can’t afford. We’re providing a rate just like any other service provider would, and the people that feel comfortable paying that, choose to do it, the people that don’t, that’s okay.

And so I think a lot of times it gets mixed into the conversation where really what it comes down to is there’s fear of looking too greedy or fear of looking like you’re in it for the wrong reasons. And so people act out of that fear by kind of like retaliating and saying, no, you can’t do that, because I don’t think I could do that. I don’t think I could charge more. So you can either.

 And that’s actually one of the reasons I started this podcast, the Designer Practice podcast is to design a practice that you love. One thing that I don’t necessarily ascribe to is being stuck into a box. We all have our ideas and our ways of wanting to design our practice. And if it’s within that box and that is exactly how you want to set it up, that is your perfect practice. But more times than not, we choose a structure because it’s what we’ve been taught.

It’s what we see other people do, but it doesn’t necessarily mean it’s supportive of our clients. It doesn’t necessarily mean it’s the only way it has to be. And it also doesn’t mean that your a bad social worker or therapist. It means that you are developing strategies and you’re developing services that are uniquely tailored towards your clients.

And I’m going to do a little bit of a plug here. It’s like I’m also the author of The Passive Practice and one of the main things is identifying ways that we can incorporate additional revenue streams that also support our clients, which could be free, low cost.

But at the end of the day, it’s how you set up your practice isn’t right or wrong. It isn’t ethical or unethical. Of course, I’m sure there’s some unethical things we could do, but at the end of the day, most of us are not out there to be unethical. So it’s really identifying what is it that we need in our practice to help our clients.

And I think if we’re coming at it from that mindset, we’re being very ethical because we’re looking at ourselves, which I think is self-care. We’re looking at our clients, which is very client-centered. And then we’re also looking at how can we build different services that don’t exist. And that’s very social work.

Absolutely, and that’s when I’m working with therapists and coaching, that’s one of the conversations that we have a lot is that not only is offering something different, whether it’s intensives or whatever you decide to offer in your practice, not only is it usually beneficial for you and the client, but it also adds a layer to like, this is social work. We’re finding a way to help people in different ways, and that’s one of the main premises around social work is being able to think about what your client needs and help them in a way that benefits them.

And sometimes the weekly therapy model isn’t what they need if they’re in a situation where they can’t commit to weekly therapy, or they can’t pay for weekly therapy for the next year or whatever it is offering them a different service is not a bad thing. It may be new and scary, but that doesn’t make it bad or unethical.

Absolutely. I actually just want to share a little story because we’re talking about therapist Facebook groups and I think we all see the different comments in groups. And very recently I saw a post it was more about supervision intensives versus therapy intensives. But this exact question come up, is it ethical to have intensive clinical supervision? So, maybe four- or five-hour supervision, usually in a group format in a specific amount of time.

And fortunately, there were people who provide clinical supervision identified yes. It is, right? Now there may be certain requirements that your regulatory body needs, but that doesn’t necessarily mean it’s unethical or ethical. It just means that you need to know your standards and what it is that you need for your licensure process. But it doesn’t mean inherently that it is unethical to do supervision that is intensive.

And if we think about even, the group format, for example and I’m going to even use like say families or couples. Just imagine going into a 50-minute session when you have three, four, or five different people trying to have an opportunity to chat. The 50-minute model is not going to be suffice for everyone to feel heard or to feel seen. And so an intensive model, whether it’s supervision or whether it’s therapy, is a hundred percent going to be the better way to go.



Absolutely. And that’s one thing that I have loved is that we are starting to see more and more people offer intensives. And therapists are some of the most creative people, so they come up with all kinds of different ways to offer intensives.

And I’ve seen parenting intensives where they’re doing like PCIT style therapy and they’re having a kid come in for observation and then working with a parent. And those are super cool because that’s another modality that really could benefit from longer sessions. I see couples, I see family sessions.

Recently I had a therapist that I was working with and we were working on a reset for women in their forties and up that are experiencing some kind of like major life change. And so she wanted to build some kind of intensive around offering them a reset for oh you, you’re an empty nester now. Or, oh, you’ve moved away from your family, or whatever it was. And we were kind of getting creative with that. And it is really cool to see all the different opportunities that are out there and how so many different clientele and so many different modalities that we offer really can benefit from an intensive model versus 50 minutes where, like you said, time just flies and 50 minutes may sound like a great amount of time until you really get into some good stuff and then all of a sudden that time is gone and you’re like, okay, well I guess we’ll just try to remember next week where we left off and pick back up.

Then you’re letting the couple or the family to go home with things being unresolved.

Yes. And, my experience with EMDR, that was like the worst thing ever. You know, you would get to a place where you had to just kind of contain things and then be like, okay, well. Good luck. Hope the next week is okay, and send them on their way. And then they’re coming back next week and we’re having to spend at least 15 minutes just checking in on how things have been from the previous EMDR session. And so, I mean, you spend those first 15 minutes checking in and then you jump into EMDR and you leave 10 minutes towards the end to wrap up. It’s not even 50 minutes that you’re doing EMDR, you’re doing it for 20, 30 minutes. So, and it’s the same in family sessions or a couple sessions or whatever you’re doing. You’re doing those check-ins and then saving that time at the end and 50 minutes just isn’t enough.

Absolutely. So I think we have some listeners that are probably like, Ooh, this actually sounds very intriguing and I am totally on board, at least consider doing, therapy intensives. So how can listeners integrate intensives into their practice when a client might already have a primary therapist? And what does the continuing of care look like, especially if they’re now seeing you when they have a primary therapist already, but they’re seeing you for intensives.

Yeah, so for me that oftentimes looks like the therapist will refer to me for the intensive, or maybe the client finds me on their own and I do intensives in packages. So either a one day, two day, or three day, whatever they decide, we work through that package and then they go back to their original therapist. I also will give them the opportunity or the option to have me send over any documents that I have to their primary therapist if they want me to. So if there happens to be any paperwork or screenings or whatever that I’ve had them fill out on my end and they want me to share that, I definitely will.

I recently had a girl that her therapist sent her over to me, and while we were doing our intensive, she kind of spaced her days out a little bit instead of doing them back-to-back. So she had days in between and she would check in with her original therapist, during those days just to recap what she had worked on in the intensive and talk to her a little bit about it and how it applies to what they had already been doing. And so I thought that was really cool that she got to have that opportunity in the middle of the intensive to talk to this therapist she’d been working with for over a year and say, Hey, this is what I learned through doing this work and here’s how it applies to what you and I have been doing for a year. So that’s always really cool.

For other therapists that I work with, I see a lot of sharing clients back and forth and okay, you do the intensive on this and I’ll keep doing the more traditional 50-minute model over here on these things. So I think that’s also kind of a benefit of intensives is that you can have a client come to you just for their main concern that they want to work intensively on, and then they go right back to their original therapist.

I love this. And I think this actually goes into the whole ethical conversation again, and I don’t want to use the word ethical because it’s really based on your standards of practice. So different regulatory bodies might actually have different standards to talk about how you would approach someone who has already a therapist. I’m going to use here, in Canada, I’m registered with the Alberta College of Social Workers and there actually is a standard that talks about how we approach the continuing of care when there are, maybe two practitioners involved providing the same types of service.

And so this is where it’s really important for us as individuals to know our standards of practice for our regulatory bodies or licensing boards, because this is another thing I see in Facebook a lot of times is someone will ask a question and you’ll have probably 10 different answers, and they’re probably all right, but they’re all right for different states, for different provinces, and even for different professions, like a social work regulatory body, standard of practice might be very different than a psychotherapy regulatory body or a psychologist regulatory body.

So this is why it’s really important that we are aware of our standards of practice, because it’s not necessarily the same across every profession, every province, or every state.

Yes, absolutely. And like you said, you go in these Facebook groups and you’ll see a hundred different answers to one question and it can make it really confusing. And I think, again, going back to what we were saying earlier about the ethics stuff. That’s where the fear comes in is because there are so many different answers.

And like you said, they could be all right in different ways and for different reasons, but it makes it very confusing for the person asking the question. And so then there ends up being more fear because now I don’t know who’s right and who’s wrong, and I have more questions than I have answers. It just makes it overwhelming.

 And it really does come down to your state and where you’re practicing at and your license type and those are things that we can easily look into together and make sure that we’re always doing things ethically. But when it comes down to it, an extended session is not an unethical thing. That’s no matter where you’re located, that’s just offering a longer session. That’s all it is.

Absolutely. And I’m glad you pointed that out. I actually personally have never seen it anywhere, that the duration of your services would be in your standards of practice.

Now, someone could send me an email right after this goes live and say, hey, it’s in my standards of practice, and I would love to see it. So feel free to send it along. But again. The one thing I was commenting on is how we might do continuance of care, right? So that might be varied across different professions.

So we talked a lot about the ethics side of things, but I know there are some listeners thinking, okay, I really, really like this idea. I like intensives. How can I start integrating this into my practice as a whole?

So usually where I tell people to start, it’s by identifying a few clients that you currently have that could benefit from going a little bit longer. And you may already have some in mind just listening to this. You may be thinking about like that one client that we always seem to gain momentum at the 40-minute mark and then we have 10 minutes left.

Or that one client, every time we end, I wish we could go a little bit longer, identify a couple of those and then from there you can start the idea of offering them maybe a 90-minute session and throw it out to them and see how they feel. Hey. I’m starting to offer 90-minute sessions for those that want a little bit more depth or a little bit more continuity. How would you feel about it and kind of have that conversation?

I know in the state’s, insurance again, runs the show so a lot of therapists are like, okay, well what if I take insurance and I’m offering 90 minutes? Does that mean that they have to pay out of pocket? It can. You could decide that you want to just charge an out-of-pocket fee for 90-minute sessions. Some insurance companies have gotten on board with starting to pay 90 minutes. So, it’s always something that you can kind of look into or have your client look into, but that’s a great place to start and you’re using clients that you’re already seeing, that you already have that rapport with, and you’re just kind of offering them that extra 30 minutes just to see how it feels for you and for them, and then go from there.

I love that. Hannah, you mentioned that you offer coaching to help therapists with including intensives into their practice. Can you share what it would be like to work with you and what listeners can expect when working with you?

Of course. So typically, when I am coaching clients, I’m doing it one-on-one. So I have several clients that I will meet with on maybe a monthly basis, maybe biweekly, depending on how quick we’re trying to get things moving. And we’ll just meet one-on-one for hour long sessions and talk about their specific goals where they’re at, give them homework at the end. And then I’ll usually send ’em an email to kind of follow up and say, hey, this is what you’re working on this week. And keep that momentum going.

Because I love my intensives, I do coaching intensives where we meet for three hours at a time. Those are really two hit the ground running. So when people are coming in for those, it’s like, okay, tell me where you’re at and let’s figure out exactly where we need to start with. And we really like kind of map out a whole scenario with building intensives in their practice or whatever their offer may be.



Sometimes I have therapists that don’t necessarily want to do intensives, but they do want to offer some kind of package service or premium offer or whatever you may call it. And so we’ll work on building those things too. So depends. For the most part, we’re doing intensive building, but work with where the client’s at and work in those different models, either the one-on-one or the three-hour intensive where we’re really just hitting the ground running and trying to get it started as soon as we can and get you up and moving.

Amazing. And for any listeners who might be interested in dipping their toe into intensives, I know you also have a free Facebook group. Can you tell listeners what the group is about and what they can expect if they join?

Absolutely. So the Facebook group is all four therapists that are still finishing their MSW or their program for therapy. All the way up to therapists that have been in the game for 15, 20 years and are just starting to kind of restructure things. So we’ve got a wide range of people in the group, but they’re all kind of the same mindset that they are curious about intensives or they are starting to offer them and need help, or they just want to network and meet other therapists that are offering intensives. So there’s a lot of community in there, a lot of great conversations that happen between therapists that are new to the game or already offering it.

And they get a chance to just meet and talk about what’s working and what’s not. And then I also post a lot of freebie. So I usually aim for a freebie a week. And we will drop those in there so that you have guides on things like how to set up your Google My Business account, or how to start offering intensives with clients that you’re already seeing or insurance need to knows and things like that. Just to kind of help you get started.

Those are all already in the group just ready for you to take and run with. And then I usually will periodically jump on there for either a live training, or a prerecorded training that I’ll drop on a specific topic that I see a lot of therapists in a group asking about. So I try to watch out and see what everybody’s questioning and then go from there and build a training around it.

I love that. So to connect with Hannah, head to her website at blueprint-and-bloom.com, or to join her Facebook group, head to kayladas.com/hannahsgroup

Or you can simply scroll down to the show notes and click on the link.

Hannah, thank you so much for joining us on the podcast today to discuss how to manage fear with providing intensives in your private practice, specifically as it relates to it being ethical.

Absolutely. Thank you so much for having me. I could talk about it all day long, so I’m always happy to run through all of the ethics questions that people have.

Thank you everyone for tuning into today’s episode, and I hope you join me again soon on The Designer Practice Podcast.

Until next time, bye for now.

Credits & Disclaimers

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