Betrayal, Repair, and the Business Behind the Work
Hear Emily Mori and Kara Smith discuss betrayal, grief, stabilization, couples-therapy training, specialization, insurance, interns, and access.
42:07 · Published 2026-07-09
Listening map
- 00:39 — Introducing Kara Smith
- 05:44 — Why infidelity training matters
- 10:08 — Grief for both partners
- 14:56 — Stabilization before decisions
- 20:05 — How digital connection changes betrayal
- 25:08 — Family work across generations
- 29:58 — Building a relationship-specialist practice
- 34:58 — Insurance, interns, and access
Machine transcript
Machine transcript — may contain wording, punctuation, or speaker-label errors. This is the complete timestamped source record, published for reading alongside the episode. It is not quotation approval.
00:00 — Cold open
You didn't go into therapy to become the biller, marketer, tech department.
00:06 — Cold open
An emotional support human for your own business. But here we are.
00:13 — Show intro
This is Private Practice Is a Bitch, a Ludara original. Real talk, zero filter, better systems, less burnout. Private Practice Is a Bitch. Private Practice Is a Bitch. Private Practice Is a Bitch. Private Practice Is a Bitch.
00:39 — Emily Mori
Hi everybody, welcome back to Private Practice Is a Bitch. Today I have a very special guest, Kara Smith, with me here to talk about infidelity. That's something that I'm super excited to learn more about today, as it's not something I personally work with a lot in my own, you know, therapy work that I do with clients. But I'm very excited to see, you know, we're going to explore what this looks like with couples and individuals. And what, you know, the grief actually looks like in infidelity work, because those things are both, you know, tied in. Everybody kind of knows me, because if you're here, you've been listening, or maybe you've just joined. But I'd love to, you know, give Kara a minute to introduce herself. You know, kind of let us know, you know, who you are, what you do, and how you got started in the field.
01:32 — Kara Smith
So I am, hi, Kara Smith. I'm a licensed marriage and family therapist in Maryland. I've been doing this work for 24 or 5 years now. Not specifically just with infidelity, but in the therapy field. I have a practice I run in Maryland. It's called Maryland Marriage and Family Therapy Centers. Two locations, one in Urbana, Maryland, and one in Marriottville, Maryland. And basically the, you know, the goal of our practice is to really get people matched up with relationship experts. So most of our clients are coming for, it could be individual therapy, it could be family therapy, it could be couples therapy, but all of it surrounding relationship work.
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02:27 — Kara Smith
And mostly MFTs work for me. I do have a few others that kind of do some adjunct support, like, you know, that we can refer clients to internally. But it's just been really important for me, you know, after doing this work for so many years, to have a space where you're actually going to get a therapist who is an expert at couples therapy, at family therapy. And you're not just kind of put with somebody who is, you know, a jack of all trades. Absolutely.
02:59 — Emily Mori
I think that's so important. Couples work is really difficult. How did you become interested in doing relational work?
03:07 — Kara Smith
Now, when I decided, well, first of all, I had a youth group leader in middle school and high school who was a family therapist and lived in the same community as I did, so it just was like the first time I'd ever even heard of the concept of family therapy. And this was like 80, late 80s, so probably was, you know, family therapy was still kind of getting out there and people weren't doing it as regularly as they are now. So it's really interesting. So when I got in, decided to go get my graduate degree in marriage and family therapy, I really thought I would do more family therapy. But as I kind of pursued the degree and got into the work, I realized how much I enjoyed the couples work. As I've gotten older, it's gotten even more interesting to me. I think partly it's a little bit less imposter syndrome as I've gotten older and had my own, you know, marriage and relationships that I kind of felt like I could wear that hat. And it's just become a really rewarding approach and really rewarding people to work with.
04:16 — Kara Smith
You know, it's a little different than individual therapy when you've got two people in the room. They don't always like being there. Maybe they never like being there. I don't know. But ultimately, like to get to the other side and have them, you know, feel some healing, feel new connection, to actually want to come in and hang out with me for an hour. It's a great kind of arc to go through. And, you know, I didn't expect to be here. I didn't I had no idea where I was that this was where I would end up. But it's been great.
04:48 — Emily Mori
That is so cool. And I think that you're speaking so much with so many people, right? Most people, you know, they don't enter relationships thinking that there's going to be hurdles or problems. I mean, you know that those things exist. And sometimes people don't know how to navigate these areas. And I think it's really cool to kind of figure out, you know, what you're passionate about and be able to do it for work. And it sounds like, you know, you've really grown out in the area that you're in. And to be able to offer, you know, in-person services is very cool. Do you find that a lot of the couples that come into therapy, you know, they're working through a lot of betrayal and trust issues? I know kind of the big topic when we were planning out, you know, that there was infidelity. And I'd love to kind of hear your take on that. You know, what does it look like as people are grieving, you know, relationships and then, you know, safety?
05:44 — Kara Smith
Yeah, I supervise people now I have over the years, interns. And, you know, one of the things I tell them is like, you cannot be a couples therapist if you don't know how to work with infidelity. It is just going to show up in your office. And I think, you know, I look back at grad school and I had like one class in it. You know, it was a great class. And they were like, I don't even know if it was like the entire class. It was probably like a couple of weeks. You know, this is how you kind of handle infidelity was this very kind of textbook, you know, a little bit if just my my impressions of it kind of hokey, like, you know, tie it all to bow. And it's such deeper.
06:26 — Kara Smith
Heart wrenching work that I have, you know, I've kind of learned as I go, I've kind of, you know, realized what's showing up in my office and noticing patterns.
06:40 — Kara Smith
Like this idea of it being grief work was really a later realization. Nobody is not like I was taught that. I'm sure if I Googled it, somebody else had already realized this, too. But I was never taught it, you know, thought of it as grief work until I was able to witness kind of the stages people went through. But it really has helped me conceptualize and help my clients conceptualize how they're going to get through it.
07:06 — Emily Mori
Yeah, absolutely. And that that's true, too. I think I only took maybe like one family and couples combined, you know, 12 week class on that. And then, you know, kind of left up to your own device to get that training. And, you know, you have to be able to work with infidelity if you're going to work with couples, because that's one of the biggest reasons that ends up being kind of that tipping point for why, you know, people, you know, seek that out. Do you find that, you know, when you're working with new therapists are surprised by that? Or what's the vibe?
07:41 — Kara Smith
Well, I think because I'm working mostly with marriage and family therapists in terms that they have some idea of it. But I also I really don't think they're even aware of it. But I mean, and this is something we may get into as we're talking about this. There is such a stigma around infidelity affairs. You name it. Nobody's talking about it. And so I don't think the general population, even new therapists, realize the enormity of what's going on behind the scenes in people's houses and how many times people are going to show up looking for support for that. That, you know, huge betrayal, that huge, huge hurt in their marriage. We just we always feel like people come in for communication issues. And sure, that's a big piece of what we what shows up in our office. But the infidelity is I think we are all have underestimated how often people are dealing with this. Absolutely.
08:45 — Emily Mori
I think that a lot. And also the idea of kind of open marriages. I think in my years of work, that's something that I, you know, realize a lot of people are open to that as well. You know, when we're talking about grief with infidelity, what do you what exactly do you mean by grief in this area?
09:02 — Kara Smith
Yeah, that's a that's yeah, important because it's different for the person who is the unfaithful partner and the person who is the betrayed partner. And I'll try to use those terms so we can distinguish who's who in this. You know, the betrayed partner, I think, is probably a little bit more obvious. I mean, their world is just turned upside down. You know, the rug is pulled out from under them. What they thought was their reality, what they thought was their life, what they who they thought their spouse was. It's all put into question. And so they're really coming in grieving their their current situation. They're grieving their past going. What was real? What wasn't in grieving what they thought their future was? So when, you know, there's a dream, there's the fairy tale they had in their mind is just ripped out from underneath them. And so we are starting from scratch with the betrayed partner in terms of helping them figure out what's up and what's down, what's real and what their future path looks like. It's a lot of pain.
10:08 — Kara Smith
You know, most people who come into my office tell me this is the most painful thing that has ever happened to them in their lives. It's it's it is it is a lot to sit with. But certainly my job is to help them see that there is a path forward. And so I think seeing that initially my office was like, wow, this is grief and this is palpable grief that we are sitting with. And so the other piece is the unfaithful partner dealing with their own grief. Yeah, not very unfaithful partner is going to grieve as strongly. The ones that are going to heal the most effectively, efficiently are the ones who are grieving. Also, that they're going, what the heck did I just do? How did I get here? Who am I? Because most people who come into my office are not people who ever thought they would have an affair. And so they're sitting there going, what did I just do? And how do I look at myself in the mirror?
11:10 — Kara Smith
So they are dealing with grieving their own identity, knowing they have to kind of reinvent themselves and start from scratch to build trust again. And the shame is huge, you know, that they have to really face a loss of maybe their own integrity, their grieving.
11:29 — Emily Mori
Yeah, absolutely. And I mean, I think it's interesting to touch on the idea that the betrayer, you know, is going to be experiencing their own grief, right? It's not black and white. You know, I think that the conversation around the grief and the sadness really gets missed by external forces. You know, an idea of infidelity, you know, pops up. Do you think there's a stigma or kind of a left? Oh, yeah.
11:57 — Kara Smith
I mean, the stigma is one of the bigger barriers. There's, I mean, in so many layers that it's a barrier. I think one of the more obvious ones is people who have a spouse that's been unfaithful have this core belief that if their spouse was unfaithful, that they would just leave. And that is repeated over and over again. It's in, you know, in media. It's in entertainment. It's, you know, the huge scandal at the Coldplay concert last year. Like, everybody just came down on them like they were just, you know, criminals and that she had to leave. Like, that impacts their psyche so much that they almost think there's something wrong with them for wanting to stay, despite their spouse's or significant other's betrayal.
12:48 — Kara Smith
And so a lot of my work is being the voice for that healing is possible. I'm never going to direct them or tell them what is the right thing to do. But certainly people get through these things. They heal and they actually many times find that their marriage is stronger as a result of the work they do.
13:11 — Emily Mori
Yeah, I'm sure. I mean, and I think, too, people, I'm sure, around, you know, there's a stigma and a lack of awareness to how many people choose to stay and heal in these relationships. Do you feel like there's a lot of outside forces trying to influence, you know, the stages of grief and, you know, the reinventing of yourself without other people's desires?
13:36 — Kara Smith
You're saying like their own, in their lives, the people in their lives? Yeah. Yeah. One of the things I, if they start seeing me early enough, a lot of times it's too late, is cautioning them on how many people they tell. I would love for us to live in a society that's everybody's forgiving and able to see people's humanity and see, you know, that humans, wonderful humans make huge mistakes. But that's just not the reality. And so there you have, these couples have to be careful about who they're opening up to because long term, they're going to have a lot of other voices in their ear that aren't necessarily supportive of the process. If it's not the right person, I tell them to tell someone who's maybe loves them both dearly. That is someone who maybe has been through something similar and can support them through it.
14:31 — Kara Smith
But otherwise, it's a pretty lonely journey because I think they, I mean, this is more my opinion, but also my experience is that too many people knowing can be a barrier because of what we're talking about, the stigma that comes back at them of like, you're staying, that's unbelievable. You know, people can't fathom it unless they've been through it or know somebody's been through it.
14:56 — Emily Mori
I think people like to have labels on things and they like to know exactly what's happening. You know, people are nosy and like answers and often it's not like a quick, you know, yeah, I'm going to stay, I'm going to go, I'm going to do like, there's repair, right? And it doesn't always mean rushing for forgiveness.
15:15 — Kara Smith
Yeah, it's a slow, long process. And then it's not black and white. It is, it is a lot of three steps forward, two steps back, five steps forward, one step back. It is, it's tedious.
15:32 — Kara Smith
And, you know, rewarding probably at the same time, kind of getting through it and starting to see a light at the end of the tunnel. But, I mean, that goes back to some of this grief work is like my job being to hold the space for them to work through this. And generally it's the betrayed partner's grief that gets to be on the table first. You know, that's really, really of, you know, it's almost a crisis at that point that they need to be taken care of and their grief needs to be addressed.
16:07 — Emily Mori
How do you remain unbiased in these situations when we're juggling, you know, a grief almost caused by the other party in a sense, but coming together, you know, therapy. And I'm asking, obviously, as a therapist, I know how therapists can do it, but I'm wondering for maybe our non-therapist listeners that might hear this and be interested in it for their own view.
16:30 — Kara Smith
Anybody who's going to work with infidelity has to take a good look at their own internal beliefs about it and shouldn't be doing it if they think that people who are unfaithful are bad, evil, you know, amoral, you know, like all of those things are going to just give you a very, you know, kind of a lens that's not going to be helpful. You know, partly I think some of my, you know, I think, I'll take a step back for a minute, like most of us have experienced infidelity in their lives in some way or the other.
17:16 — Kara Smith
Personally, family, friends, you know, it's, it's pretty common that most, I think it's, I think the statistics say that 50% of marriages experience some sort of infidelity at some point. So I think for me, it's, you know, obviously being a therapist, we're taught to be unbiased as much as we can, examine our own biases and, you know, look at things from a more complex lens than good and bad. And I think it's both my own life experiences and also sitting in the room with people who have made these mistakes, have been unfaithful and really just seeing what wonderfully real humans they are. I mean, I've been able to see amazing amends be made, real change be made, and marriages grow stronger. So I think anytime somebody walks into my office and, you know, they're kind of, you know, they're just, I don't know, for lack of a better word, naked, they're just all, everything's just out there.
18:24 — Kara Smith
Or it's hard not for me personally, not to have compassion for them. And I will say most of the couples I see, this is how they come in, is like, just help me. And that's both of them. They're so lost. They're so scared. For me, it's hard not to have compassion for somebody who's admittedly lost and scared despite their wrongdoings.
18:47 — Emily Mori
Yeah, I mean, it's one of those things where in order to do the work, you have to believe it, right?
18:54 — Kara Smith
You know, you're closed off to all of the possibilities.
18:57 — Emily Mori
And you mentioned that stat about 50% of marriages, you know, who might have some type of infidelity. I'm curious, do you, and this, you know, just kind of popped in my head, have you noticed the trends since you've been in this field so long with social media or, like, different pops of when these things seem to pop or has it been consistent with that?
19:19 — Kara Smith
You know, I think for me, it's been pretty consistent. I mean, I do kind of antennas go up for trends sometimes, but they're all just, you know, guesses. But one of the things that's been really apparent is social media, our easy ability to connect with anybody makes it so much easier. Now, does it mean more people are having affairs? I don't really know that for sure. What I do think is more people are, so there's a broad spectrum of infidelity. Who, you know, they're chatting with somebody through a porn site or they're chatting with an old girlfriend from high school.
20:05 — Emily Mori
Is that infidelity?
20:07 — Kara Smith
You could ask five different people, you might get different answers. It's really about the dishonesty with their spouses when it's kind of like, okay, we're doing something wrong. And so I think it just opened up the opportunity. So it's hard for, but I don't know that it means there's more people having sexual affairs. Hopefully that's me.
20:27 — Emily Mori
It definitely makes sense. Just comment. Any type of betrayal, right? It's really the mistrust. And it sounds like that's what you're really trying to rebuild when these types of things happen.
20:38 — Kara Smith
Yeah, but I do think, you know, just kind of struggling with social media and the ability to connect is making infidelity much more accessible.
20:51 — Kara Smith
And people are showing up in my office and it's not like a full blown sexual affair. It could be they're talking to an old girlfriend or boyfriend and they weren't telling their spouse about it. We have no idea where it would have gone if they hadn't gotten caught up and gone nowhere. But like those things were not happening 30 years ago. You know, somebody's talking to a friend in California. And so I do think if people aren't aware and kind of shoring up their marriages, these things are going to just be happening more and more. Yeah, no.
21:22 — Emily Mori
And I mean, I guess that's true, right? It's tough to connect to people if you don't have that ability and that's so much. Do you think that, you know, can both people, can they grieve at the same time? Or do you find that there's less acceptance for having both parties grieve? Or do you kind of pave that pathway, you know, in the. Yeah, I think.
21:47 — Kara Smith
I think it's like certainly the betrayed partners healing has to come first.
21:54 — Kara Smith
The unfaithful partner's grief is actually part of the healing process. So the fact that or the experience of seeing your partner who's been unfaithful feel real pain and remorse is actually really important in helping the betrayed spouse heal. They need to see that their partner cares about what they did and the damage that they've done. Without that, it's really hard to heal, actually.
22:24 — Kara Smith
The funny thing to say is like the betrayed partner needs to see their spouse or significant other in pain. Sounds mean, but they do. They have to have it be this palpable regret and remorse for them to feel like, okay, they want to heal with me. They're being honest with me now. Why would he be or she be crying right now if they really were going to go cheat again? So it's a it's a big part of trust building and rebuilding altogether. Absolutely.
22:56 — Emily Mori
Yeah. So so so with that, I mean, have you found yourself so you say you have a couple of therapists that work under you? Yeah. We focus a lot of our time tonight on infidelity. Do you work on other types of relationship issues, too? I mean, what what are some of the big, you know, hot topics you see coming into your practice outside of infidelity? They exist.
23:21 — Kara Smith
Yeah. I mean, it's funny. With couples therapy, most people come in saying we have communication issues. And that's just a blanket, a blanket statement of we're not figuring out how to connect and show each other how much we love. And we're not feeling loved and cared for. And we're not showing our partner how we love and care for them. We're we are not doing this well. So I think that is, you know, just been kind of a given over the years that everyone says they have communication issues. That hasn't changed that much. I think we still get that fairly regularly.
23:55 — Kara Smith
I think this is kind of a side note, but one of the and this isn't couples. So one of the cooler maybe we were going to put it. But one of the cooler things that I've seen coming through that we're getting a lot more of is adult parent child relationship building.
24:08 — Emily Mori
Oh, now that's interesting.
24:10 — Kara Smith
And it's such a my personal opinion, just a great population to work with. Yeah. But I love it because I think it shows how much more people are utilizing therapy and seeing it as a valuable tool in healing. And I don't think 30 years ago, 20 years ago, people were going, I want to go to therapy with I'm you know, they're like 40. I want to go to therapy with my 65 year old mom and dad. Like it's just such a great use of therapy and just that people are really invested in healing their relationships. And it's that that is one of my favorite changes recently.
24:51 — Emily Mori
I love that. Do you know that, you know, like you said, it's when we're talking about the older population, right, where it may have not necessarily been the accepted thing to get a therapy, you know, and then we've got a younger population kind of bringing. Yeah.
25:08 — Kara Smith
Really invested in their self care and their relationships and see it as such a great tool. There's a lot of I think, I think one of the bigger themes within that is LGBTQ adult children whose parents are struggling with accepting or understanding their lives and who they are and who they are in the world. And really, and really, those kids drag and they're not kids anymore. I call them kids because they're the younger generation of the two. They're like, okay, mom and dad, let's go to therapy. So you can figure out, figure this out with me.
25:42 — Emily Mori
So, well, yeah, and I would imagine it's really fulfilling to see, you know, people that maybe have not been able to make changes for such an extraordinary amount of time to be able to really sit back and to see people in their family that maybe they once disliked or had some problems with.
26:04 — Kara Smith
It's great opening for them because so many of them would never have gone to therapy. Like this wasn't something they did growing up or that anybody did that they knew about. I actually find that a very similar theme to couples with infidelity because I won't say most, but a lot of people coming in with infidelity and they're so desperate and in crisis. These are not people who normally access therapy. Yeah. So it's just that there's this thing that they're like, I don't know what else to do that they seek out help. And so I think that's a rewarding part of it too, is getting people who would not normally ever have gone to a therapist, show up in my office and find it a safe and healing place and see this as a new tool in their life. Yeah.
26:54 — Emily Mori
Yeah. And I mean, I'm sure you have to also balance burnout and, you know, you're also a business owner. You're doing the clinical side of things. It sounds like you're doing some supervision too. How do you juggle, you know, being the owner and also, you know, being all these other, these other parts, these other paths?
27:14 — Kara Smith
Well, I have an amazing office manager.
27:17 — Emily Mori
That's the best.
27:19 — Kara Smith
I, when I, well, she's actually like an old friend of mine, but we grew up together and I said, you're going to be my boss. So she's pretty good at telling me what I need to get done. And, you know, I think a lot of people become therapists aren't necessarily getting into it because they're organized and they're administratively, you know, organized people. So I think it's outsourcing, finding a good team. I've also had a really great experience in finding a team to work with me. I have a lot of trust in them and have really been able to find people who are passionate about what they're doing. And, you know, that actually doesn't cause me that much stress. Yeah. Great. Yeah. I think a third piece to that is, and this is probably good advice for anybody who's going to be in private practice, is finding something you feel really good about doing. And as weird as it sounds, I mean, infidelity work has been the most reward. I wouldn't be doing, I guess, as much as I do, the most rewarding population I've ever worked with.
28:27 — Kara Smith
And I think it's partly because, A, I've been doing it long enough that I kind of feel like I know what I'm doing and get a lot of positive feedback. It's really, you know, this idea of these people who come in for infidelity work, they are humble, they are raw, and they are ready to work. A lot of them, the defenses are already down. I kind of feel like I'm cheating sometimes because with real couples, sometimes we're working really hard for people to get their defenses down and be vulnerable. They're so vulnerable and ready. And so it's as much as I don't want people to be in that match pain, it's also knowing I can help them makes me feel like this is what I need to be doing every day. Well, right.
29:14 — Emily Mori
And I'm sure, you know, the couples you work with, they're thinking, you know, and experiencing that the world's over right now. Yeah, yeah. That sounding board and to be able to see, oh, no, there's actually, you know, a glimpse of hope there. That's huge.
29:28 — Kara Smith
Yeah, absolutely. And I mean, I don't want to say I'm giving them permission to heal with their spouse, but I am in a way by saying, look, people do this all the time. I don't know where you're going to go. I don't know what this path looks like. But I do know that healing is possible. Both of you want it and both of you are willing to put the work in. And I think that gives them a little bit of relief that like, OK, I'm not doing something wrong by choosing to stay with my significant other. Right.
29:58 — Emily Mori
It can be a choice and it's a very personal one. Absolutely. How large is your clinical team now?
30:08 — Emily Mori
That's so funny.
30:09 — Kara Smith
I should like know these numbers off the top of my head.
30:11 — Emily Mori
I mean, it's good to be so busy.
30:14 — Kara Smith
You don't like a lot of turnover, which is nice. I, you know, I make sure people feel well compensated for their hard work. There I just had somebody leave and I have a couple more coming on, but generally I have like seven or eight people on my team. That's awesome.
30:32 — Emily Mori
Yeah, it's a nice combination.
30:34 — Kara Smith
Some people are mostly in person. Some are all virtual. Some are, you know, most are a hybrid, a combination of the two. And so.
30:43 — Emily Mori
Do you only see kind of families, couples? Is this kind of a good, you know, resource for families and couples in Maryland?
30:50 — Kara Smith
I mean, I would like to say it is, I think. All right. Yeah, I think, you know, I, first I would always recommend that if you're going to seek out couples therapy, make sure that this, the person you're seeing has real, that you don't have to be a marriage and family therapist. Marriage and family therapists are awesome. They have the training they need. But there are plenty of people who are other kind of licensures that can get the training. It is. I've met plenty of wonderful couples therapists that didn't go to get a marriage and family therapy license. So just making sure they have the training. And that's, you know, coming to my practices. Everybody who's doing couples therapy, they're here with me, has the training. They have the expertise. But, you know, there are certainly lovely, wonderful couples therapists. Just make sure they've done extra training in couples therapy.
31:49 — Emily Mori
Yeah, and that's really good advice because there's a lot of people, you know, that, that wear many hats. And some of you just really need that specific approach. Yeah. Training. And I think it's good that you've made sure, you know, your team has had that. And you mentioned having a great office staff and, you know, great administrative team, too, which can really make a practice move, you know, so smoothly. Have there been any challenges that you've had as a practice owner that maybe you didn't anticipate and, you know, you've kind of hopped through the hurdles?
32:25 — Kara Smith
Oh, where do I begin? No, I'm just kidding. No, you know, it's been everybody. It's funny because people will be like, wow, that's so amazing. And I'm like, I don't know that it's been that hard. I think for me it's having somewhat of a risk. I'm okay with some risk. Yeah. I'm a bit of open to, you know, having some debt. None of that bothers me too much. I guess I have a little optimism in some ways. I'll say, honestly, insurance. Insurance is like the worst part of it. You know, at least once a week I go, gosh, I wish I just didn't have to take insurance anymore. It's been, it's just, I mean, I could get on my soapbox for a long time about that. I have chosen to stay paneled with one insurance company because I do want people to be able to access good services. No, we don't. This is maybe way off on a tangent. And I don't take insurance for couples therapy for many reasons. But, but for individual therapy and family therapy, we will, we still accept insurance, even though, again, it's, it is, it's painful. And it's inconsistent.
33:35 — Kara Smith
And it's not user friendly.
33:38 — Emily Mori
So, no, it's not, it's not going anywhere anytime soon. No. And it's hard because it's like, you're damned if you do, you're damned if you don't. I mean, my populations, I mean, I guess they have the same, they can have the same presenting issues, but I primarily work with autistic folks. And, you know, especially with the kids, I find, you know, they're working with a dozen and a half other specialists and it breaks my heart not to take the insurance because it adds up. But, you know, there are just some times when it's kind of like, is, what is the saying? Like, is the juice work, the squeeze. Yeah.
34:15 — Kara Smith
Yeah.
34:18 — Kara Smith
Some glitch happened last winter. I don't even, I don't even know what it was.
34:25 — Kara Smith
I finally figured it out, but probably three months, I didn't, insurance paid me nothing. Yeah. And I actually had to take out a personal business loan to make payroll because of that. And I mean, I have, I'm not like a amazing savings, but I have a cushion. I'm, you know, I had a cushion to make, get it through those few months, but after a while, you're just, and it got figured out and it's fine now. But I mean, it is, it's, it's not for the faint of heart. That was not an easy period.
34:58 — Emily Mori
It's not easy at all. And I think people just, especially those that don't necessarily know, you know, what's going on in the health insurance. It's not just show up with your insurance and, you know, take it and that's it. It's a lot of fighting, you know, more than it should be to actually.
35:16 — Kara Smith
Probably just hours, hours on the phone waiting for somebody who may or may not be able to help you. It's really, it makes sense why people steer away from taking insurance. One of the things I've done just for my own, like, I didn't get into this field because I was planning on getting rich and I'm not, but I still have to pay the bills. But one of the things that I've done to kind of help my ethical dilemmas of couples therapy and how expensive it is and wanting it to be accessible to more people is take on interns. Because I give, they, they can charge a much reduced rate. That's pretty similar to what your co-pay would probably be. And then I think they're, you know, they're getting a lot of bang for that buck because these interns come in ready to work. They've got the supervision through their universities. They've got supervision through me. They don't have a huge caseload. I mean, I think it's a real win-win. And I. Absolutely.
36:17 — Emily Mori
That's great. And I mean, I think that that's so true because interns, you know, while they might not be fully licensed and they're still learning, the supports that are in place. I mean. Yeah. And I think a lot of people overlook that. Yeah.
36:33 — Kara Smith
Yeah. And I'm also quite pleased how many people are willing to do it too. I think it's the other side of it. Like when I, you know, the first time I took an intern, I was like, oh my gosh, is anyone going to want to come see this person who has like almost zero experience? And then he's wonderful. And they let themselves be filmed. I mean, let's add that. Like that's just such a wonderful thing that they're doing for this student, for me, for. Yeah. Like, so it's kind of been a cool experiment to see that people really are willing. And they're like, okay. They just want to help too. So.
37:09 — Emily Mori
You know, I'm interested. We have, I guess, kind of for like a last kind of topic for tonight, you know, bringing up filming. I don't think people really know about it unless they're working, you know, with the group that has interns. Right. But for those that are listening, sometimes, you know, those in graduate school either need an audio recording or a video recording. And it's always done with permission, right? There's never like a surprise.
37:34 — Kara Smith
We get permission before it happens. Yeah.
37:38 — Emily Mori
But I'm interested. Not that it's the same. Because I totally don't believe it is the same. But like kind of for the hot topic, what do you think about the AI recording with notes and stuff? And I mean, using recording as a tool, you know, it's here. Yeah, I know. It's kind of like a hot button topic. But, you know, I'm wondering, you know, with some clients I've experimented with it. Some I don't. You know, it just kind of depends.
38:07 — Kara Smith
You know, I haven't done it yet. And there's no real reason why I haven't. Well, I mean, I guess there is. I'm a little skeptical. I'm a little scared. Why are they, you know, they beach in the head with privacy confidentiality stuff. And it feels really outside of my own. I don't really quite understand the parameters. Obviously, when we're using an electronic health record, we want to trust that they're working within, you know, confidentiality laws. So I've had a couple of my clinicians going, Kara, can we get this? And I'm, you know, knock, knock, knock. And I'm open to it. I'm just switching to a new electronic health record. So it's on my list of things to figure out if we're going to do it. I would like to make all of our lives easier.
38:53 — Kara Smith
I would like to see, you know, people struggle with getting their notes done. So if this is going to, I'm open to it. I think that is where I'm standing. I'm open to learning a little bit more. I'd like to make my life easier notes wise too. So if this is a tool we can use and it feels respectful to our clients and of their privacy, then I'm absolutely willing to look at it.
39:20 — Emily Mori
Yeah, no, that's how I am too. I mean, I like AI for a lot of things. I don't necessarily know about it for notes. Just other than like doing demos and testing things. I don't really know, right? But I just thought that was interesting because we do use it, right? And similar things, you know, and we use similar things. But I could see how even for people it would kind of create like a barrier, you know, because maybe it would scare people. Yeah.
39:49 — Kara Smith
And I don't actually know the laws around disclosure. Do we have to tell our clients we're using AI to write notes? I don't think we do. I mean, it's very different than like if we're filming or doing an audio recording and they have to present it to their supervision group at their university, like that isn't obvious. We're getting permission. But yeah, but I mean, if this doesn't go beyond our notes, then I mean, they don't know what, you know, just.
40:17 — Emily Mori
Yeah, it's an instrument. Yeah, it's an interesting world, you know, and trying to figure all those things out. Yeah. But it's really cool that you do the intern work. I think it's important for people to, you know, to try different internships to figure out what they like, what they don't like, and to have the experience working with couples early on, right, is nice. So many places will say, well, can you do this? And it's like, well, no. And that just needs to be okay. Because not everybody can work with couples. Yeah.
40:48 — Kara Smith
And I think most, I mean, everybody who I've had as an intern are MFT, marriage and family therapy programs. Most of them are, or all of them, I think, have been virtual programs, which has been an interesting thing to see. Really cool, great programs. That I, again, another thing I was skeptical about a long time ago was these virtual programs, but they're turning out some great students and great programs. And I've been really happy to, like, kind of see, kind of launch these new, new, excited therapists into the world as I've gotten older and maybe not as eager as they are when they're taking over.
41:30 — Emily Mori
No. And I mean, that's right. Life is a cycle. Yeah. Well, thank you so much for joining me tonight. You know, private practice is a bitch, no matter which way we swing it. I really appreciate you diving in with me and fidelity work. For everybody listening, right, follow, like, subscribe and keep on listening for some more people we have joining.
41:55 — Kara Smith
Thank you so much. It's been great to talk about it. All right. See you later. Take care. Bye.
42:06 — Kara Smith
Thank you.