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Hey, y’all. Welcome back to The Testing psychologist. Glad to be here with you. Today [00:01:00] I have a pretty powerful episode about a topic that a lot of us think about and not many of us have done anything about. We’re talking about professional wills.
This is a topic that comes up a lot. I’ve been asked about it quite a bit. And I, as you’ll hear in the podcast, personally, did not create a professional will until very recently when I had a little bit of an existential crisis tied to a medical event. Luckily, I have Dr. Robyn Miller here to explore everything that you need to know about professional wills.
Robyn has an interesting story. She is a psychologist who ended up serving as the executor to one of her good friend’s practices when the friend fell ill and died relatively quickly. She shares that story, and the fallout and the impact of being the executor for a practice, and everything that she learned. She’s parlayed that into [00:02:00] a business where she helps other clinicians maintain continuity in their practice, find an executor, and handle everything related to a professional will.
So a little bit more about Robyn; she’s a licensed psychologist and practice in Bethesda, Maryland since 2002. She is also PsyPACT certified since 2021. She practices from a psychodynamic and relational perspective, treating teens and adults, specializing in trauma, depression, anxiety, relationship problems, eating issues, menopause, and life transitions.
She got a BA in Child Studies from Tufts University and a PhD in Clinical Psychology from the University of Rochester. She completed a predoctoral internship at Harvard Medical School, Massachusetts Mental Health Center, and a postdoctoral fellowship at Harvard University Health Services. She provides training, supervision, coverage, Practice Executor consultation and services, has written on Professional Wills, and has appeared on many podcasts and delivered thoughts on this topic. Her business, [00:03:00] TheraClosure, specializes, like I said, in helping clinicians walk through this process. You can find all those links in the show notes.
Our conversation today centers around her experience serving as an impromptu executor and everything that she learned in that. She shares some of her own stories. She shares stories from clients who have experienced clinician deaths. She shares stories about those that she’s worked with in her business.
And like I said, we dive deep into this topic. The idea is that you walk away not only understanding what all of this entails and what we might need to do as clinicians, but I think we strike a nice balance between the helpful aspects and some of the aspects that can be pretty distressing both for you and for whoever ends up being the executor of your practice will, should that happen.
So there’s a lot to [00:04:00] take in here. And if you start to listen to this episode and experience a little bit of an existential crisis, that’s totally okay, and something that is worth working through. So without any further delay, here’s some conversation about professional wills with Dr. Robyn Miller.
Robyn, hey, welcome to the podcast.
Dr. Robyn: Thanks so much for having me, Jeremy. I’m so glad to be here.
Dr. Sharp: I’m glad to have you here. This is a little bit of a difficult topic, maybe a morbid topic, but also a topic that is incredibly important to our field. A lot of people are asking about it. A lot of us don’t know exactly how to approach it. So I am glad to have you here [00:05:00] to talk about professional wills and everything that entails. So thanks again for being here. I think we have a great conversation ahead of us.
Dr. Robyn: I appreciate that. I hope it won’t be too morbid. I like to think that it’s more about being prepared than being paranoid, so that you can just practice in good health for a long, long time, knowing you have done your due diligence and put your very best clinical decision making and an effort into your patient’s care.
Dr. Sharp: I think that’s a good way to put it. I’m going to ask you why this is important to you here in just a second, but I’ll lead with my own personal story.
I mentioned when we were doing the pre-podcast chat that I came right up against this issue 3 or 4 months ago because I was scheduled for a heart surgery in January. I had a very loose, informal professional will before [00:06:00] that, and having that experience come up made me have to confront all of this and think through some of these tough questions, but it felt really good to get it done and know, hey, I’m covered. Things are in place now. I say that just to maybe reassure anyone, yes, it brings up some existential stuff, but if you do it, at least for me, it was incredibly relieving, and it’s comforting to know it’s there.
Dr. Robyn: And it often takes coming face to face with either our own mortality or that of someone that we love to get it, but then you are in a more stressful time time-pressured space where you need to get it done in a crisis. It’s more difficult than if you do it with forethought when you’re calm, when it’s not urgent, and you can take care of all the pieces, and feel good about having it done.
[00:07:00] Dr. Sharp: Right. There’s so much to get into here, but I will ask you my introduction question for everyone, which is, why is this important to you? Why pivot and dedicate your life to this?Dr. Robyn: Well, thank you. It has been a strange detour in my career. I’ve been a therapist in private practice for a long time, psychologist, and I love doing that, and I’m continuing to do that.
However, I have branched off in offering education, really wanting to help people understand the importance of professional wills, and then also working on finding a solution to make it easier for people to put this plan in place and know who to turn to, to trust that all your wishes will be taken care of.
So I made that detour sadly [00:08:00] when my very closest psychologist, colleague, friend, and supervision partner of 17 years got sick with a terminal illness and died six weeks later. And from the moment of getting that phone call from her saying, “I am in the hospital. They found a tumor. Can you take my practice?” to the point of her passing not very much later, and then four months beyond, I was consumed with doing the very best that I could on her behalf for her and for her patients that I know she was so dedicated to and invested in her work as a therapist. That part of my honoring her was to do the very best I could for [00:09:00] them.
And then in doing so, it opened my eyes to the way people can be treated if we plan for it and have the time and the capacity, which most of us don’t have when we’re met with the crisis of a colleague who all of a sudden you have to help figure out what to do with their patients and their files in an emergency situation.
But with her guidance over those few weeks before she died, I was able to see, okay, what does a therapist want? What does it take to do that so that the patients are transferred with the most caring, empathic, sensitive touch, and then supported through a grief in order to get to the place where they can then [00:10:00] get the next stage of treatment or stage of support that they need, not only now for their original presenting issues, but now for this traumatic loss and abandonment of the therapist that they’re attached to, and so connected to?
And so I’ve used that very painful experience for all involved. Certainly for my friend who went through this devastating existential ending, her patients, and for me, having served for her. The lick wrap of that is that was the prominent experience that opened my eyes to this subject. Then a year later, I wrote a paper about my experience to process my grief.
And then after that, it happened to a [00:11:00] second friend who faced an incapacitation and thankfully recovered, but there was a period where we didn’t know, and I stepped in and covered her practice for several months.
And then I started doing trainings, and then the reactions I got from people hearing my story are like, oh my God, I never thought about that. I wouldn’t know what I want. I don’t know who would do these things for me. I don’t know what would happen to my patients. This is so overwhelming.
And so then I started to write more and to create TheraClosure, which is my attempt at devising a solution to all the challenges that keeps most of us in this profession from doing what is clearly articulated in all the disciplines ethics codes, which is to create a plan for the facilitating the services, the care of your patients, and for securing the confidentiality of their medical records in [00:12:00] the event of an unexpected practice closure, typically the incapacitation or death being what’s referred to, but it could be anything else as well.
Dr. Sharp: Right. I appreciate you sharing that story. There’s so many things that we do and where so many places that our practice comes from, it’s that personal component that drives us. Unfortunately, you had to go through it to be able to help others with it.
I’m struck by the layers in that whole process, and how you were dealing with your own grief, I would imagine, and then trying to handle the logistical components of executing this professional will and saying goodbye and all these things.
Dr. Robyn: It was so painful. I can speak to a few of those elements. [00:13:00] If we can imagine how they were interwoven is one was, yes, my grief was huge. I’m still grieving and missing my friend, thought partner in private practice, and still miss her every day.
Grappling with what I needed to do for her was both a huge honor to be entrusted with her practice in this way, but also a huge burden because I was 100% occupied on … Any contact I had with her had to be about what do you want me to do about this person? This is what they said. Where are they going to go? Asking her questions about her practice and things she wanted to tell me. I missed out on this very short opportunity to just be with her and grieve.
[00:14:00] On the positive side, it was an honor. I was able to do something at a time that is often a very helpless time for people who are dealing with a loved one’s illness, and you can’t do anything. It’s certainly better than baking a casserole and then dropping it off at the door, which is often all we can do.I know it was helpful, appreciated, and important to her. I think it gave her some comfort at a terrible time, but it was excruciating for me. I don’t know that it was in the best interest of the patients, ultimately. I think I did a pretty loving job for them.
I’m glad for that, but I think someone who wasn’t in such a grief-filled, [00:15:00] devastated place might have been clearer, more efficient and more capable of meeting their immediate needs than I was in that moment while I also was trying to keep my own full-time practice afloat, deal with my young children, and then make time to call.
She had about 30 patients a week, and to make time to call all of them, and call them to notify them before they were left banging on the door, wondering where is she? And calling colleagues, trying to see who had an opening for referrals so I could call the patients back and I can get into more detail about what is exactly involved. But the degree of timing was incredibly overwhelming, and a very painful time.
I don’t think I shared [00:16:00] with you, but maybe in saying this now, I think it is a part of my journey, which is that two months after my friend died and I was coming to the end of closing her practice, I received a diagnosis of breast cancer.
Dr. Sharp: Oh, goodness.
Dr. Robyn: And went right into then my treatment. I’m fine, thankfully, but on this path from watching her having such a devastating illness and taking care of the practice in this way, my situation was put into perspective so that it was much easier, probably for me to handle, given that I witnessed this tragedy firsthand.
But at the same time, it reinforced this, none of us are [00:17:00] immortal. We have to face it, even though most of your listeners are probably thinking, I’m young, I’m healthy, I’m nowhere near retirement. I’m not as old as Dr. Miller is. I don’t need to think about it. I get it, but none of us is immune.
When we take care of patients, we invite them and encourage them into a powerful relationship with us, the bond that we rely on as the vehicle of change or of good rapport to do any valuable testing or evaluation work; that is what we count on. If we can use that for good, we have to be able to understand that it also has the power to devastate people if they are abandoned suddenly.
And so [00:18:00] no matter how old you are and whether you’re healthy, I hope that you’ll listen and understand this is just part of running a practice with good ethics and good care for your patients.
Dr. Sharp: Yeah. I’m struck by already. We, in our conversation, are paralleling the process where there’s just going to be an inevitable mix of emotional stuff with practical stuff, and that’s how this goes. We’ll navigate through it. It’s interesting, people talk about the universe handing you information or telling you things, and I’m like, oh my gosh, talk about the universe giving you a set of circumstances to communicate something.
Before we totally dive into the practical components, I’m so interested in the personality and emotional pieces here. [00:19:00] Do you have any sense about yourself, what it was that spurred you to act on all these experiences and turn it into a business, when we get down to it; turn it into an opportunity versus just going through those experiences and saying, oh my gosh, that was hard, thank goodness I can get back to my real life now and stabilize again?
Dr. Robyn: I think there were lots of pieces that contributed to my deciding to take the path and many points where I might have gotten off the path for the next thing. I never considered it before like everybody else that I knew. Psychologists are trained well in ethics, and I had heard [00:20:00] of professional wills and heard, oh, we should do one.
And 20 years before my friend and I made that one piece of paper document that we found from a template on the internet. I’ll sign my name, you sign yours. Okay, we’re good. Check. We did it. And thought we’ll never need this, that’s all there is to it.
It didn’t include most of the information that was needed, details, or anything actionable, but we did it. And certainly never thought then during those next 17 years of practice, I never thought much about it again until this happened. And then yes, the pain of it.
I need to say probably the first influence on me was the way my friend, I’m going to call [00:21:00] her Dr. B, just easier to give her a name. So Dr. B’s way of handling her own tragedy did teach me so much. Not only, as you mentioned, handed me some roadmap for dealing with my own illness soon after, but she was one of the most generous people I have ever met.
Her attitude towards this devastating diagnosis and immediate incapacitation because she never came back from the hospital to her practice again, and the effect on her young family, and each devastating thing she had to cope with, I think I would have been 100% absorbed in [00:22:00] my own world and my own tragedy. I don’t know how much thought I would’ve had at that time towards my practice and my responsibilities, but she was able to maintain a lot of space for her practice as she was going through all of this.
It was so important to her to think and to communicate to me what was going to be the very best plan given this tragedy, but for each person, their circumstance, their attachment to her, their risk factors, their financial circumstances and everything factored in to how they were going to take the news, when I should tell them, what kind of treatment they would maybe be open to, who would be the best person to send them to; all of the kinds of things for every person.
[00:23:00] I said to her at some point, I don’t know how you are having the mental space, the emotional space to do this. I don’t think everybody would be taking as good care as you are down to these infinite details beyond the sense of duty and what you need to do for duty. She shrugged and she’s like, “I can’t imagine doing it any other way.”That was who she was. She made me think. That was the first idea that there is a way to do this. This is clinical. This is not an administrative duty. This is not just a risk management duty. This is not something that you do to check a box. This is part of being the [00:24:00] best skilled, most skilled, most devoted, most cutting edge in your performance of a clinician as you can be.
And so that idea percolated for a time. Like I said, then I wrote the first paper, but that was truly just to process my own grief at the year anniversary of her death, and to sort out what did I do because it was intense and painful.
But then having a second person, having that happen, to be honest, I started to feel angry. Not angry at my friends. I loved my friends. I’m honored to be able to have done this for them, but I started to feel angry about what a messed up [00:25:00] system we have, where we have this ethical duty to consider these really hard things; this mortality and make a plan beyond the grave, but we have no resources to do that other than turning to some internet template trying our best to figure out what we should write down, begging a friend to do it or maybe promising my estate will pay you your hourly rate if you do this for me down the road, you have no concept of how much money that would be, that would cost estate at the time, what you’re settling your best friend with.
Again, unintentionally. I don’t blame them at one single bit, but I started to be angry at this burden that we pass around like a hot potato, and just thought for our [00:26:00] own sakes, as the therapist, we need a good solution to consider our practice as colleagues. We need a good solution to not have to in a moment’s notice, take on somebody else’s entire caseload in practice, and for our patient’s sake to have a good transfer of care with a caring clinician so that you know the patient is going to be notified, they’re going to be supported, they’re going to get referrals, all the things that matter, which I’ll tell you some stories as we go about what happens when someone doesn’t have a professional will and how that impacts the patients.
All of these things led to my deciding, I think we need a solution here. I was working on it in the back of my mind, bringing the ideas together. And then once I started doing trainings and met [00:27:00] with people going, “I don’t know how to do this. I don’t have anybody to ask. What do you do if you don’t have someone to ask?” that it then propelled me forward in this endeavor.
Dr. Sharp: Absolutely. I think it’s probably worth transitioning to talking nuts and bolts with some of this stuff. I think people are probably sufficiently intrigued and maybe worried at this point after feeling like, okay, how do we actually tackle this? So maybe we start with just super basic, what are we talking about when we say professional will?
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[00:29:00] Dr. Robyn: In all of our ethics codes, APA ethics code for psychologists, in marriage and family ethics codes, in the social work ethic codes, in the licensed professional counselor ethics codes, all of them have a very similar statement of, part of our ethical duty is to plan for facilitating the continuity of care for our patients, and for keeping the confidentiality of medical records.Different states have certain requirements, different, disciplines have certain requirements, but those are the ethics codes that we all have in common that say you got to think about this. It’s an ethical duty to plan.
People say you don’t have to have a professional will to fulfill that ethical obligation, but I don’t know of another [00:30:00] way to fulfill that ethical obligation without a will, which is a written down document that is directed towards your personal executor, like your next of kin. They are going to inherit your practice the moment you are deceased. They don’t know what to do with your practice, and you don’t want them to be messing with your practice or having anything to do with it.
So this professional will is a way of saying, honey, in the case something happens to me, here is the person I want you to call who is going to take responsibility for everything related to clinical care and confidentiality related to my practice. That’s really what it is; a wish list that you put together that is instructional both for your [00:31:00] next of kin to know what to do, and then for the person that you name in there.
And depending on where you’re located, that doesn’t by law have to be a clinician. The attorneys that I work with, say, Robyn, it’s an administrative issue. It could be an attorney; it could be a family member.
I want to say very loud and clear, one of my big messages is this is a clinical job. You do not want an attorney or a family member calling to give your patients this terrible news. It’s a clinical job, and anyone other than a clinician will not know how to tell them this news, how to listen to support them, how to find appropriate referrals. They will not know your ethical obligations regarding confidentiality, and [00:32:00] what to do with your records, and so forth. So it needs to be a clinician for this to be beneficial to your patients.
So that being said, that is called the Practice Executor, is the person who will step in to do what you have listed; the instructions in your professional will. A professional will in and of itself is not a contract. It doesn’t require anybody to do anything. I can say I named Barbie to be my professional executor, and she will do X, Y, and Z for me.
That’s essentially, I did it. I wrote my will. I can name my best friend, but it doesn’t mean they’re going to be available and that they’re going to do all those things. They might not be, and they maybe don’t have the resources to do all the things. So you want to think about it, making it into a [00:33:00] contract.
So a professional will becomes a contract when both people sign it, not only you saying, here’s what I want, but the other person saying, yes, I agree to do this. So I think that’s important, and that is not a part of any of the online templates that are available.
Dr. Sharp: So up to that point, you’re saying we essentially just have a document, and it’s a hope more than a mandate, if that’s the right word.
Dr. Robyn: Exactly. It’s a hope. We did our due diligence, we checked the ethics box, but all it is. Lots of people are paying attorneys to draft this. Of course, there are lots of legal pieces, so you do want someone knowledgeable about the impact of the law to at least help you think about what you need to pay attention to,
but at the end of the day, for $1,500 to $3,000 working with an attorney, [00:34:00] you are going to come away with a piece of paper that says, my professional will names Jeremy Sharp to be my practice executor. If something happens to me, he’s going to do this and this and this and this and this. That doesn’t mean you’ve agreed to.
Dr. Sharp: That doesn’t guarantee I’m going to do that.
Dr. Robyn: And it doesn’t pay you for all the time it’ll take you to do that, or all the years of retaining the records that would be required of the person who is named here. So there are so many things beyond the first step people think of is, okay, how do I make that paper? Who do I name? That’s the tip of the iceberg.
Dr. Sharp: And I would guess, if any, those of us who have put things like this in place, the majority probably have a document and not a contract. I don’t know, you have more experience, but the contract it seems would be in the minority for sure.
[00:35:00] Dr. Robyn: Yes. I was reacting as you said, the majority have this contract, but I did a survey, and I think this wasn’t exactly what you meant, but it made me think, the majority do nothing. That’s what happens. The majority don’t have any plan in place at all, and so many don’t even know this is important. The ones who know; most of them feel guilty that they haven’t done it, and think they will get to it.In my survey, only 31% of therapists have that piece of paper to begin with. And of that 30%, very, very few would have had that made up into a contract.
Dr. Sharp: Got you. Just to back up and be super clear to define this for people, the thing that we’re talking about here is specifically for [00:36:00] the ethics and the element of managing your practice and your medical records in your case. This is not getting into the business side of things of who controls the business of your practice or the asset of practice, correct?
Dr. Robyn: Exactly. You can incorporate business elements into it. I’ll explain that, but this is not your last will and testament. This is not saying who gets access to your money, who owns your practice, who gets your credit cards, or anything like that. This pertains primarily to patient care transfer and confidentiality of records.
If you and your executor want to, you can open it up to, and what I have done and offer now to [00:37:00] do, I can issue final statements on behalf of the practice. So I can send out whatever bill is still needing collection for services that have already been rendered. I can send those out to patients and hope that they will remit payments so that the estate is able to collect what they are due. I don’t get that money. I facilitate that money so that the estate that now is coping with a tragedy and a loss of income, would be able to at least collect all services that are provided.
I can help with some business elements like notifying malpractice insurance, notifying the licensing board, assisting with closing down your Zoom account and your Psychology Today account, and eventually maybe your EHR, if you use electronic records. I can [00:38:00] help with those sorts of things, but I don’t personally get into accessing anyone’s financials or any of that.
Dr. Sharp: Right. Let’s jump to this question of what happens if we don’t have a professional will in place in the format that you’ve talked about, a contract? What happens?
Dr. Robyn: There are different scenarios. A long time ago, I had a teenage patient whose father had told me he had an amazing therapist who I happened to know. He went on about how she was helping him through this bitter divorce. She was amazing and everything else. And then a week later, I found out that she had died suddenly from an accident. I wondered, God, does he [00:39:00] know? Who’s going to tell him? How will he find out?
I decided to call him. I said to him, “I’m not calling about your child. Don’t worry. You know about your child, but can you go somewhere private and call me back?” And he did. I told him, I said, “I don’t know if you have heard, but as you shared with me how important this person was, I wanted to let you know that she passed away.”
He was shocked, devastated and sobbed. He said he had gone to her office for his appointment. He had seen a note on the door that said, call so and so psychologist, and he never did because he thought, oh, she had an emergency. I’ll go next week.
And so that’s one example of what happens. People just go, they might knock on the door, they might come back the next week, they might leave you messages, and I hear this story all the time. I left messages for three weeks. She never called me back. [00:40:00] Someone who lost her therapist of 15 years told me that she thought, oh, she must have finally given up on me.
Dr. Sharp: Oh gosh.
Dr. Robyn: Or returned phone calls.
Dr. Sharp: Oh, that’s so sad.
Dr. Robyn: Until then, three weeks more went by when that patient got a text message from a friend saying, “Hey, I am sorry. How are you doing?” And the patient thought, what if this must be a mistake. What are they texting me for? Only for it to turn out that the therapist had died and no one had told her. So that’s what happens often; is people don’t even get told.
Dr. Sharp: Sure. That’s heartbreaking. It’s very sad to think about. So the impact is going to be primarily on our patients more than anything else. Is that right? Is there any legal implication or ethical implication if we [00:41:00] don’t have a professional will in place?
Dr. Robyn: There are several implications. Gosh, is your internet messing up?
Dr. Sharp: I don’t think so.
Dr. Robyn: No. You got real fuzzy for me. I can’t see you, and the words are garbled.
Dr. Sharp: Oh, let me see. The visual is nothing to worry about. If the sound is getting garbled, though, that is a problem.
Dr. Robyn: Okay. I can hear you now. I’m on my highest.
Dr. Sharp: Sometimes Riverside goes a little wonky. The video will get a little fuzzy for sure, but the sound usually stays intact, but if the sound goes out, then let me know.
Dr. Robyn: Okay. I [00:42:00] got you now, but it had sound a little funny. I’m sorry. I hope we can edit this part out.
Dr. Sharp: No, we can do that.
Dr. Robyn: Okay. We jump back where we were.
Dr. Sharp: Yeah. I had just asked if there were legal or ethical implications.
Dr. Robyn: Yes. Important question. So client abandonment is a real thing. We all know not to abandon our clients. Death is not legally going to be considered abandonment, but patients are going to feel that way. They will feel abandoned. And so if they don’t find out in a proper manner or receive transition of care in a proper manner, your state and your practice may be at risk for negligence in their care.
You also open your estate and your [00:43:00] practice to violations of confidentiality because what happens a lot of the times are family; it’s often a husband or an adult child of the therapist ends up being the one going through the files and eventually making phone calls. They may know these people socially accidentally. The patient may be really mad to get a call from, and it’s certainly violating the boundaries of the therapy but violates confidentiality in its legal terms.
Other times I’ve heard from colleagues that they have had to go to a colleague’s home and dig out of the basement, 40 boxes of records going back 50 years of practice. And if the colleagues aren’t the ones doing it, you know what happens? Family, they don’t know, they don’t understand. They [00:44:00] might put these boxes of records on the cab, and then you are definitely open to a real liability.
Dr. Sharp: Okay. So note to the audience, don’t keep your records in a box in your basement, first of all, but point taken. So confidentiality is an issue and negligence is an issue.
Dr. Robyn: The other thing that I’ll add to it is that the burden to your family is at risk. If you don’t have a plan at the time of your death, your family is going to be the ones getting these phone calls and fielding phone calls from patients. Where are they? What happened to them? Can you tell me what happened?
Somebody told me their patient kept calling the wife of the dead therapist because the patient wanted to know, where is his grave? I want to go to his grave.
Dr. Sharp: Oh gosh.
[00:45:00] Dr. Robyn: I feel deeply for that patient who wants a way to say goodbye, but I also feel deeply for the wife who’s going through a tragedy and now fielding these kinds of requests from the spouse’s patients. And so you want to protect your family as well at a time of tragedy, having to deal with this mess of a practice that they likely know very little about. You want someone who is savvy and understands what needs to happen to be the ones to step in, field those calls, and answer the questions against the people who are going to be.Dr. Sharp: Of course. So then is that a pretty common provision in a professional will to even have that person be able to specify how to communicate with clients about visitation, services, or things like that?
[00:46:00] Dr. Robyn: That is an important part of the professional wills that I advise people on. I think the boundaries and your personal preference as a therapist, the way you relate to your patients and what you would want for their sake and also for your family’s sake; you should think about that and spell that out, because otherwise someone’s going to make decisions for you that may not be what you wanted.I do ask people, in the event of an accident or of an illness, how much information would you want shared with your patients? Some therapists say nothing. I am very boundary. Just tell them a medical issue or an accident. That is all I want.
I also ask, would you want them notified if they ask about a memorial service or any kind of plan? Some people say, [00:47:00] no, tell them that’s private for family only. Other people say, yes, I am totally transparent with my patients. I feel like it would be stressful for them not to know. Please do tell them.
My friend, Dr. B said, tell them I have terminal pancreatic cancer, which was horrible for me to say over and over and over to people, but was important for her so that they didn’t have hope that she was going to get better and come back, and they weren’t left wondering. She wanted them to know.
She initially thought, I want to protect my family. I don’t want them to come to a service. But before she died, she changed her mind and said, I want anyone for whom it would be comforting to be able to attend. So if they ask you, Robyn, you can tell them they can come, but please respect the boundaries around my family. And so that [00:48:00] is what I told them.
Of course, other people might have just shown up without asking me because it was in the newspaper. There’s a lot of elements that we can’t control as this goes, but we can put a pretty good plan in place that takes care of everybody as best as we can.
Dr. Sharp: I think all these points we’re discussing so far leads to this question of who should be the executor of these professional wills. You mentioned probably not a family member, that’s pretty tough, or a close friend. I think you’ve alluded to and maybe said that should be a clinician; someone who can navigate the guidelines of our profession, client conversations, and hold those emotions and things like that.
And so I’ve just been thinking in my head this whole time, okay, where is the perfect combination of a clinician who’s close enough that we could ask, but not so [00:49:00] close that they would be completely devastated. How do you advise people around who to pick?
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Dr. Robyn: I have come through my experience to think it’s a bad idea to name a close colleague. From a shared, [00:50:00] it’s a tremendous undertaking and devastating. It’s just, I feel, not good practice, even though it is maybe the standard or has been.
But one of the reasons why it has been is because before COVID, we lived in an era where we had paper calendars, and we all had only in-person patients. We kept our records and files in a locked cabinet. So we needed someone who could come into our office, look at those papers, and get those files, but that’s not the case anymore.
Most of us have transitioned to at least some electronic record keeping, calendar, and practice management, and even those who haven’t, it’s okay because we can digitize records and take custody of them. It doesn’t [00:51:00] have to be as I did for Dr. B all those years ago, where I went to her office and lugged banker boxes, one after the other, to my car to take back to store securely. We don’t have to do that anymore.
So that opens up, who else can it be? It doesn’t have to be your suitemate; it doesn’t have to be somebody right there. It shouldn’t be your closest friend, even though I know a lot of people, and I did initially, too, think, oh, that comforts me that someone knows me pretty well and knows my practice that they would do that. I know it comforted Dr. B that I did it for her, but given all the rest that I learned since, I think it’s not best practice.
The patients don’t care. The patients aren’t looking, and they’re not asking, are you Dr. B’s best friend? Why are you the one calling? They just want to know, are you able to be present for [00:52:00] them? Can you help them with what they need? And someone who’s not grieving is going to be able to do that in a better way.
So far, the answers to your questions are yes, a clinician, not someone you’re super close with. It doesn’t have to be someone right near you. I think lots of people then name someone a little further out in their collegial circle. You can do that, but hear the burden that I’m talking of what exactly is entailed. And I do want to get into a little bit more of the specifics of what exactly the practice executor needs to do.
But that burden, even if that person isn’t going to be grieving you terribly, think about the likelihood of them having 40, 50, or 60 hours available urgently to drop everything and do this for you, because at least [00:53:00] the patient part is urgent. The administrative aspects come later, and that’s okay, but people need to be called urgently and these aren’t 5-minute calls. They aren’t robocalls. These are sensitive, lengthy calls with people who are processing.
So if you have an agreement with a colleague who is outside your immediate circle, then you want to think about compensation. And so you may want to say, my estate will pay you hourly for the time it takes you, but then remember, you’re paying them not for 2, 3 or 4 hours’ worth of work, which might seem totally reasonable. Sure, my estate will pay you $1,000 to help with this. You are going to be paying them for 40 or 50 hours at their rate. So your estate’s going to get an [00:54:00] unexpected $10,000 or $15,000 bill. Consider that. It’s not a great plan.
You can come up with an alternate arrangement depending on that person’s willingness. You can set a flat fee. You can make a donation to charity. They can do it on a volunteer basis, but remember, are they going to have the time, and is it a burden lead that you want to put on that person? So that’s my view on this one-to-one arrangement.
A better arrangement is a group; a cooperative arrangement where let’s say you have a peer supervision group and five or six people go in together to say, if something happens to any one of us, the rest of us will share the job. That is better. It is better because it’s not all on one person. You can divide the labor.
You need to, if you [00:55:00] do it that way, be very clear from the beginning. Each person needs to be very specific about what their wishes are and an agreement within the group about who’s going to cover what pieces, because otherwise, things fall through the cracks. Someone thinks the other person called the patient or someone thinks the other person is going to get the referrals, those kinds of things, and how they communicate.
It also does open a little bit of a confidentiality risk. If you are in the same circles, it may make it more likely that one of your patients could know one of the other therapists more socially in your community, even if you don’t realize that they know your colleagues. And so there’s a bit of a risk there, but that’s a better plan. You can do it that way.
And then thirdly is [00:56:00] the solution that I devised to try and answer all of these obstacles, and that is a professional executor service designed for this exact purpose. So what I racked my brain for many months and interviewed a lot of people and tried to figure out what can we do to solve all these problems?
So what I devised is a service where clinicians are the point person who will first meet with the therapist who is interested in creating a professional will. We have a one-hour consultation. I want to get to know you as a therapist. What are you like? How do you work? What’s important to you? What kind of patients do you see?
How long do you typically see people? What’s your style? What’s your relationship like with them?
[00:57:00] And then I’m going to take you through all of these professional will questions; how do you want people notified? Who do you want them referred to? Do you want to name people that you would want me to check with to see if they could take on your patients because you know them and respect them, and then if they can’t, I find referrals for you or do you want me to not bother any of your colleagues and just go straight for my own referrals for your patients? We can do that.Do you have colleagues you want notified? Are you a supervisor? Do you do testing and who is going to be the person who steps in if you are mid eval? Is someone going to take over that testing protocol for you? If you’ve written the report but haven’t delivered it, who’s going to give that feedback session for you?
Do you want to, [00:58:00] as a uniquely maybe testing thing to consider, I’ve had testing practices that I’ve worked with say, no, no one would be able to step in for me and complete the process. It’s my data. No one could interpret it for me. It’s so individual. They’ve chosen to put into their professional will that they would want any testing that aren’t completed, they want those clients to be refunded for anything they’ve paid up front, so that that client can take that money and go have a full battery done somewhere else.
So if you like that idea, you got to write that down, and you have to make a provision that your estate is going to refund that money, and the practice executor can help facilitate that. There’s a zillion details you need to think through. Again, the boundaries that I talked about, about [00:59:00] a funeral. How much information to share? I’ll take you through all of those.
Then we do get to the administrative matters. Would you want us to issue bills on your behalf? Would you want us to notify? Would you want us to help with shutting down your website or changing your voicemail to refer people on to us if they’re looking for you, or looking for their records so that they know where to find someone who can assist them. We take you through your wishes on all of that.
Then we get into the details about how will we get the information that we need in order to fulfill your wishes, and that needs to go into the will. How do we get your passwords to your EHR? If you don’t have an EHR, where do you keep your calendar? Where do you keep the records? Who has those keys? Who do you get them from? Who would be able to digitize those paper records and send them to us so that we could take [01:00:00] custody and be that point of transfer if patients need them in the future?
How do you get your two-factor authentication? When you log into your SimplePractice, even if I know the passwords, who’s going to have your cell phone or your email access to give me the code that I need? All these things that if you leave it up to a friend, you may not have thought about all this, and then someone can say, sure, I will do that for you, but then they’re locked out of your EHR and nobody’s getting any phone calls anyway, because if you have to go to the EHR directly, they require a death notice and a certificate, and that can take weeks.
And so your patients for weeks, nobody is calling them. Nobody’s helping them. So all of these things need to be figured out and documented. And we do that. We document it into a legally reviewed professional will. [01:01:00] It names TheraClosure, it names us as the practice executor. So you don’t have to ask a friend. You don’t have to leave it to chance. We, as clinicians, are the ones who are promising to be on retainer for you.
So once we create this professional will, that’s what we are. For a yearly fee, we are on retainer for you. And if we were notified by your personal representative, and that’s part of the plan we come up with, who would notify us if something happened to you?
Once they do, then we step in to follow that plan step by step that we devised with you. And so that would include then, we use the password instructions and we offer a password manager that presents an easy way for us to access passwords, includes a two-factor authenticator so that we can [01:02:00] immediately log into your EHR. We can see your calendar, we can see your contact list, and your files.
We can start calling clinicians experienced in these grief notifications. We can be the one knowing what matters to you, and reach out and handle your patients in a clinically minded way, notify them, assist them with referrals, assist them for support. Call them multiple times until we get the referrals in hand that hopefully, they are willing to accept.
And then we take custody of your records so that eventually, if you have an EHR, we download the records, we put them in our own encrypted files so that we can then close down your EHR eventually. So your estate no longer has to continue paying for that.
[01:03:00] We have custody. We can transfer the records to anyone your patients wish us to do that for, new providers, if necessary. Sometimes I’ve gotten subpoenas for records of a deceased colleague.We do all of those things as well as the billing and the administrative aspects as outlined without any follow-up fees so that you know you’ve already paid upfront in a controlled way. Like car insurance, you’ve paid knowing that if something happens, you’re covered and then there is no additional cost to your family for the clinical hours and for the storage of the records if something does happen.
So I tried to tackle how do we deal with storage, passwords, getting access, and not having a big bill at the end, and not having to ask a family or a friend. Where do we keep all this? How is it [01:04:00] legally reviewed? All the things to try and make it easy.
My wish is that I said 30% have wills, I would like it to be 30% don’t have wills. Let’s get that changed so 70%, if not more of therapists can say, okay, I have spent the two hours with TheraClosure, that would totally in some including paperwork and everything else involved, and a one-hour meeting with us, I’ve spent 1.5 to 2 hours. I know that a good plan is in place. I know I have controlled the costs.
It’s outsourcing and a really important job that we as therapists, we’re not lawyers, and we don’t know how to do this, and saying, okay, I’m going to value this. I’m valuing it as a business expense. It’s part of providing good care to my patients. Here’s an easy way to do it, so I don’t have [01:05:00] to sit on it for the next six years wondering, am I going to get to it? Will I do it? Who’s going to do it for me?
So that’s my solution that seems to so far be really appealing to people. I keep getting these incredibly lovely messages of gratitude like this is the solution I’ve been looking for. Thank you so much for building it. And that to me is like nothing else.
Dr. Sharp: That makes sense. Peace of mind is valuable. It is very valuable. And when you talk about all the responsibilities that go into being an executor of a professional will, it does seem overwhelming.
It’s all, I don’t want to say little things, but the two-factor authentication examples, that to me is the perfect example of something that is small but so important, and super annoying, and the thing that could just break [01:06:00] someone’s will if they’re in the middle of this process and they’re like, I don’t have the phone number. Who are you texting right now for this two-factor authentication?
It’s just that little stuff that you don’t think about. You’re like, oh, I’ll have so and so, my good friend, be the practice executor, and they’ll be able to handle it. But there’s just so much that goes into it.
Dr. Robyn: Exactly. And so yes, it takes some work, but the biggest obstacle is denial. None of us wants to think of those saying this is something worth paying for. This is something worth spending two hours doing. That’s a hard barrier. It’s hard to get people to say, we’re all busy and we all have 1,000,000 expenses. We all have so many things on our to-do list.
This easily gets pushed to the bottom, but for the many, many patients that I’ve now interviewed, spoken to and been the bearer of bad news for, it is so [01:07:00] devastating and so many bad things can happen to them and their care. There’s people who say, I never went back to therapy after that. I was so devastated. I gave up on the profession. What kind of jerk was my therapist? I thought they were taking good care of me, but nobody called. I don’t even know what happened to my records. I’m not trusting a therapist again.
I did have someone write me an email saying, I will never go back to therapy again. I poured my heart out for years, and this is what happens to me. And then months later, they sent me an apology, saying I was so devastated by the loss when I sent that.
You do have to remember the patients of the practice are already in therapy because they’ve experienced loss, trauma, or are depressed and aren’t to do what would think would be best for them to take care of themselves in a moment of crisis. These [01:08:00] people have needs.
And also some therapists I’ve talked to have said to me, “Oh, my people are high-functioning. They wouldn’t need that kind of handholding.” Well, that’s probably true for many patients, but even so, it’s ethical. It’s good practice.
I interviewed 15 analysts who had their analysis done in a certain way. Of the 15, only one person knew what happened to his medical records.
Dr. Sharp: Oh my gosh.
Dr. Robyn: The rest never found out what happened to years and years and years and years of worth of their medical records. So it is an honor to be entrusted as a therapist with people’s stories, with their vulnerable selves.
And as part of our duty for the service we provide and the payment we take for the service we provide to [01:09:00] ensure end-to-end care that if something were to happen to us, that person would receive a timely and sensitive notification about that. They would receive assistance with referrals, and they would feel like you as their therapist, though they were devastated to lose you, they would be able to hold on to you inside as a good object with positive transference. Boy, I was devastated my therapist died, but man, how caring that he put in place this plan that someone would handle it this way.
I’ve heard lots of stories in my interviews as well, of people saying, I was devastated to get that call, but I feel like my therapist handled it beautifully. They had someone who reached out to me who was really sensitive, who helped me through, who told me what happened.
Many people I have found do find great [01:10:00] comfort if they’re able to attend a memorial service. So that’s not a recommendation, that’s so individual for each therapist, whether you’re comfortable with that for your family or not, but patients tend to feel like if they’re told it’s okay to go, that that feels valuable to them.
And also if someone is ill, and is able to have a goodbye phone call or one final session, that also goes a really long way for patients who feel really cared for, feel like that’s very generous of the therapist to be willing to do that. The patients like to be able to express how grateful they are for the work that you have provided them.
I had one patient of Dr. B who I called to notify by phone. And he said to me on the phone like, “Oh my God, I’ll be fine. Tell her not to worry [01:11:00] about me. Tell her I will be fine. I don’t want her to be distressed about what this is going to do to me. I feel so terrible for her.”
I said, okay, I will, but I’m also here to help you get connected. He said, “No, no, no, don’t worry about me.” Two hours later, he was knocking on my door at my office with a letter that he wanted me to give to her because he hang up and panicked, how am I going to express my gratitude for all that Dr. B has meant to me? I was able to communicate that for him.
It makes me emotional now thinking about it. The degree of bond with our therapists and as therapists, with our patients, is so important. It’s the vehicle of therapeutic change, but the loss of it is also profound.
One [01:12:00] piece of the loss that I think requires a clinician to communicate the news and be supportive is that it’s not a socially sanctioned loss. You can’t do the way you could if it was a close family member, you can go to your workplace and say, I just lost my close family member. I need to grieve. And people are going to say, oh gosh, of course, I’m so sorry.
You don’t go and say that about your therapist typically. And even if you did, people don’t really get what a profound loss that is. And so a lot of the people I spoke to are like, yeah, I didn’t really talk about it because they I didn’t think anyone would understand.
There are people who cried with me, telling me the story of their therapist’s death 40 years ago, remembering
that [01:13:00] loss and shock, and saying it was more devastating to lose my therapist than it was to lose my parents.
Dr. Sharp: I believe those cases happen. And you’re so right, it’s not something that we talk about a lot, and bereavement leave isn’t necessarily meant for therapists. It’s still so important.
Dr. Robyn: I’ll share our anecdote if I can. Back to the details we don’t think about, when I went to Dr. B’s office at the very end of taking care of everything, collecting her files and storing them, I looked around and I thought, is there anything else here that is potentially confidential or that falls under my responsibility? Her family was going to come and pack up her office, and take care of the belongings in there, but [01:14:00] I looked around and I saw these unique handmade pieces of art, and I knew that they were gifts from patients.
I just knew it. I looked at them, and some had writing on the back. And some that you could just tell from, and I know the kind of relational work that Dr. B had done. I didn’t know what to do, but I thought these shouldn’t get thrown in the trash, and they shouldn’t get taken home with the family. What else should happen to them? And so I took them with the records and thought, I guess these are my responsibility as well.
Two months later, I got a phone call from a woman saying she had terminated her very long and powerful treatment with Dr. B two years before Dr. B died, but she just found out that Dr. B died, and she [01:15:00] wondered what happened to all of those pieces of art that she gave to Dr. B.
I definitely told her I have them. They’re stored securely and I can mail them back to you. And she said, “Yes, I gave them to Dr. B because I wanted her to hold onto me, but now I would like to hold on to her. Still this gives me chills. That connection with that person was so meaningful to me to be able to do that.
As therapists, we can’t solve every problem in the world. We can’t anticipate everything. We can’t protect our patients from loss, but we can protect them from traumatic loss by having a good plan in place. So that’s what I’m asking people to think about.
Dr. Sharp: Sure. I [01:16:00] appreciate the way that we, you primarily, have navigated potentially sensitive conversation. It seems clear the service that y’all are offering is super valuable and necessary, even from an ethical and legal standpoint. So I’m glad that you’re out there. I appreciate you coming on and having a meaningful yet practical conversation about something that’s important for our field.
Dr. Robyn: Thank you. I appreciate the opportunity. I’m first and foremost just trying to educate people about how important it’s, and trying to get you to think about what is involved. And whether you decide to use TheraClosure, or you find a group, or you ask your best friend, just do it with open eyes and know what you are asking and what the potential risks are to your patients and to your family.
If you would like to check us out, we’re at www.theraclosure.com. [01:17:00] I would be happy to offer a 15% discount to your listeners. They could use the code “SHARP” and I will put that. You also can sign up for a free 20-minute informational call. You also can download for free an ultimate professional will checklist from our website. So I hope that we’ll just continue to spread the word and help people take care of this.
Dr. Sharp: Absolutely. Thanks for that. I do hope people reach out. And just circling back where we started, it was a tough process to go through for me to establish this whole thing; this will, but ultimately helpful, relieving, and validating to hear you talk about how important it is. So thanks again, Robyn. Thanks for being here.
Dr. Robyn: Thank you so much. Thanks a lot.
Dr. Sharp: All right, y’all. Thank you so much for tuning into this [01:18:00] episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.
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