Introducing Psychotherapy Studio (and the Everything Psychotherapy Bagel 🥯)
One of the reasons I went into psychiatry was that I was interested in more than medications.
I wanted to understand why people struggle, how they make sense of what happens to them, and what actually helps people change.
But we tend to get better at what we repeatedly do.
And just as importantly, we tend to move away from, or at least not move toward, the things we don't practice.
We see this even with medications. Most of us have medications we know well, trust, and reach for more readily than others. Familiarity breeds confidence.
Psychotherapy is no different, except I think there's another layer to it.
I'll admit something. I understand psychology pretty deeply, but I can still find myself anxious about actually doing psychotherapy.
What if what I say doesn't help? What if I choose the wrong intervention? What if I don't know where to take the conversation next?
There's a certain vulnerability in that.
With medications, when something doesn't work, it's relatively easy to say, "Well, that medication wasn't a good fit."
With psychotherapy, it's harder not to wonder, "Was it something I said? Did I miss something? Am I actually any good at this?"
And when you're sitting across from someone who is trusting you to help them, those questions carry some weight.
So we naturally return to what we know. The interventions we've used before. The conversations we're comfortable having. The familiar approaches that feel safer.
But familiarity and competence aren't necessarily the same thing. And staying with what's familiar doesn't give us many opportunities to grow.
You might understand CBT, ACT, DBT, motivational interviewing, supportive therapy, or behavioral activation conceptually.
But knowing what an intervention is, knowing how to do it, and feeling comfortable enough to actually try it with a patient are three different things.
Therapists often develop those skills through supervised practice, case consultation, feedback, and repetition. As psychiatric prescribers, our opportunities for psychotherapy-specific learning and practice can be more variable.
And sometimes, when we're not quite sure what to say next, our brains offer a truly groundbreaking therapeutic intervention:
"Have you tried just not thinking about it?"
Probably not our finest therapeutic moment.
But that little moment captures something important. We may understand why thought suppression isn't particularly helpful and still struggle to find a better response in the moment.
Knowing the theory and translating it into an actual conversation are different skills.
And that's part of what led me to build Psychotherapy Studio.
A few weeks ago, members voted on a roadmap idea for a living 90833 Playbook.
I started building it.
And then, as occasionally happens around here, the idea got a little out of hand.
Because documentation and coding are really only the end of the process.
Before we can document psychotherapy, we have to know what we actually did.
And before we can do it, sometimes we need a better understanding of what our options are, why an approach might fit, and how to use it.
So the Playbook grew into Psychotherapy Studio, a new interactive learning environment inside Think Beyond Practice.
Or, as I've started calling it:
The Everything Psychotherapy Bagel. 🥯
A little bit of everything, with plenty to explore.
Psychotherapy Studio isn't just a collection of articles or documentation templates. It's designed to help you move between understanding an approach, recognizing it in practice, exploring how to use it, and describing the work accurately.
Start with what the patient is bringing.
Prepare helps you explore clinically reviewed therapeutic approaches, concrete interventions, and examples of what that work might actually sound like in the room.
Because "use CBT" is not particularly helpful when you're wondering what to say next.
Recognize helps you work backward from what happened in the conversation and consider which therapeutic approaches actually fit.
Sometimes you did something useful and therapeutic without having a neat label for it at the time.
And sometimes what felt therapeutic was actually education, reassurance, or ordinary clinical conversation. Recognizing that distinction matters, too.
Document helps you think through five elements:
Modality · Intervention · Focus · Response · Time
The goal isn't to manufacture impressive-sounding psychotherapy documentation. It's to describe what genuinely happened in a way another clinician can understand.
And yes, we'll occasionally challenge phrases like:
"Patient was receptive."
Were they, though?
Code helps you think through 90833, 90836, and 90838, including the distinction between medication management, psychoeducation, and separately reportable psychotherapy.
Because a heartfelt conversation doesn't automatically become a billing code.
Browse lets you explore therapeutic approaches and reference material. Troubleshoot looks at situations where real clinical conversations don't follow the textbook. Practice connects the material to cases and simulations.
And the different parts of the Studio are meant to inform one another, rather than exist as isolated resources.
What I really hope Psychotherapy Studio becomes is a place where we can continue developing our therapeutic skills.
I think many of us entered this field because we were interested in people, psychology, behavior, relationships, and the possibility of meaningful change.
But as we become more experienced prescribers, it's easy to become increasingly sophisticated with medications while continuing to rely on the same handful of therapeutic interventions.
Not necessarily because we don't want to learn more.
Sometimes it's because trying something unfamiliar with a real patient can feel uncomfortable.
And nobody particularly enjoys feeling like they're making it up as they go along.
I want this to be somewhere we can explore an approach, understand why it might fit, see what it sounds like, practice recognizing it, and gradually become more comfortable using it.
Not because every patient encounter needs to become a psychotherapy session. And certainly not because every supportive conversation should be billed as one.
But because therapeutic skills are worth developing in their own right.
The Studio isn't a replacement for supervision, formal psychotherapy training, or clinical judgment. It's another place to learn, rehearse, reflect, and build confidence.
Psychotherapy Studio opens with quite a bit to explore, but I'm not finished tinkering with it.
Over the next week, I'll be working on refining the experience, particularly how we move between clinical focus, modalities, and interventions.
Ideally, I want you to be able to start with something a patient is struggling with, an approach you're curious about, or an intervention you want to understand, and follow those connections wherever they're useful.
I'm also planning a little recurring feature:
A short, occasionally ridiculous, but clinically useful psychotherapy teaching moment.
One familiar clinical misstep, a little explanation of why it misses the mark, and something more useful to try.
Think of it as a psychotherapy snack.
No CE credit for chewing.
Further down the road, I'd also love to connect the Studio more directly to the patient-specific Clinical Framework in Think Beyond AI, so that understanding what's happening clinically and exploring potentially useful therapeutic approaches can become a more connected process.
But I also want the Studio to remain somewhere you can explore simply because you're curious.
Not everything has to begin with a patient encounter.
Psychotherapy Studio is now open for Full members.
The Psychotherapy Documentation Phrasing Bank remains included for Forum and Full members and available separately for Free members.
I also genuinely want your feedback.
I'm building this from my own clinical experience and the problems I've encountered in practice. That means there will inevitably be things I haven't considered, approaches I could represent better, or workflows that make perfect sense in my head and absolutely none when someone else tries them.
If something feels awkward, clinically questionable, confusing, or you find yourself wondering why on earth I designed something a certain way, please tell me.
I would rather improve it based on how clinicians actually use it than defend a design simply because I created it.
My hope is that Psychotherapy Studio becomes a place where we can keep learning, experimenting, and getting a little more comfortable with the therapeutic side of our work.
Come curious. Leave with something you can use.
And maybe take a bite of the Everything Psychotherapy Bagel while you're here. 🥯