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Episode 27 · 33 min · Sep 2, 2026

This Therapist Left Clinical Work to Fix Broken Systems | Dr. Mariah Maurice

with Mariah Maurice,

Dr. Mariah Maurice chose her dissertation topic almost against her will. Her doctoral program required students to research something inside their own wheelhouse, and at the time she was working as a hospital social worker, a role she calls the most rewarding of her career and also the one that forced her to face the thing she feared most: talking about death. So she studied patient autonomy at the end of life. What she found in those interviews with hospice social workers ended up redirecting her entire career, and it is the thread that runs through this conversation with host Jessica Hurwitz.

Mariah has spent more than a decade in the mental health field, and she has worked in nearly every setting a social worker can land in: substance abuse treatment, community mental health, private practice, hospital case management, and hospice. She loves clinical work and still enjoys sitting with clients. But a few years ago she reached a point where the problems she kept running into were out of her hands as a clinician. The systems around her clients were not built to carry out what those clients actually wanted. That realization pushed her toward a doctorate, research, and the kind of advocacy that aims at policy rather than one case at a time.

Her research revealed something both simple and uncomfortable. Nearly every social worker she interviewed believed deeply in patient autonomy and saw it as an ethical duty. Yet the barriers to honoring it were rarely about intention. They lived in systems. Family systems, where a seriously ill patient may quietly give up a wish to avoid conflict with loved ones. Healthcare systems, where families are not given enough education and providers can come across as too assertive at the worst possible moment. And the workplace itself, where high caseloads, rushed visits, and weekly interdisciplinary meetings leave social workers feeling undermined because the room defaults to the physician or the nurse as the expert.

One of the sharpest moments in the episode comes when Mariah describes how easily patients get labeled non-compliant. Someone misses an appointment and the chart says they failed to follow through. Her response is always the same question: why didn't they show up? Maybe there was no ride. Maybe something happened at home. The social determinants of health, she argues, are exactly where clinicians need to look, and applying that lens across every setting she has worked in convinced her this was not an isolated gap but a pattern.

Jessica asks what comes next, and Mariah is refreshingly honest. She loves talking about her research. What she dreads is the part where institutions have to change. Hospitals have functioned a certain way for a long time, and people are tired, behind on documentation, and wary of anyone who walks in announcing a new system to learn. Her answer is lived experience. She can stand in front of hospital case managers and say she has carried the same caseload and felt the same burnout. She believes that showing up as someone who has been boots on the ground earns a kind of trust that a title alone never will. She is now bringing her work to conferences, including an upcoming one focused on autonomy for adolescents in schools, and developing a framework to help organizations put the findings into practice.

The conversation widens into coordination of care and what happens when communication between providers breaks down. Mariah describes working in a clinic that integrated medical and behavioral health under one roof, the first time she saw that model actually work. She also challenges a common habit among helpers: handing someone a referral or a list of resources and considering the job done. A food pantry list is only useful if the pantries still exist and the client can actually reach them. Setting up an Uber ride home or helping with a benefits application can look small, but she asks clinicians to think one step further. If this support does not happen, what happens next? A family may go hungry. Someone may have to choose between food and staying alive.

In the new Voice Notes segment, Jessica asks what Mariah would tell her younger self. Her answer is to trust the gut feeling that a bigger problem exists, to have the uncomfortable conversations, and to find the people who think differently too, because the world will not always welcome what it needs to hear.

For any therapist who has ever felt that the paperwork was winning, Mariah offers a quiet reminder that the small task in front of you is often the only bridge a client has.

In this episode, you will learn:

  • What research with hospice social workers reveals about the barriers to honoring patient autonomy at the end of life.
  • How family dynamics, healthcare system gaps, and provider burnout quietly override what patients actually want.
  • Why a client labeled non-compliant may simply be facing a missed ride, an unpaid bill, or a crisis at home.
  • Why lived experience earns more trust than a title when asking organizations to change how they work.
  • Practical ways to close referral gaps, like calling resources before handing a client a list.
  • How thinking one step beyond a small task, such as a ride home or a food benefits application, changes outcomes for clients.
  • What coordinated, multidisciplinary care looks like when medical and behavioral health work together.
  • Why trusting your gut about a bigger problem and having uncomfortable conversations can shape a career in mental health.
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