Topic 5: What Therapists Don’t Talk About {by 6/27}

Based on the readings due this week consider the following three discussion points: (1) Based on Chapters 1 and 4, what particular “Myth” (or Taboo/Secret/Question) piques your interest the most?  Explain.  (2) Based on Chapter 5, what “possible clue to taboo topics” concerns you the most as a practicing therapist?  Explain.  (3) Based on the Appendix, of all the information presented on therapist self-reported feelings and behaviors, what concerns (or surprises) you the most?  Explain. Your original post should be posted by the beginning of class 6/27.  Post your two replies no later than 6/29.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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52 Comments (+add yours?)

  1. Brittany King
    Jun 24, 2017 @ 20:29:03

    1. A myth that caught my attention what the myth “therapists are invulnerable, immortal, and ageless”. It brought up the idea of safety and how many times therapist’s become comfortable in the environment they work in and forget about safety. I think that when you work for a place you like, you can grow comfortable and let your guard down thinking that nothing bad can ever happen to you. So when you let your guard down, you ignore warning signs about a potentially dangerous situation. We may think that we do not have anything to worry about because of the place we work, but we are not untouchable, things happen and we need to be aware of warning signs. The other part of this myth that caught my attention was the part of being immortal and ageless. Many times I think of working until retirement but life may have different plans. With that being said, how do we handle when a colleague passes away unexpectedly. Will we be able to get access to their client’s information? Will we be able to access any electronic files? Will we be able to get into their belonging in the office? These are all questions that it is important to think about. While it is easy to not think about passing away or just to feel like we are immortal and ageless, life happens, and it is important to be prepared. By being prepared for things like this, we are helping not only our patients, but colleagues as well because no one is immortal or ageless. This is something no one really talks about so this myth really got me thinking about this idea.

    2. Out of the “possible clue to taboo topics” that concerns me, the one I am most concerned about is the “discrepant record”. This is the idea that there are some significant discrepancies between what is documented versus what is actually happening in therapy. This can be a clue that taboo topics, uncomfortable feelings, and unidentified or misidentified factors impacting the therapist and/or the client. A discrepant record is misleading and confusing for someone reading it. So if someone has a goal for therapy and in your notes there is not mention of what is being done for that goal or if you’re inaccurately describing something, there could be something the therapist is avoiding. For me, notes are one of the most important pieces of therapy as it provides a way for the clinician to go back and really track progress of the client. So if there is any clue that the notes are filled with discrepancies, what is really going on? If a client identifies a goal or topic they want to work on and then there is no mention of it, why is that? To me, it is concerning if there is a discrepancy with notes and that maybe the clinician is struggling with the goals or topic the client wants to discuss. In therapy, there are many things clients will bring up that we may be uncomfortable with. However, it is our job to seek supervision around it so that we can help the client address it. Our notes are legal documents so if there is discrepancies, it can be an issue if something ever arises and these notes get utilized for court or anything like that.

    3. The one self-reported feeling from the appendix that surprised me the most was the “feeling so afraid about a client that it affects your eating, sleeping, or concentration”. If a clinician is to the point where they are so scared of their client that is impacting their eating, sleeping, and concentration, they need to be seeking supervision and consider transferring that patient off of their caseload. The lack of sleep, eating, and poor concentration will spill over to their overall functioning and have a profound impact on their ability to be an effective therapist for their other clients. When I think of a client who is impacting those areas of the therapist’s life, I think there must be a safety issue and/or there may be concern around the client’s safety. If it is around a safety issue where the therapist is afraid for their own well-being, there needs to be a plan to help the therapist because I personally do not believe that a therapist should be afraid to the point where their eating, sleeping, and concentration is impacted. It is concerning that to me that this has been a raised fear and in my mind, this means that there are places where handling a situation like this is not addressed. I was surprised that this was a fear because this to me means that the client should not be seeing this therapist and that something is not being done to help this therapist deal with what has gone on.

    Reply

    • Emily Morse
      Jun 25, 2017 @ 17:51:57

      Brittany, I also found that the myth of therapists being immortal/ageless caught my attention. It was honestly something I had not thought of before, especially the point about if a colleague passes away unexpectedly. I think this is something that is often overlooked and can have some serious potential issues (i.e. not being able to access their records or even voicemails). I agree that it is not often discussed or planned for. Having a plan for this occurrence should be commonplace practice in professions so there is no undue burden on other colleagues and/or clients.

      Reply

    • Janean Desjardins
      Jun 26, 2017 @ 00:02:19

      Brittany-
      I agree with you that notes are the most important part of therapy and aid in the progress of the client. In using noted to look back at what a client’s goals are and tracking the progress notes to see if these goals are being met and tracked properly is important. You raise a good point that if there is a discrepancy in notes what is there to hide and why is not in there? One would begin to wonder the integrity of the therapist and what they are actually doing with the client to begin with. The question could be raised if they are actually proper therapy in there sessions with clients and is that what is causing the discrepancy in notes as they do not know what the goal is or how to take notes on a session they did not properly construct. Also, when not having properly documented notes if that client is then handed off to another clinician for whatever reason, the other clinician then has to decipher what is going on with the client. The less information in the file, the more difficult it will be for that therapist o figure out goals, progress, and history on the client. Often they may need to repeat information that has already been covered which can be frustrating for the client. This can also tie into being immortal in the sense that if your records are not up to date or clear, the clients are the ones that suffer from clients records not being fully completed if something was to happen to a therapist.

      Reply

    • Marisa Molinaro
      Jun 29, 2017 @ 08:48:49

      Brittany,

      I agree with your comment regarding the myth being immortal and ageless. I hadn’t really put much thought into this topic until having this reading assignment. I think it may just be part of our “make up” to think that we can handle more than we actually may be able to. Also, it is important to remember our own safety not just the safety of our clients. Your point about a colleague passing away unexpectedly was also something I had not really thought about. It is important to make sure these are topics that we discuss with our colleagues and that safety is something that we do not overlook.

      Reply

    • Amina Lazzouni
      Jun 29, 2017 @ 09:08:24

      Brittany,
      I agree that the discrepant record taboo topic is concerning. In class, in my internship, and where I work, the importance of accurate documentation is constantly being stressed. I think at times some clinicians forget that clients can sign a release for their records and have a right to see what it is in their record so accurate documentation is so important. It is also important if the courts get involved because they can turn into a he-said-she-said at times, and if a counselor is accurately documenting their sessions with a client, it protects not only the counselor but could protect the client as well. I was also surprised about the self-reported feeling of being so afraid of a client that it affects eating, sleeping, etc. I think when it gets to that point, the counselor is no longer able to be effective as a therapist so not only is the therapist doing a disservice to him/herself but it is also a disservice to the client. I think sometimes therapists do not want to refer out when they have a difficult client, but if it gets to a point where one’s life is so deeply affected that he or she cannot even eat or sleep, I agree that a line needs to drawn and something needs to be done about it.

      Reply

    • Emily Noyes
      Jun 29, 2017 @ 17:21:47

      Brittany- The self report statement of being so scared of a client that it impacts your sleeping/eating, etc. surprised me too. It makes me wonder how a situation as dangerous as this got so out of control, as there are so many steps one could take before it ever got to such a point. I think you make a good point about your concern about how an agency never addressed this. It makes me wonder how many places like this are out there, as I am coming closer to graduation and beginning the job search process.

      Reply

  2. Emily Morse
    Jun 25, 2017 @ 17:46:50

    1. I found that reading the questions in Chapter 4 were very thought provoking, and some of them were a little uncomfortable to think about or try to answer. One question that piqued my interest was: Have you ever worked with a client that frightened you? If so, could you work effectively with that client? This was especially interesting for me as it recently occurred in my practicum (a young adult partial program). One of the patients had a long history of violence and psychosis. He was pretty agitated during the groups I was working in with him, and I found myself nervous when I was sitting next to him. I recognized this thought and immediately felt awful for thinking it. I didn’t even want to share the thought with my supervisor because I was embarrassed/felt bad for thinking it. I had him in my process group that I was leading, and again felt nervous when he was sharing in group. I was afraid he would become too agitated or even just say something violent and I would not know how to handle it effectively. When I was reading these questions in Chapter 4 about being frightened by a client, they really made me think about this recent situation. Being frightened by a client would presumably affect how (and if) you do effective work with the client. I’m still a little unsure about how to work through this without it affecting the therapeutic relationship, but I think recognizing and acknowledging the thought is a very important first step.

    2. One “possible clue to taboo topics” from Chapter 5 that concerns me greatly is repetitive therapy. I feel like this is a common occurrence, as I have often heard from other people in therapy that they don’t feel like there is a direction to the sessions. I think this can happen on the part of the therapist or the client (or a mix of the two). As for the part on the therapist, repetitive therapy could occur when the therapist cannot keep the client on track and allows the client to just return to the same topic over and over. I am concerned about this, because I can often have trouble interjecting when clients are speaking and redirecting. I am still trying to figure out how to do this effectively without cutting off the client and making the client feel invalidated or harming the therapeutic relationship. The client can also play a part in repetitive therapy, as chapter 5 mentions, through unrealistic assessments, constant new “unexpected” crises, or making progress and losing it. Overall, repetitive therapy is something I clearly want to avoid, and I am concerned because I feel like it has one of the greater chances of happening often in therapy. I want my clients to actually get something out of therapy instead of feeling like it is directionless, aimless, and not doing anything solid to help long term. I think (again as I said in question 1), it is very important to recognize and acknowledge when this is happening, which is the first step to gaining insight as to why it is happening and how we can stop the cycle.

    3. As discussed in question 1, I am very concerned about fearing a client. Especially as a woman, being attacked is something I generally fear in life, but this fear is exacerbated doing clinical work with someone with a history or violence and/or someone who is physically agitated. I am concerned about being attacked or in a situation where I am at risk, but it is actually the thought itself that is more concerning to me. Like I said previously, acknowledging this thought is so important, but how will I work through it to not allow it to affect my clinical work? If I am afraid, I will appear as guarded, and how can this create a safe space for my client? I know there will be times when I have these feelings of fear, so it is important to figure out how to work past the feelings and still provide effective therapy.

    Reply

    • Janean Desjardins
      Jun 25, 2017 @ 23:49:26

      Emily-
      I completely understand where you are coming from and fearing that you are going to be repetitive in therapy and how easily that can occur. Starting out it is very easy to let your client’s just talk and not want to interrupt or redirect the conversation to where you want it to go. This can be especially difficult when you have a talker. I had a client when I started my practicum that would talk without taking a breath. I had to learn in order to guide the conversation to be productive to say something along the lines of that sounds interesting, but can we go back to this….(whatever the original goal was) and explore it a little further. I follow up with if we have time we can go back to discussing this because it sounds very interesting, or something along those lines. I find that clients respond to this because you are validating what they have just rambled about, but you are also bringing them back to the point at hand. You do raise a good point about repetitive therapy though that if it continues is to recognize it and acknowledge it. This is important to do, as self-reflection can bring a lot to the table. It will allow you to figure out what is going on and how you can then change it. I think that is a great perspective to have.

      Reply

    • Brittany King
      Jun 26, 2017 @ 06:06:36

      Emily,

      I think at one point or another, a lot of people have had one patient/client that they were nervous about. The fact that you are so honest about it is a good thing. Supervision is one of the best ways to process this client and even getting ideas about how to deal with a situation if it arises. For me, when I had a client who had a violent past and would escalate quickly, having a plan was really helpful in at least easing my mind on what to do. When I knew I had a plan, I felt that I was more confident in working with the client. I think it is always hard whenever we get a “negative” thought about our clients but at the end of the day we are human beings and as long as we process these thoughts and work past them, it will help us serve our clients to the best of our ability.

      Reply

    • Jackie Bradley
      Jun 28, 2017 @ 13:34:19

      Emily
      I commend you for being able to be self aware about your thoughts and feelings regarding your particular client. Personally I have not yet worked with a client who I am afraid of, but I can totally understand why someone like yourself would have those thoughts and feelings regarding safety and how one would handle a dangerous situation. I think that being self aware of your worries or apprehension about a particular client is a great first step to dealing with clients who have dangerous tendencies, histories, etc. I think that if you are willing, speaking with your supervisor about your thoughts and concerns would be relieving for you as you can discuss plans or strategies for dealing with threatening comments or dangerous situations with that client of yours.

      Reply

  3. Janean Desjardins
    Jun 25, 2017 @ 23:37:49

    (1) Based on Chapters 1 and 4, what particular “Myth” (or Taboo/Secret/Question) piques your interest the most? Explain.

    A myth that caught my interest was learning ethical standards, principles, and guidelines, along with examples of how they have been applied, translates into ethical practices. We learn ethical codes and standards throughout our course work and during internship in order to prepare us for proper standards in clinical practice. As students we learn all the background as to why these ethical codes have been put in place to protect both the client and the therapist. Overall the ultimate ethical code is to do no harm. I feel as though while it is not appropriate to harm your clients in any way, it goes beyond just the thought of harming your client. We are going into a profession to help our clients in the most sensitive areas in their lives and they are putting this into our hands. Walking into that session every day there needs to be a notion of maintaining your ethical code at all times. I feel it is also our responsibility in our profession to call attention and report anything that we see that is unethical. When there is anything that is unethical going on that we may not be doing ourselves, but we see and do not report we are just as responsible for causing whatever harm is occurring. Just allowing something to occur because others may not know or the higher up may not see does not mean that it is not something that should not be reported. It is also important to know what the ethical codes, laws, and standards are in order to be sure that you are maintaining proper standards.

    (2) Based on Chapter 5, what “possible clue to taboo topics” concerns you the most as a practicing therapist? Explain.

    A taboo that concerns me the most is “dehumanizing the client.” I find that this happens very often especially with clients that have more extreme diagnosis or comorbid diagnosis. The more complicated and challenging the therapist finds a particular population is to work with it seems that it can be frustrating for them to connect on a therapeutic level. When this therapeutic connection does not happen it is taken out on the client as though they are the ones that are causing it to happen. Most often the reason is put on the difficulty of the diagnosis they are trying to treat with the client and how to managed symptoms that occurs with the diagnosis. All too often you hear therapists refer to clients as “that bipolar or borderline that I’m seeing.” This is stated instead of referring to their client as, my client so and so I am treating that has borderline. If you need to distinguish the fact that a client has a diagnosis for clinical guidance there is a professional way to do so and give the client dignity. The client is not identified by their diagnosis and they are not their diagnosis, so therefore they do not need to be presented this way. Clients are people first and that sometimes therapist lose sight of that.

    (3) Based on the Appendix, of all the information presented on therapist self-reported feelings and behaviors, what concerns (or surprises) you the most? Explain.

    When reading the self-reported feelings a couple of things came up, but one that I found more concerning was “feeling afraid that a client may need clinical resources that are unavailable.” I found this to be concerning because it is all too accurate and a problem for many clients. I believe that many of us have been in a position or know of people that have been in a position where they have not been able to get a client a service that they need. As therapists we can do all we can during sessions on a weekly basis, but there are times when clients need services in order to aid in the process. Some clients may need services such as, group therapy, substance abuse services, inpatient care (short or long term), housing/shelters, food pantries, or clothing needs. Based on the client these needs may be more urgent than others and often there may not be room at some facilities or a client may not qualify. This puts a client at high risk based on what their needs are if they are not being met and leaving the therapist feeling stuck, unable to help. I believe that this is a universal problem that requires more resources and better functioning facilities to help aid in the resolution of this problem.

    Reply

    • Brittany King
      Jun 26, 2017 @ 06:10:49

      Janean,

      I too had a similar feelings around the feeling about being afraid that a client may need clinical resources that are unavailable. We always want to provide our services with the best care possible and sometimes, that is things that our outside of our office. Getting referrals in for clients can be difficult sometimes and present a challenge. We want them to have every service they need but they may not have the proper insurance, transportation, or time. I always try may hardest to get my client’s the proper placements and referrals and building relationships within the community to ease that process.

      Reply

    • Jacleen Charbonneau
      Jun 27, 2017 @ 11:24:53

      Janean, I like your mention of the myth that learning ethical standards translates into ethical practices. This reminds me of one of the studies found in the book from our Research Seminar class, which conducted a survey on many professionals in the field related to whether or not they would engage in unethical practices. It was found that something along the lines of 2-3% of therapists would report untrue findings to their research studies. Overall, just because some individuals learn ethics codes doesn’t actually mean they are maintained in practice, unfortunately.

      Reply

    • JULIA SHERMAN
      Jun 29, 2017 @ 14:51:05

      Janean,

      I agree with you that learning the ethical codes and how they are put into practice was an important lesson that we learned from this reading. In our field, where things can often be considered subjective and could be easily placed in a “gray area,” it is vital to be well informed of the ethical codes of conduct and how to enforce them to ensure that we serve our clients in the best way possible. In our field, we function not only as counselors but as advocates for our clients. The clients that we work with are often part of vulnerable populations (mentally disabled individuals, physically disabled individuals, children, etc.), so the role of being an advocate and a mandated reporter should not be taken lightly. I find it very comforting that there is a published standard for how we should act ethically, not only so that mental health professionals are well informed of how they should act but also so that professionals feel supported when they report others for unethical conduct. Without this code, it would be much easier for professionals to dismiss unethical conduct for fear of appearing to “tattle” on others. I personally have had experiences in the past month in which I have had to report others for unethical behavior (once on a coworker for verbal abuse toward a client, and once on a parent for neglect). These experiences made me feel like a sort of “professional tattle tale,” despite knowing that I did the right thing, so I was grateful to have the support of organizations such as DPPC and DCF.

      Reply

    • Jason Prior
      Jun 29, 2017 @ 19:45:32

      Jenean,
      I really appreciated your description of how we should use the ethics we have learned. Everyone harps on the “do no harm aspect” and forgets that each session should be helping someone. Sure we go into this field with the intention to help people, but sometime that feels like it takes a back seat. This is particularly true when we talk about ethics in a “don’t do this” context.

      Reply

    • Meagan Monteiro
      Jun 29, 2017 @ 22:07:06

      Janean,

      I appreciate you talking about the application of ethics as I think it’s something people often overlook. I think that there is an idea that we are all in this profession to help and that the idea of do no harm is just assumed. I think that we need to be aware of how we interact with clients to ensure that we are behaving in ways that are ethical. I love that you mentioned the fact that people are labeled with their diagnosis. This is not person-centered and can led to some mistreatment or bias over time

      Reply

    • Salome Wilfred
      Jun 29, 2017 @ 22:46:01

      Janean,
      The “dehumanizing the client” taboo was also a concern for me. Like you stated, working with clients who are extremely difficult to work with and have a number of diagnosis is specifically my concern. Through my experience, I notice that clients with multiple diagnosis tend to exhaust me. I find that I put a lot of time and effort into these clients, due to their multiple diagnosis, and find myself becoming even more exhausted as a result. I feel like I need to work on setting better boundaries and not working harder than my client.

      Reply

    • Taylor Gibson
      Jun 29, 2017 @ 22:49:17

      Janean,

      I appreciated that you brought up the issue of not being able to access services that our clients may need. For a while, I was the only provider for a client whose symptomatology was incredibly complex and was dangerous to themselves. I felt a disturbing sense of hopelessness that my presence was not going to be sufficient and didn’t know what services I needed our how to access them. Once, I was able to sort that out, my sense of worry did not subside until she was off the waitlist and receiving the correct services.

      Reply

  4. Lindsay Millerick
    Jun 26, 2017 @ 11:35:20

    One particular question that caught my interest in chapter four was, “Have you ever worked with a client who frightened you? If so, could you work effectively with this client”? This question resonated with me as it reflects a recent experience of mine at the Butler Hospital Young Adult Partial Hospitalization Program (My practicum/internship sight). In reading a patient’s chart, which includes, height, weight, etc. I found that this particular individual had a history of physically violent behavior, and a tall and bulky physique. Before encountering this patient, I was extremely frightened that this individual would become triggered by the sensitive information that is touched upon in the program and I would be unable to protect myself or other patients. Interestingly enough, after gaining more insight towards the individual’s history and observing the patient in the program, I found that I was very empathetic towards this individual. Initially I did not think my work with this client would be effective, however, moving forward I predict that I will have fewer instances where a client frightens me. I have learned that notes and documentations are not accurate representations of the person themselves.
    As a practicing therapist, I am most concerned about theory-obliterated therapy. My goal as a therapist is to help clients reduce distress in the domains that he/she has identified as troublesome. However, I fear that my own feelings of discomfort will interfere with the effectiveness of therapy, and prevent the client from improving on his/her presenting problems. Guiding the course of therapy through the implementation of a particular theory can be useful when done so correctly, however, using it to avoid uncomfortable topics is not appropriate and counter-productive. In addition to being concerned that my own distress will impact that of another, I fear that I will be unaware of my uneasiness and unable to correct my actions. To engage in theory-obliterated therapy is to take control of the direction of therapy without the collaboration of the client. Theory-obliterated therapy contradicts my therapeutic values which include collaboratively administering effective therapy and improving the client’s overall well-being.
    I found it both surprising and concerning that therapists’ feelings of anger and hate can lead to diagnoses that are inaccurate; particularly borderline personality disorder. In misdiagnosing clients, there legal and/or professional consequences that could be irreparable. Clinicians should be cautious in labeling clients with borderline personality disorder as there is a certain amount of stigma towards this particular diagnosis. If the diagnosis is inaccurate, the association of an individual as having borderline personality disorder could cause unwarranted discrimination and emotional damage to this person, therefore causing more harm than good. I was even more troubled that therapists are so obviously mistaken with this diagnoses that the individual’s symptoms may not even nearly resemble that of borderline personality disorder. It is scary to think that therapists can experience strong, undetected feelings that could potentially affect the client in a negative way.

    Reply

    • Emily Morse
      Jun 28, 2017 @ 09:07:37

      Lindsay, I agree that it is concerning that therapists’ feelings of anger/hate can lead to inaccurate diagnoses. You mention BPD, but I can especially see how that could happen with personality disorders in general. I think sometimes therapists’ can allow their strong dislike of a client’s personality cloud their evaluations by solely focusing on these personality factors. Therefore, they may label a client with BPD (like you mentioned) instead of seeing other underlying mental health issues that may be more pertinent. This is extremely dangerous and something we as therapists need to be more aware of. I think the best way to be aware of these things is to take the time to self-reflect upon our feelings towards our clients and ask ourselves if these feelings are creating biases for us.

      Reply

  5. Meagan Monteiro
    Jun 26, 2017 @ 20:58:28

    1.) One question that sparks my interest in the question of Have you ever worked with a client that you hated? If so, could you work effectively with that client? I have had experiences where I have worked with clients in a group home that I have not liked particularly all that much. It is so hard! I am not sure what I would do if I were their therapist. I would definitely not be an effective therapist as I would not be willing to go the extra mile for my client. Validation and other skills would be forced and I feel that it would be very difficult to convey a genuine interest in this client. If I did not like a client, I would have to be aware of the bias that I would have. For example, I might be more likely to not believe my client in ambiguous situations, or be less likely to give my client the benefit of the doubt. I feel the best course of action would be to refer the client to somebody else, but sometimes due to resources that is not always possible. I also wonder how I would even mention that to a supervisor without sounding like a terrible person. Obviously, we cannot like everybody, but it is our job to be supportive, listen and help people. I would not know how to address this with my supervisor, let alone talk to my client about going to see a different therapist.
    I would like to point out that many therapists have probably slept with their clients due to the amount of different ways and times that the book addresses this issue.
    2.) The discrepant report concerns me the most as a practicing therapist because like other clues, we may not always be aware of what is going on at the time. After completing notes, I try to write down initial thoughts, and comments, and also take time to process because sometimes there is something that we may miss. Other times, how we feel a session went might influence what we leave out or what we include. I would worry that something might be left out to “give a client a break” or to cover up something that we wish would have went better which could have negative consequences. I think that it is easy to omit certain information from a report, and therefore it worries me the most. Another concern about the discrepant report is that while it can be easy for the therapist to omit information, it can be easy for others to pick up on it. Usually these reports will stand out, or the reader will be confused as to what happened during the session.
    3.) I was surprised to see “feeling afraid to work with a client that is HIV-positive”. I understand that there could be some health risks in working with these individuals but you could be put at risk at any point in time in the community and be completely unaware of it. Also, in a therapeutic setting, it is fairly easy to stay away from and not come in contact with a client’s bodily fluids. I am unsure if these clinicians were concerned or fearful of working with a client who may be close to the end of their life, or if they are concerned of contracting HIV. I looked back and it appears that this study was conducted in 1993, which may explain these results. I would be interested to see what psychologists are concerned about

    Reply

    • Jackie Bradley
      Jun 28, 2017 @ 13:39:23

      Meagan,
      The question of have you ever worked with a client that you hated caught my attention as well. I noticed these feelings for me arising in my marital therapy class. When we watch couple’s sessions, I often find myself thinking more badly about one person compared to the other, particularly when they are dealing with affairs. I am also unsure if I would be able to handle working with a client that I “hated” (that word is so strong!!) particularly when working with couples. I think that I would struggle to remain neutral for a couple and I would start to develop biases. I am not sure how I would handle a situation like this, either trying to work on myself and how I conduct/handle sessions or referring them to another therapist.

      Reply

    • Marisa Molinaro
      Jun 29, 2017 @ 08:52:34

      Meagan,

      I also had a hard time working with a client whom I did not particularly like. It actually wasn’t as much the client as it was their mother. I had to remind myself to keep my emotions and facial expressions in check when I was having a phone conversation or an in-person conversation with her. I usually pride myself in being calm and friendly to others, especially in situations that are for work. However, there was something about this particular mother that I just could not stand! It does bring some difficult elements into the therapy room, and I can only imagine how much more difficult it is if it’s the actual client that you cannot stand. Looking within ourselves and trying to identify what it is about them that we strongly dislike may also aid in us working through this ambivalence.

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    • Jason Prior
      Jun 29, 2017 @ 21:22:20

      Meagan,
      I do really like how you focus on the clinicians who are worried about getting HIV from a client. While this is a pretty outdated report, I have no doubt that there are still therapists who are this ignorant. These days it may tend to be other illnesses, such as Hep-C, that people are worried about. Still, the idea that even educated people can behave or think in ignorant ways exists.

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    • cpopores
      Jun 29, 2017 @ 23:36:53

      Meagan,

      I agree that the publication year probably has a lot to do with the reports of therapists being uncomfortable working with HIV positive clients. It would be incredibly surprising to see the same reports today, although I am sure there are still therapists who have biases against individuals with HIV and AIDS. I will say, the one thing that has made me fearful when working with individuals who are HIV positive is my fear for their health and safety. Doing meds at the CSU, I saw many individuals with HIV who were inconsistent with taking their medication and/or staying in treatment and seeing a doctor. Most of the time, they were individuals who struggled with substance abuse, serious mental illness, and homelessness. I appreciate the fact that the AIDS project in Worcester is such a great resources for individuals. However, I know that it is incredibly important for individuals to consistently take their medications to maintain their health, slow down the progression of the disease, and for the medications to be effective. I believe that many of the medications lose their effectiveness when not used properly. I can’t imagine having such a regimen of drug cocktails, and they have many barriers to taking medications regularly, but it always worried me when they came through with empty pill bottles or pill bottles that should be empty and they still have most of the pills, because I knew they were not taking care of themselves.

      Reply

  6. Amina Lazzouni
    Jun 26, 2017 @ 21:00:10

    1. The myth that piques my interest the most is the myth in chapter one that says, “If you’re a good therapist, the money will take care of itself.” I think the money issue is a taboo subject that many therapists do not like to talk about because many therapists are in the helping profession because they genuinely want to help people and do not go into counseling for financial gain. While I think this is true for some therapist, I do think there are many therapists who are financially motivated. There are several clinicians were I work and there is a $75 cancellation fee for clients who do cancel before the 24 hour limit and there are clinicians who will charge consistently, and others who will rarely charge. I never really thought about it because I haven’t practiced my career for money yet, but I do think there it is an important concept to consider because while many therapists are in the career to help, and not really motivated by finances, everyone still needs to make a living and money is an essential part of having a comfortable life. I have also experienced many clients who refuse to pay their bills, and some clients have outstanding balances that are so high that they truly cannot afford to pay them. I have hear clients say, “I need services are you cant deny me because I can’t pay,” and often they are upset because they genuinely need help, and it is difficult for both the client and the clinician when the client cannot pay. With that being said, there are two types of clients that I have encountered in my experience: clients who genuinely cannot pay, and clients who simply do not want to or feel that they have the right to services despite their financial situation. I think it’s an uncomfortable situation to be in, and I’m not sure how I would handle it myself. I have also seen clinicians who make payment plans with their clients who do not have insurance and cannot pay, but I am not sure what financial situation those clinicians are in and if they can afford to offer services at a significantly reduced rate. With all of that being said, I definitely agree that “If you’re a good therapist, the money will take care of itself” is a myth and not true, but I think dealing with money is specific to each client and clinician and should be dealt with on a case-by-case basis.

    2. The possible clue to taboo topics that concerns me the most is “seeking repeated reassurance from colleagues.” The book says that therapists are likely to seek repeated reassurance early on in one’s career, and I have just started my internship but I already find myself doing this. I mostly seek reassurance from my supervisor, but I do also occasionally ask other interns or employees at my internship site about their opinions about my work. I haven’t received much negative feedback yet, but when I have, I have done everything in my power to correct what I did “incorrectly” and then sought reassurance for my corrected work. I am very affected by what people think about me, and at times, while I do think that consultation is positive, I think the reason one is looking for consultation is important as well. Asking a supervisor, seasoned therapist, or even intern about their opinion on a matter that you do feel well equipped to handle is a positive reason to seek consultation, and while I do do that often, I do also seek consultation for reassurance purposes. The problem with seeking reassurance for me personally is when I do not receive it, I am very affected and then feel like I have to prove to whoever’s reassurance I am looking for that I deserve to be reassured. Another issue with seeking reassurance is being a new therapist, I do not have a “style” yet and if someone disagrees with my style, it doesn’t necessarily mean that I am wrong, so if I were to change my style based on a lack of reassurance, it may cause me to counsel in a way that is not natural to me and may not be beneficial to me or my clients.

    3. Based on the appendix, I am most surprised about the section about sexual feelings. The section said that research published (in 1986) found that 87% of therapists (95% of men and 76% of women) have been sexually attracted to their clients. I think 87, 95, and 76 percent are all much higher percentages than I would have guessed for therapists being sexually attracted to their clients. The section also says that many (63%) felt guilty, anxious, or confused about the attraction. That means that 24% did not feel guilty, anxious, or confused, which I think is concerning! I also think it is strange that the section mentions that therapists become sexually aroused during sessions. I can’t really think of any scenario when I would experience that, or why that would happen. That may be unfair because it is a normal physical reaction to certain scenarios, but I just personally find that shocking. While I know that attraction cannot always be controlled, so I think its natural to feel feelings of guilt, anxiety, or confusion, but I am surprised that 24% did not feel negative feelings about their attraction. I am not personally worried about being sexually attracted to clients, but I am definitely shocked and surprised by that statistic.

    Reply

    • Lindsay Millerick
      Jun 28, 2017 @ 09:52:31

      Amina, I can relates to seeking reassurance from supervisors and peers at our level of clinical experience. Because we are at the very beginning stages I think seeking validation is normal and expected as we are concerned as to weather or not our performance is positively influencing clients. However, after you have been practicing in the field for a while, your level of comfortability and confidence will likely increase and eliminate the need to seek reassurance.

      Reply

    • Emily Noyes
      Jun 29, 2017 @ 17:18:24

      Amina- I had a very similar experience at my internship in regards to the seeking repeated reassurance from colleagues. I’m naturally someone who is hard on myself, especially being in the role of a new therapist. I found that I was very critical of myself at the beginning of my internship. I am still am figuring out what my “style” really is, but I did find that as time went on in my internship that I started to gain some insight in to how to deal with the stress and obstacles that I experienced and began to learn more about myself as a therapist. I too chose this to talk about in my blog, and I feel that this is a typical concern for any new therapist, and it is something that will become less of a concern as we begin to identify our style as a therapist and our techniques in therapy.

      Reply

    • mjoyceac
      Jun 29, 2017 @ 17:18:58

      Amina, it’s great that you have such considerable insight into your thoughts and feelings regarding seeking reassurance. Especially as a new clinician it can be hard to feel comfortable when doubting your clinical work and it’s logical to seek reassurance. For myself, one of the best things I did for myself was allowing myself to make mistakes. As a new clinician, it is unrealistic and nearing perfectionism to expect that anyone would be a perfect clinician with only a month of experience. Granted I have a certain level of insight to your site, I know that our mutual supervisor was always open to giving both positive and constructive feedback. One of the best things to do is start doing process recordings with her during your supervision as soon as possible. I found that the process of going through the session recordings was much more valuable than talking about general approaches, in terms of gaining reassurance and feedback.

      Reply

    • cpopores
      Jun 29, 2017 @ 23:47:30

      Amina,

      I thought the myth about the money taking care of itself sort of interesting too. I think that there are different career paths we can take, and some lead to more money than others. For example, some therapists can make a lot of money in some private practices, and many don’t work with insurance because of the hassle and poor compensation from insurance companies. On the other hand, many therapists who work in nonprofit community-based settings work incredibly hard and with underserved populations. This can be fulfilling, but they’re underpaid most of the time.
      In terms of the insurance, I’m interested in where the individuals who didn’t want to or couldn’t pay were. I’m especially interested because, in MA, masshealth and the associated insurances typically have great mental health/substance abuse coverage. If individuals are uninsured, it is very easy to apply for masshealth and goes into effect pretty quickly. Also, many community nonprofits in Worcester will treat individuals whether they have insurance or not. However, I guess there may be individuals above the income to qualify for masshealth but still can’t afford decent insurance…in which case, I could see it being difficult to get proper mental health treatment. I don’t think that all of these individuals actually understand that when they try to get services without paying they may be affecting the therapist directly and that we don’t get paid all that much. In some cases, we still make more than them. Also, doctors usually make plenty of money even when we don’t pay our bills, and may people go to the ER to get treated because they know they are entitled to treatment, but never plan on playing the bill because they can’t afford it.

      Reply

  7. mjoyceac
    Jun 26, 2017 @ 21:44:52

    I found myself interested in the same myth as Brittany, which states that clinicians are invulnerable. To me it is laughable for anyone to think that counselors are invulnerable, as we are often exposed to the threat of physical and psychological harm. Most of my clinical experience has been in environments where physical harm was all too much of a reality for counselors, where I even experienced a concussion during a client restraint. While most counseling environments are not as dangerous as others, it is our responsibility as emerging clinicians to respect the very real prospect of harm. With so many of our peers getting IHT positions, I find myself feeling anxiety for them, as I wouldn’t feel comfortable in such a position. Also, after reading chapter 4, I found the question “Have you ever worked with a client that scares you?” resonated with me. There were several patients at the residential facility that absolutely horrified me, but I find myself in such a better place to address difficult, acute clients with the training through Assumption.

    One of the taboo topics that I found interesting was the idea of therapy being repetitive, which is something I wonder about with my upcoming job at Spectrum. In my internship, I found that therapy had pretty concrete beginning, middle, and end phases. With Spectrum, I’m curious as to what feelings I will experience as maintenance is often the goal of many and I wonder how I may feel when things seem repetitive. I need to analyze my approach if a client continues to struggle with something week, after week, after week, to the point that it is clear the repetition is ineffective. It is necessary to address your approach if it is repetitive and not moving a client towards their goals using a logical approach. I was talking to a friend whose daughter was in therapy, and felt that her daughter had become friends with her therapist and all they did was just talk about random stuff every week. I think at our core as CBT therapists, we cringe at the idea of just talking our way through therapy, rather than using directed interventions.

    One of the most shocking things was the high rates of sexual attraction with clinicians towards their client. First, I am honestly surprised that the numbers were so high, as I would expect clinicians to answer with socially desirable responses of NOT being attracted to a client. I’ve always heard stories here and there of an inappropriate client-clinician relationship that aren’t sexual in nature, and it’s shocking for me to consider how unprofessional it is to experience those feelings of attraction to a client.

    Reply

    • Salome Wilfred
      Jun 29, 2017 @ 22:58:59

      Mark,
      That myth shocked me as well. I cannot even count the number of times a client has said something to me that REALLY hurt. I feel like for some reason, clients (especially teens- in my experience) have this idea that because I’m a therapist and “mentally sound” things don’t bother me. Well, they are oh so wrong! I like to think that as a therapist I’ve better at handling it, but honestly, that’s probably still a work in progress as well.

      Reply

  8. Stephanie Halley
    Jun 27, 2017 @ 10:09:35

    1) One myth that really caught my attention was “therapists are invulnerable, immortal, and ageless.” As I read on about the therapist who was threatened with a knife by the patient, she had stated she felt too comfortable within her clinic. I wouldn’t deem it a bad thing to be comfortable, but it is important to remain aware that these clients are not in the same position as ourselves, safety wise. This one struck me as well, as I am working in the prison. The men I work with are very manipulative and as I am not used to this population, I need to be aware of this and not be “too comfortable.”

    2) One of the clues that worried me is the discrepant record. As my job now is more community-based and with kids, we often play games, or sports, etc. As long as we can prove how it is therapeutic and related to the goals, it is fine. But we are often trained with “little is more” in our notes. So I am worried that training will carry over into my therapy.

    3) I would say I am most concerned about fearing a client. As I stated earlier, being in the prison, I am not working with necessarily “good” people. Although I am brand new within my practicum, I feel it is always in the back of my mind and just a little on edge. I guess I worry about the fine line of fearing my client, and being too comfortable, and where is the happy medium between the two. Although there is a guard always outside for me, therapy with these men is the one time they are allowed to be vulnerable, which can really stir up some emotions in them. Last week I had a man sobbing for quite some time and he said “I’m not worried about killing myself; I am worried about crying in my cell. You can’t cry in jail. They’ll eat me alive” and unfortunately he is right. So these men wait until they are with me or another clinician, and everything that is bottled up is released: whether it is anger, sadness, etc. So I could be vulnerable to assault.

    Reply

    • Jacleen Charbonneau
      Jun 27, 2017 @ 11:17:19

      Stephanie, I think you’re right that we shouldn’t deem comfortability as a bad thing. I think there should be a balance, and that clients should be well aware of their surroundings but also be able to become comfortable with particular clients, ultimately trusting their judgment. It is difficult to be on guard 24/7, which I am sure can become exhausting overtime and lead to burnout.

      Reply

    • JULIA SHERMAN
      Jun 29, 2017 @ 15:02:50

      Stephanie,

      Like you, I am certainly concerned by the amount of therapists who have felt fear toward clients, but I am not surprised by it. During my work as a residential counselor with children, I found myself becoming fearful toward certain clients (often children who became easily trauma reactive and would engage in violent behaviors toward others). This fear made it very hard to go to work without feeling a high amount of anxiety, and no amount of coping skills seemed to help with this. However, during my work at a therapeutic day school where children also tend to engage in violent behaviors, I found that I did not become anxious in the same way. It was easy to tell what the difference was–the school had the necessary supports (both in terms of staff ratio and in terms of the presence of isolation rooms) to manage such behaviors to minimize injury. The group home that I worked at did not employ enough staff at a time and did not have the proper isolation rooms to manage unsafe behaviors. So from these experiences, I have found that it is important for counselors to have the proper supports available to help minimize the presence of fear. Experiencing fear toward a client can make it very difficult to engage in treatment properly (i.e. A counselor may be hesitant to set proper limits for fear of triggering the client into becoming physically aggressive). Unfortunately, due to the lack of funding for many mental health programs, it can often be difficult for organizations to get the correct supports for such clients, leading to ineffective treatment.

      Reply

  9. Jacleen Charbonneau
    Jun 27, 2017 @ 11:15:34

    1. I appreciate how the readings this week touched upon the idea of safety, since I believe that many times, in the classroom, students often do not discuss this or pay much attention to the area of staying safe. Therefore, the myth relating to the idea that therapists are basically invincible and are immortal is one that not only interests me, but I can truly appreciate being included in the readings. Therapists may grow comfortable in their work, which I can see happen if one is conducting therapy sessions day after day for a number of years; however, I am sure there are therapists who have had experiences that left them feeling a bit shaken up, as well. For instance, I have had a few of these rare experiences in my lifetime as an in-home tutor for students with mental and physical disabilities, as well as a therapist. It is these circumstances that allowed me to debunk this common myth that many may believe, especially when working with populations that require less intensive interventions. I can honestly say that I do have my guard up when first conducting therapy with a client, especially if the therapy is in-home, until I get to know the person well enough and I can become fully comfortable working with him/her. Moreover, I feel as though this myth works like a chain reaction. For instance, as an intern, I am sure one may feel more uncomfortable/threatened by certain clients more than others simply because he or she is new to the field. However, those who are supervising such interns may not have this same concern or fear due to his/her experience in the field. Depending upon one’s supervisor, interns may be taught to not fear situations due to the stamina of their supervisors. Overall, I think more discussion of safety and more thorough safety training in clinical practice is important in order to recognize that invincibility as a counselor is a myth and that situations can arise from time to time.

    2. The book brought up the taboo of the Patient-Friend. Therapists and patients, although they are in a unique type of relationship where the patient reveals his or her deepest secrets to the therapist with full trust and confidence, cannot be friends. This may often be confusing to the patient, who is the individual disclosing such information to the therapist. I believe that it is the ethical obligation of the therapist to clarify the relationship boundaries once the therapists does sense that the patient views him or her as a friend. On the other hand, as humans who get involved in different types of relationships, therapists may also find that he or she is starting to experience more of a friendship than a professional therapy relationship with the patient. This is a concern because the idea of dual relationships becomes an ethical issue; if the patient and therapist become friends, then the patient may not feel as though he or she can disclose particular information in fear that he or she may disappoint the therapist-friend. I have always been a very social person and when I began my internship, I had to make a conscious effort to remind myself that the therapist-patient relationship was one that was in the benefit of the client, so self-disclose was NOT an option unless it was in the benefit of the client; overtime, this effort became more natural as I fully adopted and understood my role as therapist. It can definitely be tempting to self-disclose, especially if the patient is similar to your age and is experiencing some of the same situations that you have, but reminding yourself that this therapy session is for the client only can help avoid this taboo. If a therapist feels that he or she needs to self-disclose, then he or she, in my opinion, should seek his or her own therapy outside of work.

    3. The appendix mentions therapists’ self-reported feelings of sexual attraction, which is very concerning to me. The high percentage of those who have reported feeling sexual attraction, and even arousal, when meeting with a client is actually shocking. In the instance where a therapist begins feeling sexual arousal while meeting with a client should be a time to refer the client out to another therapist. Particularly, I am thinking about the ethical obligation of “do no harm,” and if a therapist is sexually attracted when meeting with a client, then the therapist may treat the client differently or see the client in a biased way. Moreover, I don’t think it is fair to a client to self-disclose sensitive and personal information to someone that they have no idea is sexually attracted to him or her in that moment. Therapy should be a safe space where no judgment takes place, and even if the judgment is not necessarily in the area of thinking the client did something “bad” or is “bad” (e.g., the therapist judging his or her client as attractive), therapists should ensure that they are working on these areas of judgment to maintain a judgment-free zone for the client.

    Reply

    • Amina Lazzouni
      Jun 29, 2017 @ 18:05:05

      Jacleen,
      I think you brought up a good point about the patient/friend relationship. I think its often easy to get caught up and think about a client as a friend, which can pose a number of issues. First, you often have conversations with your friends, and when lines get blurred, a therapist may lose sight of why they are there and have more of a conversation than a productive therapy session. Second, like you mentioned, having a friendship is crossing a boundary and could affect and potentially derail an effective therapy relationship. Third, it is possible for friendships to lead to other, more inappropriate boundary issues, so I think it is important to address the issue as soon as possible.

      Reply

  10. Jackie Bradley
    Jun 27, 2017 @ 11:31:36

    1. A myth that I found to be the most interesting was that therapist are invulnerable, immortal, and ageless. Reading the short story about the clinician who was held hostage and threatened was a solid reminder that we as therapists can not let our guard down in our environment. This myth section further explains that the clinician felt she was too comfortable in her environment. She ignored warning signs and began to feel “safe” in her environment and admits that the warning signs may have been interpreted differently if she had been on the street or in another setting. As previously mentioned, this myth is a reminder to all clinicians no matter what environment they may be working in, that safety needs to be a top priority. It is important to have plans for possible scenarios where we may be placed in danger.

    2. Repetitive therapy concerns me the most as I become a practicing therapist. My worst nightmare is seeing a client for some time and feeling like there has been no real progress made. I think that if this were to happen it could heavily rely on the therapist, but could also be affected by the client. That is what makes the collaborative process of therapy so important. The therapist needs to keep the client on track and encourage them to work toward the goals that they have set. In doing so, it will help to keep the client from remaining in repetitive cycles. If the client is coming to therapy every week with a new crisis and list of problems going on in their life, it is so important for the therapist to intervene and help the client to tackle one important issue at a time. I hope that as a practicing therapist I will gain skills to help me keep clients on the right therapeutic path and encourage them to step out of those repetitive crisis cycles.

    3.What surprised me the most in the appendix was the high rates of sexual attraction therapists feel toward their clients. I was surprised that so many therapists reported feeling sexually attracted to their clients, but was also not surprised by the high rates of confusion/embarrassment/guilt that came along with those feelings of attraction. I guess it is human nature to be attracted to other people, but it puts a therapist in an uncomfortable position when they become aware of that attraction and the feelings of guilt it brings along.

    Reply

    • Lindsay Millerick
      Jun 28, 2017 @ 09:59:18

      Jackie, repetitive therapy is concerning to me as well, not only over the course of therapy but in individual sessions. I often run into this problem when leading a process group at my practicum site. It is more than appropriate to select a theme or two to focus on in group sessions if they are relevant, and people seem to be insightful on the topic. Unfortunately, I have run into a few situations where the same themes keep coming up and have already been addressed. Sometimes the patients are able to add more content to the subject, but most feel they have said all they could already. I am working with my supervisors on facilitating more effective groups and redirecting conversations.

      Reply

    • Stephanie Halley
      Jun 29, 2017 @ 21:57:02

      Jackie,

      I agree to your fear of repetitive therapy. It certainly makes it painful when you feel you’re just going around and around in circles and no one is getting anywhere. I think you made a good point by saying us as clinicians need to hold our clients accountable for keeping on track. If we remain on track, they will gain the skill set to manage these weekly crises on their own.

      Reply

  11. Emily Noyes
    Jun 27, 2017 @ 14:03:02

    1.) Out of the questions presented in chapter 4, two of them particularly peaked my interest. The first one was “have you ever worked with a client you hated?” In my opinion, the word “hate” is a little too strong, but I can relate to having clients who I didn’t enjoy working with. I’ve had quite a few that I can think of off the top of my head that would make me feel anxious working with them. Some of the reasons being that they were not receptive to therapy, and that they were very resistant and would refuse to work with me. This is something that I struggled with, especially during the earliest of my experience in counseling. I know that this is something that is commonly experienced when working with clients across all populations and settings, however, feeling this dislike towards my clients made me feel guilty, and made me question if this is something that a “good therapist” commonly experiences. The second question was “have you ever worked with a client that frightened you?” I chose this question as well because it ties into the first one, meaning that I’ve had many clients who fall under both of these categories. One experience in particular was working in residential. The program I worked for housed children who had significant behavioral issues and required physical restraints. I can think of one client specifically who was the most aggressive out of all of the children in the home, and was a big child who badly injured multiple staff members on multiple occasions. He also ripped doors off their hinges and smashed car windows when he became escalated. I was expected to meet with this client, one on one, in a room behind closed doors once a week. He was resistant and never opened up to me throughout my time working with him. I used to get very nervous prior to meeting with him, and since I didn’t have the training (nor was I allowed to by my agency) to properly protect myself if he were to become escalated during one of our sessions. This reaction to my client (in comparison to simply not liking a client) never made me feel guilty, but it was certainly something that I would become hesitant to talk about with my other co-workers because I wasn’t sure how to go about a situation like this since I had never been in one before.

    2.) As a practicing therapist, I’d say that one of the possible clue to taboo topics that concerns me the most is seeking repeated reassurance from colleagues. The authors talked about how therapists go to their supervisors week after week with the same questions and concerns, only to find themselves not ever moving past the starting point. The book talked about how this may reflect an underlying feeling that the therapist may have towards the client that they are not necessarily aware of. The reason I chose this was because I can relate to this issue, and I feel as though some of the issues that I would consistently speak of with my supervisor week after week never got fully resolved. I think that this is something that really caused me to feel defeated, and question by ability to provide therapy. It made me feel that I was incapable of really connecting with some of my more challenging clients and made me believe that I was not doing anything that was of therapeutic value for my client. I have come to learn that this is a struggle that all new therapists experience, and that I will learn a lot as I continue to strengthen my counseling skills. However, I think that this is something that I never discussed with my supervisor or other colleagues because I thought that it was something that wasn’t “normal” to experience after working at my agency for several months. It made me feel that I was not trying hard enough to resolve my issues with my clients.

    3.) What surprised me in the therapist self report index was that statement “feeling so afraid about a client that it affects your eating, sleeping, or concentration”. Although there weren’t a significant amount of responses under this question that showed that therapists commonly experience this, there was a higher number than I expected who stated that they sometimes felt like this. The numbers seem to be slightly higher for working with male clients, which I can understand on some level, especially female therapists working with male clients. However, I think that it is an extreme statement to say that this is negatively influencing their lives in a pretty significant way. If I were a therapist, I would certainly consult with my supervisor or other colleagues if I ever got to the point where I was having difficulty sleeping or eating. If this is impacting your personal life to such an extent, I can only imagine how it is affecting your own work and the ability to provide therapy.

    Reply

    • mjoyceac
      Jun 29, 2017 @ 17:24:09

      Emily, after hearing all of your stories during our internship class, it is no surprise to see that you wrote about those experiences in this post. I think one of the most difficult settings to work with clients is in residential, especially with dangerous populations. Having worked in multiple residential settings, I have gained such a respect for the clients I may “hate” or “fear”, as they have the potential to do serious harm. While working at the WRCH, one of the charge nurses had her eye socket broken by a adolescent female client who was punching her while in a headlock. There were no staff in the area, which is ridiculous considering the program’s size and staffing, and I can’t help but be even MORE afraid for clinicians and direct care staff working in these settings.

      Reply

  12. Taylor Gibson
    Jun 27, 2017 @ 14:55:09

    1) The myth that I found most interesting was the “myth” that therapists are invulnerable, immortal, and ageless. I am often on high alert when meeting a client and family for the first time or when I anticipate that a session will be tense. However, much like the example in the book, I often find that I start to get comfortable in the homes of the families I work with and that I’m not as aware of my surroundings as I should be.

    I had not even considered what the book went to go on to say about professional wills. Perhaps that is because I’m not to the point in my career where the logistics of running an office are even a factor to consider but I’m not sure that it would have occurred to me even if I had been.

    2) I would say that the most concerning of the “clues to taboo topics” for me would be the dehumanized therapist as this was a problem that I experienced just recently. When speaking with the parent of one of my clients, the conversation drifted from the client’s trauma history, which I was fully prepared to discuss, to her mother’s concurrent trauma and feelings of guilt. I have to say that I was completely thrown off guard and struggled to decide how to best meet the mother’s need in that moment. I found that in my own thoughts I was struggling to sit with the powerful emotions that came up and found myself wanting to say something technical instead. I think that I was able to stay and listen empathetically but it was very difficult when faced with a situation I was not prepared for, to not fall back on my technical training and to instead be empathetic and human.

    3) I was highly disturbed by the number of therapists in the appendix who admitted to being open to sexualized contacts with clients during or after therapy. I thought that that would be a pretty clear “no-no” but I guess that that is not the case. The idea of ever crossing that boundary gives me anxiety and I don’t understand how others would feel its appropriate.

    Reply

  13. Marisa Molinaro
    Jun 27, 2017 @ 15:20:59

    1. The myth that completely shocked me was that therapists learn therapy and practice in organizations free of competition’s influence. Even just being at my internship I saw the competition that therapists experienced with things as simple as clients coming into sessions. I think to assume that any field is free of competition between individuals is a little silly. We are competitive in nature, but even more so in a field that is based on helping others as well as retaining clients. Even though we are in the “helping profession” that does not mean that there are not areas to move up the ladder and room for growth within our field. Because of this, there is always some sort of competition built into our organization. I do believe that it is not as strong and as prevalent as it is in other fields, such as the business world. However, this does not mean that we enter our field without the desire to be better than the person next to us. I saw therapists argue over things as little as having a bigger office or being offered the better hours during the week. I think that things like this are inevitable in any profession you enter and that thinking that just because we are therapists we are void of being influenced by competition.

    2. The possible clue to taboo topics that concerns me the most is the idea of the dehumanized therapist. This is when the therapist attempts to drain away his or her humanity rather than that of the clients. Until reading this chapter I had not even really thought about that fact that this could possibly happen during therapy. I could imagine this happening when dealing with a very difficult client that has experienced extreme emotional distress. Rather than allowing transference of the negative emotions, the therapist themselves may just shut themselves down and not allow any processing of these emotions onto themselves. I feel that with the population I want to work with, this could be a possible issue that I may encounter if I am not in tune with the way I am feeling and behaving with my clients. Making sure that we are communicating clearly and understandable to the client we are working with is extremely important. At the same time, however, it is important that we have a balance and are not allowing ourselves to be overcome with emotions and feelings that are clients may bring out of us.

    3. The feeling that concerns me the most is experiencing sexual feelings or attraction to a client. I was told several “horror stories” about this at my internship and I can understand where the guilt, anxiety, and embarrassment comes from when being a therapist who is experiencing this. I understand that it is human nature to feel physically attracted to other humans and it is hard to shut that off when it happens. However, I feel that I would have a hard time processing those feelings as well as deciding whether to terminate my sessions with an individual if I did find myself feeling sexually attracted to them. If it crosses a line at any point, even if just in your thoughts about the individual, this is when the therapeutic relationship should be terminated because the ability of that therapist to be productive is most likely dramatically decreased.

    Reply

  14. Salome Wilfred
    Jun 27, 2017 @ 15:52:41

    The secret question that resonated with me was “What comment could a client make about your looks, sexuality, or other personal aspects that you would find most hurtful?” I have already had this happen to me a couple times and I do not know if I handled it in the best way. One comment that was pretty hurtful was: “God hates the gays and they’re all going to hell.” While I consider myself a pretty religious/spiritual person I am also in a relationship with a female. In the moment I just let it slide by and did not say anything. I feel like I acted in my own best interest by doing that because it was hurtful to hear and I felt like I would get into a power struggle with this client if I addressed it. I also feel like I should have allowed them to say what they needed to say without being judged. I know I still struggle with putting my personal opinions and ideas to the side in session and allowing the client a space where they can talk freely(ish). While I feel like I have made improvements on some topics I know I still have a long way to go with other topics that I may find hurtful.

    The possible taboo topic that I am concerned with is “The Dehumanized therapist.” The book discussed that dehumanized therapist start to simply use jargoon and begin to act like a wise and distant computer who just discusses what they observe and give advice neutrally without much emotion or concern for their clients well being. I am concerned that I will begin to discuss cases simply theoretically and begin to ignore the idiosyncrasies of the client and therefore become less helpful. I am also concern that I will eventually become drained and burnt out that I just stop feeling anything for my clients. I feel like this is especially likely to happen as a result of working with the same population over an extended period of time.

    My biggest concern is the emotion of anger. The book discussed the power of expressing anger appropriately and being a model for your client but I am concerned about my possible inability to acknowledge my anger when it is occurring and that potentially leading to a big problem. When I get angry I have a tendency to shut down, not talk and ruminate. This specifically happens when I get angry with people I do not consider myself very close to. While it was comforting to see this addressed during the chapter I also now know that I really need to get better at appropriately expressing my anger. This is especially true after working with a population who reports having anger problems. I would like to eventually become a model of how to appropriately express my anger but I really have no idea where to start.

    Reply

    • Taylor Gibson
      Jun 29, 2017 @ 12:50:29

      Salome,

      I’m sorry to hear that you’ve experienced derogatory comments from your clients which hit close to home. Although certainly not the same experience, I have experienced clients making derogatory comments to me about my appearance. Most of these comments have come from my young, female clients. Despite inwardly experiencing hurt feelings I tried to keep the focus on my therapeutic goals which, for many of my young female clients includes working on self-esteem and body image. By focusing my energy on demonstrating positive body image to them (i.e. “Well, you are entitled to your opinion but I think I’m pretty just the way I am. Why was that important for you to tell me?”) I was able to focus less energy on my feelings of hurt, embarrassment, and anger and refocus discussion on my clients.

      Reply

    • Stephanie Halley
      Jun 29, 2017 @ 22:02:11

      Salome,

      I can imagine your emotions and frustrations when your client made those comments to you; so sorry you had to go through that. But in the end you stated you fear your ability to handle anger. I don’t know exactly how it presents itself, but knowing your triggers (i.e., this particular comment) and essentially picking your battles was probably your best bet. Maybe further down the line when you gain more experience on handling your own triggers individually could it be discussed further with the client. But where it is still a sore wound, I think it would be something written all over your face, which may effect the therapeutic alliance you two have/had. I think you handled it well given the circumstance!

      Reply

  15. Zachary Welsh
    Jun 27, 2017 @ 16:43:42

    1. One myth that piqued my interest was the myth, “Therapists are invulnerable, immortal, and ageless.” Therapists get used to the environment in which they work and it is not always a safe one. It is important to always remember that safety comes first. I feel like I have already experienced this when working as a direct care staff on a residential unit for children. I am so used to dealing with aggressive kids that I sometimes forget that I could really get hurt in these situations. Safety must be a concern when working with this population and it is easy to forget since we, as therapists, are so invested in helping our clients. We sometimes forget to put our safety first. This myth also made me think about the idea of a professional will. This is an interesting concept that I never really thought about before. It is useful to have this in place, however, so the clients are not left without support and can continue the work they are doing.

    2. One possible clue to taboo topics that concerns me is discrepant record. This is an area of concern for me because records and note taking should be accurate and aligned with what is going on in the therapy. A good note also must be clear and concise. I fear that having this idea of conciseness in mind, I may miss something important from a therapy session and forget to return to it in future sessions. I also do not want to write too much since this may complicate the session for the reader and may complicate future therapy sessions. It is important to get supervision on this topic to know that my notes and records are accurate and beneficial to the therapy. A discrepant record can be harmful to the client and make the therapy useless.

    3. One thing that concerns me is fear in reporting child abuse. Since I would like to work with children, reporting child abuse will most likely be something I have to do at some point in my career. One fear is having the caregiver find out that I reported them for child abuse and dealing with an angry phone call or possible dangerous situation because of the report. I feel that relying on the support from my supervisor and other coworkers is crucial when reporting child abuse. This helps to ensure that the accused person cannot blame one person and lash out at them. Reporting child abuse may also harm the therapist-client relationship. If I report that a caregiver is abusing their child, the child will be removed from their care. The child may be grateful that they are no longer in an unsafe situation or they may feel like they should not have trusted you since they are now separated from their caregiver.

    Reply

  16. JULIA SHERMAN
    Jun 27, 2017 @ 16:48:26

    1) I was particularly interested in the myth that stated that, because of our knowledge and education, therapists naturally have a firm grasp of logic and do not fall prey to logical fallacies. I think I related to this one in particular because I often do feel the pressure from others to act in a certain way because I study psychology, when it is not nearly so simple. It is easy to analyse others’ behaviors and determine their fallacious thinking patterns; it is not so easy to analyse ourselves and adjust our behaviors accordingly. There have been multiple times when friends have pointed out behaviors of mine and identified their illogical origins, and I discovered that they were absolutely correct. Such instances will initially make me question my identity as a counseling major, but ultimately help me to understand how difficult it is to separate ourselves from our thinking and behaviors, regardless of the fact that in theory we should know better.

    2) The “possible clue to taboo topics” that concerns me the most as a therapist is “Seeking Repeated Reassurance from Colleagues.” This is likely because I am so new to the field, so seeking advice and validation from colleagues about the work that I am doing is still an important part of my learning process, but I still get concerned that I may become too reliant on such reassurances. While my internship supervisor has told me multiple times that I seem to work very independently, I still often feel that I request input from colleagues too often. I would like to get to the point where I am confident enough in my skills as a counselor to feel that I said the right thing or took the right course of action with a client without having to look to colleagues for reassurance.

    3) I am surprised and concerned with the high number of therapists who report being sexually attracted to clients. While I know that in the vast majority of cases therapists are (hopefully) not acting on those feelings, I imagine that having such feelings likely affects the therapy in some way, even if it is not noticeable. The therapist may be less likely to notice and identify irrational thoughts, for example, for fear of offending the client. I suppose that it is only natural to be sexually attracted to others, and this is not a reaction that can be helped easily in many cases, but I feel that it is a little strange for such attractions to develop in a relationship where one individual is clearly in a higher position than the other.

    Reply

  17. cpopores
    Jun 27, 2017 @ 17:22:40

    1. The statement that “therapists are invulnerable, immortal, and ageless” also caught my attention. I question how much of this myth is because of our clients’ misperceptions or how much is how we present ourselves. I think that trying to be objective and focused on the client can sometimes come off as sort of rehearsed or robotic. Many times, my clients have told me that I don’t understand something because I am young, or because I have not had their life experiences. I agree that I can never understand their experiences because I have not lived through them as they have, but sometimes it feels strange to hear clients’ assumptions about me. Of course, it is not good to over share or turn therapy into something it shouldn’t be. However, I have found that being professional while still being myself can help with rapport and take some of those walls down. For example, I have spilled, tripped, forgotten, walked into things, you name it, while at the group homes. I find it easiest to laugh at myself, and see it as an opportunity to show my clients that I’m human too. I think that there is a line that is sometimes hard to identify, but that normalizing to a certain extent can help clients feel more connected, and view me less as an infallible figure of authority that can do no wrong.

    2. A concerning taboo topic is “dehumanizing the client,” in part because it seems to happen so much. I believe that many people try to address this, and I hop changes in the mental health care system move in a more positive direction. However, staff, counselors, providers are often much more comfortable falling back on institutional behaviors and philosophies that dehumanize clients. For example, it is really easy to decide that we know what is best for individuals, and that when they do not comply with our orders or instructions, they are being defiant and willfully going against our wishes. I used to see this a lot when I worked at the CSU/Respite. In cases of severe mental illness, it seems that many people have a hard time connecting with clients and meeting them where they are. It also seems to be a big problem with individuals with substance abuse problems, because so many people perceive individuals as being in total control and rather than needing help, they just need to “get the picture” and “make better choices.”

    3. There are many surprising and concerning therapist feelings and behaviors in this section, including the information about sexual attraction toward clients and fearing clients. Although I am not surprised that therapists feel sexually attracted to people, their openness about it is pretty incredible. Even in an anonymous survey, there are some things people just don’t like to admit to. Apparently, this isn’t one of them. I also find it concerning and can empathize with wanting to connect clients to resources but not being able to. Many times at the CSU, we would discharge homeless individuals who were either unwilling to go or unwelcome at the one shelter available in Worcester. Other times, they would request referrals to drug treatment programs, but most of the time they were discharged before any contact was made to possible programs. Many substance abuse intake coordinators seem to either not have a voicemail or have a full voicemail, and of course they never pick up the phone. I was often frustrated discharging individuals who clearly needed more mental health care, but would not be able to do anything about it. This is a problem with the system mostly, so it was out of my hands. However, it concerns me that we lack adequate mental health care as a region and as a country.

    Reply

    • Meagan Monteiro
      Jun 29, 2017 @ 22:12:39

      Colleen,

      I knew that you were going to discuss this as this is something you are passionate about. I agree that a lot of people lose sight about why they are in the field to begin with and stop treating people as humans and start treating them as labels. I think the more that people are willing to talk about these issues and call their colleagues out the better the direction will head. I would love to live to see the day of a better mental health care system!!

      Reply

  18. Jason Prior
    Jun 27, 2017 @ 17:42:10

    1)
    There were quite a few questions that I found intriguing and thought provoking in these chapters. The one that I found myself drawn to was the question about working with a client that you hated. I should comment here that if you outright “hate” a client, steps need to be taken to put distance between you and the person. But there is a whole spectrum of negative feelings towards a client that a therapist can experience. I have found myself in the position of working with clients that I very much enjoy seeing, as well as clients who I dreaded having sessions with. The difference in how it impacts you is striking. It takes a whole lot more effort to offer services to someone you dislike, particularly if you know that the disclosure of information may make you dislike them more. We as therapist have an ethical obligation to push these feelings aside and treat that individual as any other. But damn that can be hard. Unconditional positive regard is not easy if you find the client’s behavior despicable. Not letting personal feelings bleed through into therapy is important, but exhausting. Still, they deserve help just like anyone else, so we should provide it.

    2)
    Like some of my classmates, I was also intrigued by the taboo of the dehumanizing therapist. We are trained to use a combination of humanistic and scientific skills to work with our clients. We have been taught to develop a case formulation, which is a theoretical conceptualization of the client and their problems. This must be wed to the interactions with the person. That a therapist can become so disengaged with a client that they fall back on wrote learning, throwing about terms, or only seeing the case formulation is not only unprofessional, it is unethical. First and foremost a therapist is there for the client. Each client brings a certain uniqueness to therapy. We are taught that a person is not their diagnosis. Sometimes we must work hard to make our clients realize that for themselves. To think that a therapist would fall into this thinking trap is worrisome. I dread a day where I realize that I am no longer treating the client as a person, but as a diagnosis.

    3)
    There were a lot of things that I was concerned with after reading this section. If I had to pick one, however, it would be the thought of fearing a client. In my time as an intern, even as a professional working in mental health settings, there have only ever been two clients who have really frightened me. This is not to say that I have not encountered other individuals with whom I needed to be cautious or aware of the potential dangers that have existed. Those were always known quantities with recorded behaviors. The two that frightened me were much different. Perhaps it was the manner in which they spoke about their past, or the way they expressed limited emotional reaction towards violence. When someone laughs while telling you about a a violent interaction, it raises red flags. No therapist should feel the need to walk on eggshells with a client to avoid a potential harm, but the reality is that this is more common than some would like to admit.

    Reply

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Adam M. Volungis, PhD, LMHC

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