Topic 5: What Therapists Don’t Talk About {by 7/5}

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 7/5.  Post your two replies no later than 7/7.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

14 Comments (+add yours?)

  1. Tinh Tran
    Jul 04, 2018 @ 01:59:22

    1. As human beings, therapists sometimes have experiences of vulnerability in life, and of course, getting old and then mortality are facts that nobody can’t avoid. Thus, the myth about therapists in which it says that “therapists are invulnerable, immortal, ageless” makes me curious. Does it contradict with reality/facts? The myth of the invulnerable, immoral, ageless therapist helps to raise awareness about some factors that therapists may need to pay attention to, such as safety and secure environment. I had never thought of this, but the authors suggest that therapists need to learn how to “set up a practice office with an eye toward safety – how to screen new clients, what to do if a client pulls a weapon during a session, how to secure a therapy office and waiting room in light of potential violence, etc.” The myth also reminds that therapists need to make their professional will. Supposedly, one therapist suddenly passes way due to an accident or a heart attack and her or his college can scramble to find where schedules or contact information of clients are stored. In addition, therapists should be aware of age-related factors that may interfere or impair their performance as good therapists.
    2. “Avoidance” may be one of the possible clue to taboo topics that I concern the most as a practicing therapist. Some people tend to avoid what they don’t like/want to see or hear. Similarly, one of the most obvious strategy to avoid the taboo is to avoid the client who involves a taboo topic or uncomfortable feelings. Avoidance thus creates many negative consequences, such as therapist want cancel sessions without reasons, reduce the frequency of sessions, or forget the date and time of the client’s sessions. Avoidance can also lead to a thought that whether there might be a reason to transfer the client to another therapist or if it is time to terminate. I also feel that avoidance can make a therapist avoid to discuss with the supervisor about the client or try to avoid any thought of the clients. In case that the client wants to withdraw or terminates therapy, the therapist may not make any effects to encourage the client to continue following sessions or therapist avoid of discussing any reasons. All of these “excuses” do not help clients feel better, but instead, the therapist seems to waste the client’s money and time.
    3. The most concern feeling was fear that a client would commit suicide. As the information presented on therapist self-reported points out, this fear is experienced by 97.2% of the participants. As I noticed, the question related to feeling afraid that a client may commit suicide is placed in the first line of the list question. This somehow emphasizes that the safety of clients should always be given as priority. The suicidal topic is considered as uncomfortable issue to discuss in therapy but it should not be ignored. Therapists should always concern about and address it, especially when working with depressed individuals.

    Reply

    • Kat Rondina
      Jul 07, 2018 @ 22:13:01

      Tinh:

      Your answers to 2 and 3 really seem to the together similar themes. It really highlights the true dangers of avoiding discussing difficult topics. I too was surprised at just how many therapists worry of their clients committing suicide. It’s probably the main example in our field of a difficult topic you can’t avoid. As you mentioned in section one, ensuring safety for ourselves is a different thought, as so much thought goes into protecting clients and their well being

      Reply

  2. Allison Shea
    Jul 04, 2018 @ 11:15:16

    1.) The “Myth” that was most interesting to me in Chapter One was regarding therapists being logical and not committing logical fallacies. This assumption about therapists stood out for me because I think it is common for people to believe that not only do therapist think very logically but by doing so, they don’t experience anxiety or other mental health problems. When talking about my own anxieties with friends and family, sometimes people might say, “Aren’t you going to school to teach people how not to be anxious?” When I hear that, I often have feelings of incompetency as I myself buy into the myth that therapists should be completely logical, thus being able to challenge irrational thoughts that lead to anxiety. Being reminded that therapists are not always logical–that we commit cognitive distortions that can lead to negative emotions, is important to keep in mind.

    2.) One clue that concerns me regarding the possibility of taboo topics is undue special treatment. I did find that when I was preparing for sessions for my internship, I had the tendency to spend more time preparing for a client that I enjoyed seeing or who was making progress. I may spend less time planning for a client I was really stumped about even though I needed the extra preparation. I think it could have been important to consider at the time why I was preparing more for some sessions than others and what types of emotions were associated. For example, perhaps I disliked a client who wasn’t improving, as it made me feel incompetent as a therapist. Avoidance is another clue that is a concern to me. The anxiety about a difficult case could make me avoid adequate preparation or fail to bring him or her up in supervision. It can sometimes be easier to bring up clients that are going very well in supervision to “impress” your supervisor rather than bringing in a case that has you completely stumped. Having an awareness of these clues is important in therapy because if I proceeded in this manner, I may not get the continued help needed for difficult cases.

    3.) A result that was concerning to me was that over 18% of participants had been physically attacked by a client. During my internship, I didn’t have any clients that evoked fear in me–at least not that I was going to be attacked. I can imagine if an attack happened in a residential setting there would be staff members around who could help, but I’m not sure what exactly would occur in an outpatient setting. Another concern I have about physical attacks or even just having a fear that a client will attack is that it must be difficult to establish rapport with the client and express empathy. It was also surprising that 50% of participants reported hugging and flirting with clients. It would be interesting to know the context where these incidents occurred. I can imagine that sometimes it may be appropriate if a client hugs the clinician when terminating, but I can’t imagine what the context would be for flirting that might make it therapeutically appropriate.

    Reply

    • Taylor Schiff
      Jul 06, 2018 @ 13:05:40

      Allie,

      I think you brought up such an important point that so many people who are outside our field unfortunately misconstrue. I’ve had many similar situations in which people believe that because we are training to be therapists that somehow means we are completely devoid of negative emotions or negative thoughts. They are somewhat ignorantly under the impression that because we teach others how to deal with things like anxiety or anger, we ourselves don’t experience such states. But I think what they fail to recognize is that we are vulnerable just as anyone else is to experiencing a whole range of emotions, a temporary flood of negative thoughts, or even an error in logic. We aren’t robots who suddenly opt out of the human experience! So maybe we need to better explain to others, “yes, ideally we are better EQUIPPED to deal with these various thoughts and emotions, but that doesn’t mean they never occur!”

      Reply

    • Kat Rondina
      Jul 07, 2018 @ 22:26:37

      Allison,

      I really appreciated during class when you mentioned the idea that others outside the field believing therapists are immune to anxiety and stress. Not only does this tie into the subject of logical fallacies, it also connects to the invulnerable therapist myth. We are not only potentially vulnerable to physical danger, but to all the mental health stressors that affect people including our clients. Others outside the field can feel like since we treat anxiety, we can’t experience it, and it almost feels like this can tie into the isolated therapist topic. It can feel like clients and others outside the field sometimes like we are supposed to be “optimally functioning” superpeople. These high standards can lead to a feeling of disconnection.

      Reply

  3. Taylor Schiff
    Jul 05, 2018 @ 13:17:36

    One of the myths that resonated with me most was the reference regarding competition, suggesting that therapists learn therapy and practice in organizations that are somehow completely free of the influence of competition. This notion was certainly not something I had thought about, let alone acknowledged before reading Chapter 1. And yet, in all reality, the concept of competition is omnipresent, exerting its influence in almost every facet of life. I found it interesting that Pope’s focus seemed to be more about emphasizing the presence of competition and the fact that it is just as pervasive within the mental health field as it is in any other profession or context, rather than discussing its value (i.e. whether it is helpful or harmful). There was one quote in particular that I thought was particularly powerful: “opening up, failing to mask our weaknesses, allowing ourselves to be vulnerable, speaking frankly, acknowledging our mistakes (especially when no one else has discovered them, and engaging in genuine exploration and discovery may be a handicap…” It is a sad truth that these actions, (which in my mind represent opportunities for real growth) are avoided or neglected for fear of judgment or scrutiny. Our idea of success is often defined by how we “stack up” or compare to others. Competition is a funny thing… it has the potential to push individuals and incite a drive. Although in the same context, its influence can have some damaging repercussions (e.g. denial of certain feelings or emotions, potentially unhealthy behaviors, such as exaggerating the progress or success of certain clients or only discussing or bringing the “best” cases to your supervisor).

    After reading Chapter 5, “the possible clue to taboo topics” that concerned me the most was “isolation of the therapist”, not because I necessarily believe this would be an action I might unconsciously make, but more so due to the implications and consequences of such a reaction. The experience of isolation can be an extremely dangerous practice in and of itself, but especially so for therapists who are continuing to practice. Consultation can be one of the best resources for therapists to use, especially when they are attempting to understand or accept certain “taboo” feelings. However, if therapists are not able to utilize such a resource and do not fully acknowledge their feelings within a “safe” context, those emotions are likely going to be suppressed or expressed in unhealthy ways. The idea is that the therapist, who is unaware of their taboo feelings, could begin to dismiss or push away their colleagues or even friends, (meaning people who could possibly support the individual through this difficult time) in an attempt to avoid discovery or “reduce ‘stimulus overload’.” Unfortunately, as we see with clients many times, withdrawing and exhibiting isolative tendencies often leads to feelings of loneliness or even depression. This possibility coupled with feelings of guilt, shame, fear, or anxiety (from having the “taboo” feelings in the first place) does not make for a capable and competent therapist, and will undoubtedly affect the processes of therapy with other clients as well.

    There were several findings and statistics from therapists’ self-reported feelings and behaviors that I found to be both concerning as well as surprising, so it was quite difficult to choose just one. Nevertheless, for these purposes I found the information regarding therapists’ fear to be quite revealing. According to the study, over half of the participants (53.3%) reported having felt so afraid about a client (for various reasons) that it affected their eating, sleeping, concentration. I recognize that there are some jobs in which individuals complete their assigned responsibilities and go home without another thought of work until the next day. Unfortunately, I don’t believe the job of a counselor meets that expectation despite our possible attempts to achieve that ideal. I am not naive: I realize that attempting to leave the heavy issues of clients at work is near impossible. But to think that that work has the potential to affect us to the point that it inhibits our daily functioning is a bit formidable to say the least.

    Reply

    • Allison Shea
      Jul 05, 2018 @ 19:53:07

      Taylor, you bring up some valid points about competition that I hadn’t thought about before. I would hope that because many of us in this field possess empathetic and supportive personality traits, there might not be as much competition. Unfortunately, competition is still very present. I think it’s natural to compare ourselves to others, especially as we’re first starting out. However, as you pointed out, comparisons can become dangerous if we try to hide our weaknesses as therapists, and are therefore not working on those difficulties. Competitiveness may also cause us to work longer hours than our colleagues which could ultimately cause our efficiency to suffer. I also agree that an important clue to keep in mind is therapist isolation. Not only could isolation be an indicator that a taboo topic might be at hand but it may also be a symptom of burnout. A decrease in social interaction with family and friends should definitely be a clue to a therapist that perhaps they may need to engage in some more self-care.

      Reply

  4. Liz Bradley
    Jul 05, 2018 @ 13:33:50

    The myth that therapists are “invulnerable, immortal, and ageless” interests me the most because of the concerns brought up in the discussion regarding safety. The anecdote of the therapist who was held hostage by a client because she missed warning signs that in retrospect were clear resonated particularly well with me. I think it is all too easy to go into a state of perceived invulnerability when we have been in a clinic for a while. At Lahey, all of the offices are behind locked doors that require a keypad entry. The few times we have had clients escalate, they have almost always been in the waiting room, without access to the therapists. Although the clinic is in Lawrence, I generally feel very safe at Lahey and my guard is down more so than it would be if the doors were unlocked or if I were just beyond the building walking the streets of Lawrence. One topic that really doesn’t get much discussion in our program is how to manage an irate client who is becoming violent, and how to de-escalate them or manage the situation otherwise. I have heard two conflicting ideas about where to sit in relation to the door in your office as a therapist: 1) sit nearest the door so you can easily escape should a client become violent, 2) let the client have a clear path to the door without having to get by you first so that they do not feel trapped if they were to escalate. While I do believe that therapy is generally not too dangerous of a field and that most clients would never harm their therapist, more discussion of how to maintain safety with the clients who are exceptions to the rule and do become violent would be beneficial.

    The “repetitive therapy” clue concerns me the most as a practicing therapist. With some clients, no matter how much I try to stick to a CBT format, inevitably there is some crisis that comes up every few weeks or months that throws our progress off-track. In these cases, we have to stop and address the immediate crisis before we can continue working on the CBT skill we were most recently working on. Once we are able to finally get back to really digging into the CBT work, the client has often had a relapse of symptoms that pushes back our progress. I’m not really sure how to best help these clients and how to manage these crises that come up without losing the progress the client has made.

    Many of the therapist behaviors are concerning and surprising to me, particularly the sexual behaviors exhibited by the therapists who responded. One which I found particularly surprising was the therapists who reported that they had kissed a client (as well as those who reported a client had kissed them). This is such a deliberate action that you really can’t otherwise explain. I don’t see a time where a client should ever be that close to you as a therapist, nor should the therapist ever be that physically close to a client. I like to believe that the stereotype of therapists who sleep with their clients is truly more common on television and in movies than it is in real-life, but some of the behaviors reported in this survey make me question this belief.

    Reply

    • Taylor Schiff
      Jul 06, 2018 @ 14:00:53

      Liz,

      I was under the same impression as you in that sexual contact with clients qualified as a rarity, ‘horror stories’ brought about in order to drive home a point so to speak. However, after looking at the results of that survey, I too am questioning whether such behavior is as uncommon as previously thought. How does someone who’s engaged in sexual contact with clients explain its acceptability or endorse its therapeutic value? I would honestly be interested to hear ‘the other side’ because in my mind I cannot even begin to come up with a reasonable rationale. It’s quite difficult to understand how individuals in the same position (i.e. counselor) can hold such fundamentally different views regarding ethical behavior and treatment.

      Reply

  5. Kat Rondina
    Jul 05, 2018 @ 13:43:28

    (1) Based on Chapters 1 and 4, what particular “Myth” (or Taboo/Secret/Question) piques your interest the most? Explain. The myth segment on logical fallacies was an interesting section. While I was familiar with most of the logical fallacies the authors had listed, I found some of the therapist specific scenarios interesting. An important thought I took away from that section was that it might be easy to assume that one intervention or plan may seem to make sense because it has worked before with similar clients, but that may not necessarily mean that it will work for every client. The section on logical fallacies highlights how easy it is to make false assumptions based on our past experiences and personal biases. Also, this section reminded me of the cognitive distortions section we covered a few weeks ago, and it really highlights the importance of examining one’s own thoughts and rationale and to realize that even with experience and skills we are not incapable of falling into cognitive shortcuts.

    (2) Based on Chapter 5, what “possible clue to taboo topics” concerns you the most as a practicing therapist? Explain. In reading this section, the idea of turning a professional relationship into more of a paid friendship was a bit disconcerting to me. I would hope I would not behave this way, but Pope and colleagues (2006) suggests this can be indicative of a lack of professional confidence. I would hope I could identify in the moment that the therapeutic relationship was shifting away from being more goal centered and process driven, but I feel like it may be hard to identify. Also, especially at the beginning of practice, I can imagine it can be very easy to doubt your capabilities, and if the client seems to be happy and making at least some small advances just through your camaraderie that devolving into more a friendship relationship may be tough to notice until a lot of time the client’s time (and money) has been wasted.

    (3) Based on the Appendix, of all the information presented on therapist self-reported feelings and behaviors, what concerns (or surprises) you the most? I found the study included in the appendix interesting. It was very understandable that one of the most common fears was clients committing suicide. It was saddening to see that at least in this sample, more that one quarter of the therapists had had a client commit suicide while in their care. While I know that the risk of suicide “comes with the territory” of treating individuals with mental illness, I still worry about how I would handle this scenario myself.
    I was a bit unhappy and concerned to see that almost 1/5 therapists studied had been physically attacked by a client. I know that the study provides little context to the working environment and client base of the individuals surveyed, but it still seems to be a high percentage.

    Reply

    • Allison Shea
      Jul 05, 2018 @ 19:55:46

      Kat, your response to question 1 reminded me of the personal bias discussion had in 650. Our biases can be dangerous because they might cause us to subjectively view our treatment as more effective than it actually is, which is why using empirically supported treatments is so important. You bring up a good point that as therapists a thinking pattern we might commit is using the same treatment with different clients and expecting the same results. Although core interventions might be the same depending on the diagnoses, how those interventions will be carried out will definitely depend on the individual. I appreciated your discussion of therapeutic relationships becoming like friendships. It seems like you were saying that one way to assure that therapeutic relationships differ from friendships is by having goals at the forefront of treatment rather than simply having a conversation with the client.

      Reply

    • Tinh Tran
      Jul 06, 2018 @ 15:27:59

      Kat,
      I also notice that in the therapist self-reported feelings and behaviors, most of therapists revealed their feelings of fear when they have to deal with clients who would commit suicide. Yes, as you said, it is very understandable to see that and as a training therapist, I also feel stuck if I have to face/work with clients who have thoughts of killing themselves. I guess I have to ask for help if I were in those stituations! Also, you also pointed out that many therapists have been physically attacked by clients. This information made me think that working in the field of counseling may be more dangerous than what I have thought. On the one hand, we are supposed to help clients to be better and improve their quality of life, but on the other hand, we also have to learn how to protect ourselves from some clients who may tend to harm us for some reasons.

      Reply

  6. William Nall
    Jul 05, 2018 @ 14:08:44

    1. The myth that piqued my interest was that “if you’re a good therapist, the money will take care of itself”. To be perfectly honest, this was sort of my held belief, so when I came across it I cringed a bit. I also used to tell myself and others that if you are passionate, talented, and educated about something, money will come with that. One of the running jokes in our program is this idea that we didn’t get in this field for money. After reading the segment on this method I realized there are many things that go into making money that go far past one’s ability to be an effective counselor. Things I had never even considered about making money in this field is marketing, fee setting, payment refusals, office expense, or even just developing a solid business model. With all that being said, I still believe if you are passionate and talented at what you do you can make money, but only if you know the finer points.
    2. The “possible clue to taboo topics” that concerns me the most is the concept of undue special treatment. This concerns me the most because I believe it incorporates the idea of liking clients more than others. Although, as therapist we strive for objectivity with our clients we are only human and are susceptible to favoring one over the other. I have already found myself falling victim to favoring clients. Without going into too much detail, I have experienced clients cursing at me and screaming at me in residential settings. I found myself not spending much time with those clients and spending a bit more time with the ones enjoyed my presence. Now, this may seem natural to someone outside of this setting that you spend more time with those who are pleasant than those who are not. However, as a clinician in a residential setting, you have a professional and ethical obligation to allocate time equally with all clients. For me, this was difficult based on how uncomfortable some clients made me feel. For myself, undue special treatment towards a client can simply come from just wanting to spend more time with one individual over another. My supervisor once told me, if you are considering some sort of special treatment to a client you have to ask yourself whether this is something you would do with a client that is more difficult. This consideration has stuck with me and has been a guide to treat all clients equally and avoid giving undue special treatment.
    3. Something that jumped out to me on the appendix was that 82.5% of therapist have concerns about feeling angry towards client because of his or her actions towards a third party. This concern has never even crossed my mind before. But as I read it I could imagine the situation quite readily. I would worry about feeling angry too if a client was explaining a situation in his or her actions were clearly having a negative impact on a third party. I think I would find it frustrating to have a client attempt to provide evidence to support their actions that are having a profound negative impact on a family member, friend, or significant other.

    Reply

    • Tinh Tran
      Jul 06, 2018 @ 15:05:56

      William,
      I agree with most of your points that you have said. In regard with the concept of giving special treatments for some clients, I think that it challenges us sometimes. As therapists, we are supposed to treat and care about each one of our clients equally. We need to reflect on ourselves to see whether or not we tend to give some of our clients “better care” than other clients, for what reasons we have done that. what our purpose is, and whether or not we are doing a right way as we are expected to do as a therapist. I think that relfecting on ourselves may help to limit some types of biases that we may have when giving treatments to clients.

      Reply

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Adam M. Volungis, PhD, LMHC

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