Topic 6: What Therapists Don’t Talk About {by 7/11}

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?  Your original post should be posted by the beginning of class 7/11.  Post your two replies no later than 7/13.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

17 Comments (+add yours?)

  1. Teresa DiTommaso
    Jul 10, 2019 @ 21:07:45

    1. The “myth” that piqued my interest the most while reading the chapters in Pope is that “If you’re a good therapist, the money will take care of itself.” Not only does this myth embody many of my fear in how to manage client fees and billing, but I feel as if the further explanation of the myth was completely on point about the lack of attention the billing process gets talked about in graduate training programs. I was lucky enough to have an internship professor that discussed this topic multiple times throughout the year of practicum and internship, but I feel as if it should be a required focus of a part of one of our classes. Returning to my fears about money and working in this field, although I had knowledge of the monetary situation when entering this field, a lot of my concerns about entering the field is the balance I need to have when working for the good of clients and also making sure I get paid adequately for my skills and training which I have worked very hard to attain. I think one of the major beliefs that support this myth is that because therapists are in the type of profession we are in, that automatically makes us less concerned about making money and making a living. One of my goals as I enter the field full-time is to make sure that I represent what I am worth, and although there may be not be room for negotiations early on in my career, I will be sure to make sure I make what I am worth later on down the line. I think saying that and believing that does not make me any less of an empathetic person, and this is a sentence I could not have written a year ago.
    2. Out of the entire 17 “possible clue to taboo topics” the one that concerns me most as a practicing therapist is “The Client Friend.” I am not concerned to the extent of the example the book explains, but I have similar feelings about the inadequacy of my work and the professional responsibility that comes along with doing proper psychotherapy. I think the fear of making a mistake leading to terrible consequences is always on my mind as a beginning therapist and although my practicum and internship have given me more confidence than I had prior this past year, the anxiety of making a mistake in therapy which could result in the harm of a client is still in the forefront of my mind. Therefore, I feel as if inadvertently entering a more friend-like relationship at certain moments throughout my career is something I need to be aware of, especially as a young therapist who wants to work with adolescents. Although I do not see myself becoming a friend in all senses to my clients, there are certain topics and certain moments that I feel I could enter that friendship mindset which I need to be aware of to avoid it from occurring.
    3. After reading the Appendix, the thing I found most surprising was the idea that so many therapists feel hatred towards a client. I completely understand not liking a client for professional or personal reasons, but the expression of hate for a client was very surprising for me. In reflecting on certain aspects of a client that may lead me to have feelings of hatred toward them, I can understand if the therapist hates a certain belief of their client, but I cannot understand hating a client completely. Obviously, if that does occur in my career I will refer immediately, but I do not understand it in my heart, nor do I intellectually, the ability to completely hate another individual.

    Reply

    • Stephanie Mourad
      Jul 13, 2019 @ 13:15:26

      Terea,
      I agree with you about making sure to represent ourselves in this field and get paid for the skills that we have. One of my fears is being taken advantage of for my skills and not getting adequate pay for my services. I think that we need to remember to be assertive and to take risks. Like you said, in our early careers, we may not get the pay that we want but as we build skill and experience, its only fair to get paid the right amount for our services.

      Reply

    • Allexys Burbo
      Jul 13, 2019 @ 16:22:36

      Teresa,

      Similarly, I share your thoughts regarding feelings of hatred toward clients. While it is likely realistic that in some capacity we might experience some level of negative feelings toward a clients’ beliefs or behavior, for instance, it is concerning to imagine feeling this level of an emotional response about the individual. For this reason, it is critical that in practice we continuously monitor our own thinking and feelings as they develop during the therapeutic exchange. It is not only unhealthy for the therapist to operate while harboring such intense feelings, but it may also likely prove harmful to the client and treatment. I agree that within my own value system, I could not understand to this degree feeling hatred toward any individual. It is my duty, however, to remain cognizant of my own triggers and take the initiative to then make the best choices for my clients. In this way, I ensure to the best of my ability that my own feelings do not determine or undermine the therapeutic exchange.

      Reply

    • Matthew Collin
      Jul 13, 2019 @ 21:34:17

      Hi Teresa,
      I agree, and worry about being taken advantage of, and not knowing how much my services will be worth. I think since we’re new, it’s a lot harder to determine what we’re worth which is also a big issue. I worry about staying in the same place, and not really moving up the ladder, or getting adequate raises as I advance over the years. I think, as Stephanie said, assertiveness will be a skill we will also need to develop (if you haven’t already) as we advance through our careers.

      Reply

  2. Matthew Collin
    Jul 11, 2019 @ 13:59:00

    1.) The myth that concerns me the most is the one about money. Being a good therapist, won’t make you a lot of money alone. It’s a part of the process, but I understand that the clerical work that goes behind billing, and keeping records of client notes and billing information is something we don’t learn how to do in graduate school. I’m terrible at organization – you probably can see that in most of my blog posts. As you can imagine. My lack of organization would be a problem in this type of work. I’m also very timid about how much I should be paid, and when the topic of money comes up for someone to owe me some, I get very scared and anxious. I’m worried that even asking for a 20 dollar co-pay for a client may damage the therapeutic relationship. I understand this is irrational, but it is always something that pops into my head when I ask anyone for money, let alone a client. I know I’ll have to get over this because I will want to get paid for my services.
    2. The possible clues for taboo topics that concerns me the most is “seeking reassurance from colleagues consultations”. This comes a lot with feeling like I may not be a good therapist. I may feel inadequate and constantly ask colleagues for advice, and then double… even triple check with them that I am either doing the right thing, or should go in a different direction with a client. I wouldn’t do it so much to the point where my supervisor at my last internship would get annoyed, but I may have done it too often. I’m hoping as my career evolves, I will lose some of this anxiety and need for reassurance.
    3. After reading the appendix, I found that 87 percent of therapists have been sexually attracted to his or her client at one point in their career, or even have sexual fantasies about their clients. To me, this seems so bizarre. Not to say this could not happen to me, but as of my mindset right now, I would be utterly disgusted with myself for thinking about it. I’d feel hypocritical, and feel as if I’m taking advantage of someone who is vulnerable. 87% seems like a high number, but I’m not surprised.

    Reply

  3. Cassie McGrath
    Jul 11, 2019 @ 15:35:04

    1) When reading through the myths that are associated with therapy I found myself laughing at the idea of some of them. Money being one. But the one that I want to talk about is the one that states that therapist practice at agencies free of competitions influence. I guess I find this the most interesting because as much as our field is human focused there is a large business component to the field that I think gets overlooked. It’s something that we are therapists need to be aware of. I recently was talking with my director at work, who is a PhD and has been in the field for years. He was talking to me about different agencies and the way that some agencies were more “corporate.” It was interesting having these conversations because in my brain I assumed that we only talk about those things kind of behind the scenes. It was a super interesting conversation discussing the agencies and how they approach things. I definitely think this is a myth in the field related to how we think agencies work. Yes we are in it for the people but agencies also have to make money! And to be the agency that brings in the money you have to be competitive and compare with other agencies. That’s how additional programs come to be within agencies.

    2) I think a lot of the “taboos” in this field are interesting. The client friend is definitely something I think about. I have observed clinicians who have very comfortable relationships with their clients. I also think about the “fruit loops” in our field who see clients for years on end. If you’re seeing a client for years at a time I wonder how you have no developed a more than client to clinician relationship with your client. It is definitely interesting to think about. I had a client tell me once that Her mom has a clinician who used to pick her up and they would drive around for therapy. This confused me quite a bit because it don’t get it at all or how it is therapeutic for a client.

    3) So I think all of the items in the appendix worry me because It would be awful if you experience any of these. But I also think we are human and at some level we are allowed to feel things, it’s a matter of how we handle how we are feeling that is important. I found the one about being angry with a client who was verbally aggressive with you. I can’t even tell you how often this happens at my job. I guess the idea of it impacting a therapist doesn’t surprise me. It concerns me in that if I am getting to the point that I am angry for more than just my initial frustration, I mean immediately after the verbal assault, then I am worried. This interaction happens and you are allowed to feel upset, I just wouldn’t want to still be upset the next time I see my client. I guess this concerns me even more so because I am looking at residential work and there is not a week between seeing your client, and it may mean seeing your client right after and having to deal with it. So I guess as a whole this concerns me, and makes me be very aware of my own thoughts and feeling and my burnout.

    Reply

    • Teresa DiTommaso
      Jul 14, 2019 @ 08:17:49

      Cassie,

      I can relate to your feelings on the “client-friend relationship” when it comes to people who have seen clients for a significant period of time and appear to be more of a friend than a therapist. An example I came across was one colleague who does private practice work saying that one of their clients doesn’t really need to come to therapy, but likes to talk since they have known each other for a long time. I believe this is bordering on unethical because that client is still paying for that service that he or she does not need, although they are perfectly aware of that. I feel as if it is possible at times to slip into more of a “friend” role, especially with certain populations and when discussing certain topics. Therefore, it is imperative we stay vigilant so those moments are reduced and do not become a habit resulting in the examples we have reported today.

      Reply

  4. Stephanie Mourad
    Jul 11, 2019 @ 15:46:44

    1. One that stuck out to me was “During therapy session, have you ever fallen asleep or felt very close to falling asleep? How did you respond?” (Chapter 4). This interests me the most because it has happened to me at least once a week with my clients during my practicum/internship. I had this one particular client who was very monotone and it was often very hard to stay awake during her sessions. I think this happens to almost everyone and we don’t really talk about it. In order to address it, I first did some self-reflection and asked myself why I was falling asleep (her sessions were early morning). So I did some lifestyle changes and went to bed early and made sure I got plenty of sleep. This helped me stay awake during her sessions. I also prepared more for the session. Instead of having her talk for some time, I made sure to have some worksheets that we both could do together. This also helped me stay awake.
    2. One that I found concerning is the client-friend. I’ve only heard stores about therapists meeting clients for sessions at coffee shops or walks in the park and I always found it very odd. I think its very important to separate that part from our clients in order to avoid doing harm. We are no longer therapists when the client considers us as friends. The client may get too comfortable and ask for additional sessions in public. This might cause problems in the therapist and client relationship. The client may seek advice from a friend’s point of view rather than the therapist and the therapist may get too comfortable with the client, to the point where the therapist sees their own clients as friends. I just don’t think its professional to have sessions in public unless it is for treatment purposes such as exposure therapy.
    3. One that concerned me the most was “feeling so afraid of a client that it affects sleep, eat, and concentration.” I think at this point, the therapist needs to speak with their supervisor and seek help and understanding as to why they feel this way. It only does harm to the client and the therapist in this case if the therapist continues to see this client. The therapist may want to reconsider working with specific populations or mental disorders. Of course if they are working for an agency then they might not have a say in which they see for clients but the supervisor is there to help provide you with a solution. Its always better to voice your concerns and fears rather than do harm to clients or yourself.

    Reply

    • Matthew Collin
      Jul 13, 2019 @ 21:38:40

      Hi Stephanie,
      I agree with you when it comes to seeing clients outside of a standard office. I find it to be odd, and very vulnerable – not only to you, but also the client. I also think it gives the client some sort of signal that your more friends, than having a professional relationship. As far as falling asleep in session, I think you handled those clients well in your internship. We can’t be expected to enjoy what a client talks about all the time. We just must be cognizant of not showing them we’re not interested.

      Reply

    • Teresa DiTommaso
      Jul 14, 2019 @ 08:27:20

      Steph,

      I really like that you brought up the issue of falling asleep or being bored in session, because I have experienced to some degree but haven’t self-reflected the way you have, I just attributed it to the stress of school, work, and internship combined. I admire your ability to always self-reflection, regardless of how “normal” a response may seem when we are all tired and stressed out from school.

      Reply

  5. Aleksa Golloshi
    Jul 11, 2019 @ 16:51:12

    1. I think Chapter 4 contains a lot of different questions that I’ve never considered. Some questions that stood out to me were, “under what circumstances would you disclose your disgust to the client?” and “have you ever made a mistake with a client because you were upset with the client?” These two questions are really interesting to me; the first question involves a topic that I’ve previously thought about. I’ve always said to myself that I wouldn’t be able to work with an individual who was a rapist or a murderer, as well as anyone who has abused someone else, whether physical, verbal, or sexual. I would want to make it known to my client that I don’t condone their actions, but I don’t think I would tell them that I’m disgusted. I don’t think this would be appropriate, but then would I be practicing unethically? I wouldn’t be able to be compassionate or empathetic towards my client, nor would I be able to disregard any biases that I may have in regards to the crime they committed. The second question is an interesting one that I’ve never thought about. Clinician’s are human beings at the end of the day, and I can see how one could accidentally make a mistake with a client because they’re mad at them. However, I can’t see this happening intentionally. It’s one thing if your mind is preoccupied with having strong feelings regarding something your client said, and you making a mistake because you were focusing on the wrong thing. It’s another thing if you deliberately make a mistake to jeopardize the treatment because you don’t like something your client said.

    2. One of the taboos listed in Chapter 5 that concerns me the most is the client-friend topic. I think being friendly during therapy is important so that the client feels relaxed and is maybe more willing to share and be honest. As a new clinician, I fear that it may be difficult for me to gauge how friendly I should be during certain times. I want to work with children and young adults, anywhere between the ages of 8-21. I think it’s important for the clients to like me in order for them to participate and for therapy to be effective. I might need to be a bit more friendly with my younger clients, but then I might also need to be friendly with teenagers. I don’t ever want to be too friendly however, so that no one gets the wrong impression. I think over time and with experience I’ll learn how to be friendly enough for clients to enjoy me as a clinician, but not overly friendly where they view me as their friend.

    3. I think one of the most concerning topics discussed in the Appendix are anything that discusses inappropriate thoughts or gestures. I understand that humans unconsciously decide if they’re attracted to something or someone, but I don’t think it’s, under any circumstance, appropriate or acceptable to act upon these thoughts. Another statement that surprised me is “a client physically attacking you.” I’ve actually never considered this happening to me, but it could possibly be a reality for me. I think it’s important to keep your safety in mind, but this can’t be your main concern when conducting therapy because it may hinder the process. I can understand how a client might become irritated or upset with you because you’re “suppose to fix them” but I’ve never thought of how I’d react if I was physically attacked. I think this section brought up some really interesting topics that have made me more aware.

    Reply

  6. Louis D’Angelo
    Jul 11, 2019 @ 17:08:03

    1 One of the most interesting questions or topics discussed in these chapters is the idea of working with a client who we may “hate”. Now hate is a strong word of course, but to define these scenario is we can look at clients who are blatantly racist, sex offenders, or substance abusing parents. There are many cases presented to us that we may have to dramatically push our own biases and personal feeling about the client and try and be as objective as possible. This is a taboo subject for me as I have encountered some substance using parents and have had to keep my personal feelings out of the clients treatment. When I’m doubt, consult supervision.
    2. Repetitive therapy is defiantly an interesting clue discusses in chapter 5. Sessions that appear to be covering the same ground or using the same interventions or approach with no therapeutic effect after some time can be detrimental to the client. Here the client can worsen pathological symptoms or at the very least maintain these issues while wasting time and money. Working with adolescences in substance use, the appearance of repetitive therapy can be questioned when some adolescent clients experience frequent relapse and low motivation. The work in substance abuse is difficult when symptoms persistent through treatment, and repetitive therapy can instill hopelessness for recovery for the client. As therapist working with this population, it is incredibly imposing to Maia til hope for received with the cleaner and convey empathy even after numerous relapses. Most important, practicing therapists need to be able to have an awareness of effectiveness if interventions and approaches and be able to modify, adapt, or completely change approaches if no progress is made to insure avoidance of reparative therapy.
    3. Based on the appendix, it is surprising to me that so little research has been conducted on these very imprint therapist feelings such as hate and fear and how these may be connected. Looking at some of the malpractice suits depicted in the appendix, there is good rational for the exploration of these feelings by the Thespis and how it may effect the thespians ability to give quality treatment as well as the man tap health effects on the therapist themselves.

    Reply

    • Stephanie Mourad
      Jul 13, 2019 @ 13:20:18

      Louis,
      I like that you brought up repetitive therapy. I think that if our client isn’t getting any better and symptoms are not decreasing then we need to reconsider whether or not we should change treatment plans and interventions. If that doesn’t work then I think its our duty as therapists to consider whether or not the relationship is the problem. Maybe as the therapist, it just isn’t working out with the client. Maybe the client would benefit from a different professional in our field. We need to remember not to do any harm to our clients.

      Reply

    • Cassandra McGrath
      Jul 13, 2019 @ 14:27:43

      Louis,

      I really like you bringing up the comment about “hating” a client. I think i struggle with this a lot, in that I feel like hate is a really strong word. I don’t think that I could hate the person I am working with, I may be able to hate the decisions they make or the ways that they choose to do things. Such as I may hate that my client is a sexual offender, but still not hate the client themselves. I still don’t think I could even use the word hate in that though, it is more of a disagree with than a hate.

      Reply

    • Allexys Burbo
      Jul 13, 2019 @ 16:43:07

      Louis,

      I certainly agree with your expression about the effects of engaging in repetitive therapy. For especially challenging cases, repetitive practices can have the detrimental result of leaving our clients feeling discouraged and hopeless. While these feelings could be directed generally toward a clients’ faith in the therapeutic process, such feelings also has the potential to be self-directed. In this instance, perpetuations of negative thoughts and feelings toward self can be deleterious to the client’s well-being and subsequently positive therapeutic outcomes. This type of practice can pose a number of challenges to the process that can result in drop-out or relapse, as you mentioned. Our job as therapist is to instill hope by producing outcomes that make our clients feel secure in what can be offered by therapy. Repetitive therapy, on the other hand, undermines our ability to do this effectively. For this reason, it is important to reflect on both how our clients are adapting to the practices that we implement, but more significantly, how we are effectively implementing variation through interventions that will be meaningful to our clients.

      Reply

  7. Allexys Burbo
    Jul 11, 2019 @ 17:24:46

    The “myth” that I find particularly intriguing is the presumption that “therapists are invulnerable, immortal, and ageless” (the age component of this statement might also qualify as the most comical). While this myth may provoke some level of humor upon first glance, it is indeed one that also might hold some merit as a perception for a portion of the population outside of the profession. Although admittedly my initial reaction to the myth was to giggle, when considering the underlying assumptions driving the myth, it is this type of thinking that I believe has the potential to pose a threat to the counseling profession. The perception of counselors as invulnerable and immortal, for instance, dismisses the human experience and all of its challenges – that this is generalized across all people, regardless of profession. This assertion, I imagine, is what leaves some therapists at risk for experiencing burnout – that is, when one understands self as impenetrable to the emotional and physical demands of the job, and that others may equally generate this assumption. Just as we anticipate that our clients are subject to the conditions of reality that provoke distress, it is only fair to generalize this same attitude to the individual on the other end of the therapeutic exchange. As a therapist, it is equally important to recognize that we are human and therefore experience moments of vulnerability; that we, too, encounter hardship and distress that affect us in significant ways. The comment regarding age, especially, is one that must be given equal attention. For the purpose of practice, the recognition that therapists (like the rest of the population) undergo developmental changes that can very well affect the therapeutic exchange is of particular importance. Mental, physical and environmental shifts can create lasting changes that may leave the therapist vulnerable. This can affect both the individual as well as therapeutic exchange. Although the idea is not to make broad generalizations about the potential challenges related to the aging process, the reality of this is that the therapeutic process continues for some across the lifespan and that this should be considered rather than mystified (or “mythified”).

    Of the “possible clues to taboo topics” suggested in the text, repetitive therapy strikes me as one of the more concerning when I consider practicing as a therapist. Given the nature of our work (and with a focus on CBT and evidence-based treatment) the idea of engaging in repetitive therapy has the potential to undermine the therapeutic process. In this instance, it is not only a disservice to our clients when working to gain positive therapeutic outcomes, but additionally is cause for concern as a developing therapist. The inability to establish some level of variability during the therapeutic exchange can prove harmful as it does not provoke and generate change toward progress. For a client, this may set the precedent that the therapeutic exchange does not involve challenges to dysfunctional patterns. Particularly in the instance of clients who depend on the therapist to understand and acknowledge the cues that are related to their distress, this can negatively impact therapy. From a professional standpoint, it does not instill confidence that the therapist is able to target, address and exercise effective treatment. Furthermore, it serves as a barrier for the developing counselor who will make little gains in skills or knowledge if he/she does not demonstrate the capacity (or willingness) to generate variability in practice. For this reason, it is important to identify such clues and intentionally work to address the uncomfortable thoughts and feelings that accompany them, if only for the purpose of better serving our clients.

    The most surprising information on therapists self-reported feelings and behaviors was the data related to noticing that a client is physically attractive. While it might be anticipated that physical attraction is a component that could very well influence relationships in any context, it is interesting to consider that this may also affect therapists within the therapeutic context. As the professional, it is important that by ethical standards acts driven by attraction toward clients be strictly upheld, and for this reason I can imagine how this might impact the professional who recognized that they began to experience a physical attraction toward their client. While my personal belief is that physical attraction is a biological and innate human experience, it is easy to identify how the therapist might internalize their own feelings about this experience when their client is the subject. Knowing that strict policies regarding relationships with clients is a great concern among the profession, a therapist who may notice some level of physical attraction may as a result become anxious that attraction is the predecessor to sexual feelings. While I recognize the depth of this anxiety, I also understand that attraction is not equivalent to sex and therefore does not have to be given much merit as a deal-breaker for therapy. It is my belief, however, that the therapist simply identify, acknowledge and proceed with a similar understanding as one would adopt if he/she were to recognize any other feeling or thought about a client during the therapeutic exchange – that one such variable does not necessarily have to determine the outcome of therapy.

    Reply

    • Cassandra McGrath
      Jul 13, 2019 @ 14:24:48

      Allexys,

      I like your comment on repetitive therapy. I definitely understand where you are coming from with this. I think especially where we are trained in CBT if we are doing CBT skills repetitively it could feel as though we are doing repetitive therapy. I think that being aware of this concern is the best practice, but not being so consumed with the concern of repetition as you don’t want your focus on it to take away from the sessions themselves.

      Reply

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Adam M. Volungis, PhD, LMHC

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