Topic 6: What Therapists Don’t Talk About {by 7/2}

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 7/2.  Post your two replies no later than 7/4.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

37 Comments (+add yours?)

  1. Lilianne Elicier
    Jun 29, 2020 @ 10:03:01

    The Myth: Therapists learn therapy and practice in organizations free of competition influences to me not only piques my interest but makes me laugh as well because most of us know this is no true( lol , I’m laughing hard). I wish this was actually a myth but throughout my whole life I have been competing with others without wanting too. This seems to be the norm since I was little before I entered school even. I competed with my friends and siblings at games when little and then in elementary every kid competed for grades and my own personal experience when I competed in the 4th grade spelling bee and won 3rd place. To get into graduate school you compete with a bunch of fellow applicants and most of the time for acceptance and they look at a bunch of different factors such as letter of recommendations, GPA for undergrad courses ect., Even now in graduate school I competed with everyone who applied for the fellowship and only 10 students got it. So this myth is false as even as professionals we compete with colleagues to a point for professional growth. This also happens in the learning and practice of therapy with colleagues where still continue to compete to achieve other position’s within the company for higher pay or recognition ect.,

    The possible clue to taboo topics that concerns me the most is “the dehumanized client”. As I’ve stated before I am an empathetic person and some client’s trauma history affect me greatly. This taboo topic concerns me as a working therapist because I would never think to dehumanize a client because it brings up feelings that are too uncomfortable such as “too emotional” or “too sad” for me to work with. As a reaction to this the client disappears and is no longer a client( a person ) and just turns into the diagnosis. I could never just think of a person as that schizophrenic or that bi-polar person. If I have some self-awareness that this is beginning to happen I would hope to address this concern by referring the client to someone appropriate to work with him or her. This is a concern for me and I view this is a defense mechanism that maybe the therapist is using to avoid material that is threatening to themselves. I could not imagine myself acting like a machine just going through the motions with a client showing no empathy and not establishing a therapeutic relationship with a client that will be the building block for effective therapy.

    What concerned me about the information provided on the appendix was patient suicide and violence. The findings stated that at least 18 % of therapists have reported been physically attacked by at least one client. Over one fourth ( 28.8%) of therapists have indicated they had experienced at least one client suicide. This is something that has always been a concern and a fear of mines, both getting attacked(as this has happened working inpatient) and having a client commit suicide. This is something that I always think about especially with a suicidal client, it honestly scares me the most. When working with a suicidal client I always try my best to not make sure I don’t miss any little detail and always ask for feedback with from other colleagues to make sure I am working with these clients to the upmost of my ability. With a suicidal client you can provide therapy to the best of your ability and even then it is not set in stone that the client will not commit suicide, and this always scares me. I find myself ruminating on these types of clients the most with the experience that I’ve had both at work and at internship. Anyone else feel like this working with suicidal clients? It’s also interesting that based on the findings therapists tend to be more concerned about the possibility of suicide by female patients in light of the research indicating that male patients tend to have higher suicide rates.

    Reply

    • James Antonellis
      Jun 29, 2020 @ 15:03:58

      Lilly,

      I’m glad to see that I’m not the only one who realizes how competitive our field can be. I feel like any good therapist is a little bit competitive. I also think competition is good, it helps us strive to better perfect our skills, as we want someone to make a referral to us as opposed to someone else. As far as the stats on attacks, I wasn’t that surprised, maybe because I’ve been at the IRTP for a while, and it has become something I expect to happen, but the percentage of therapists who have experienced a client commit suicide is a rather shocking number.

      Reply

    • Abigail Bell
      Jun 30, 2020 @ 13:56:04

      Hi Lily,

      It is so true that this field definitely has competitive influences and it is laughable to think that anyone would think otherwise. It is so normalized to not only compete with those around us but to compare ourselves to others which usually makes everyone feel bad about themselves. In settings where this is apparent it is hard to work as a team with other clinicians. I am also very impressed with your insight as to how you feel when working with clients who have a lot of trauma. I think it is great that you are able to identify an area that you are being mindful of in your practice.

      Reply

    • Danielle Nobitz
      Jul 04, 2020 @ 12:09:42

      Hi Lily,
      I also agree with you that competition is embedded in our lives as soon as we’re born. We participate in sports against others, compete with classmates for ranking in grade school and high school, and the competition, at least for me, seems to continue to become more and more as we hone in and narrow down on our interests as therapists and find our own niches of what we’re looking to do in our future. I agree with you that a little bit of competition is healthy, but that definitely depends on the person, haha. I think that in my personal experience, competition within academics has proved to help me increase my performance! I think when competition becomes really maladaptive and starts to interfere with a person’s functioning, then something needs to be done.

      Reply

    • Lynette Rojas
      Jul 04, 2020 @ 21:51:43

      Hi Lily,

      I agree with you that competition has been a part of our lives since we were little kids. There are definitely a lot of things we compete for throughout our lives that we don’t even realize at times. Suicide is also something that scares me when working with clients. I’m sure a lot of therapists feel this way. I have not had the experience where a client has committed suicide and I’m sure it is very difficult. This is definitely something that I think will always scare me the most.

      Reply

  2. Tricia
    Jun 29, 2020 @ 11:57:42

    (1) The myth I found most interesting was the myth regarding therapists work free of competition’s influence. As the book chapter indicates, we may scoff just reading this myth as we know from a mental health standpoint competition is embedded in everything. Personally, I found this interesting relating back with the perfectionistic personality trait I have but work on continuously. I am competing with others around me and competing with myself. I remember the competitiveness from the start of my graduate career at Assumption when applying for a graduate fellowship. From there, there was competition in gaining a practicum placement, the proficiency of work completed by students and reflected grades, the amount of stress and effort it takes for some individuals versus others, the competition was everywhere. I know competition will continue in the workplace as it comes to productivity, especially with documentation and progress notes, to the turnaround of clients with how quickly and effectively clinicians can meet treatment goals, and so on. Now there is healthy competition that motivates us to do better and continue our hard work, and the competition that derails our self-efficacy and outcome expectancies to be an effective counselor. As a clinician, I will strive to be mindful of the influences of the unavoidable competitive environment and incorporate problem-solving skills when I recognize the competitive nature becoming maladaptive.

    (2) As a practicing therapist, w2hile I find many of the taboo topics concerning I am most concerned about “The Discrepant Record.” This topic I am most concerned with as I feel it can have the most malicious, consciously or subconsciously, harm to the client by the clinician that is difficult to detect if you are not in the therapy session. I am working to enhance my clinical writing abilities but a discrepant record that can reflect progress towards treatment goals when it may not be true is terrifying. Our goal and drive as empathetic individuals is to provide the best service possible to our clients. I understand that there is a pressure to show progress in each treatment session, but to falsify that progress is a major ethical violation, as are fantasies, secret-keeping, and other taboo topics discussed in this chapter.

    (3) While this will likely change, one of the most concerning self-reported feelings is physical attacks by clients. If I had a penny for every time I experienced physical aggression from a client, granted youth clients, well I would have a good chunk of money. While I learned de-escalation interventions and was trained on how to keep myself safe (body stance, being aware of surroundings, where to balance your body weight, how to intervene when two clients are in a physical fight) we were not in a hospital setting and when faced with conflict in which we could not intervene properly our company’s policy was to call for the police or ambulance assist. As one can imagine this was ineffective for numerous reasons; police not knowing how to properly to respond to an escalated situation, the time it took for a response when the distance was not an issue, being told that there were more significant matters to handle than to send services to us, and so on. I did have a client during my internship that was mandated for domestic violence, so direct challenges and utilization of immediacy was minimal. In this case, I was mindful of the environment and the session room that was used (always put myself closest to the door, make sure there were other people around that could be of assistance if need be). This client never presented aggressive tendencies and was a client I enjoyed working with, and certainly adjusted my own biases towards, but still practiced safety at all times. Granted, in my future career endeavors I plan to work in a less crisis environment, and the occurrence of physical attacks is low, I do wonder what outpatient facilities have in place for potentially aggressive clients. I think it is important to be mindful where that worry or concern comes from, to not always anticipate aggression from clients, but to also be mindful and have a plan put in place in the event that clients do become aggressive.

    Reply

    • Lilianne Elicier
      Jun 29, 2020 @ 17:23:22

      Tricia,

      Coming from someone who has personal experience being attacked this is something that is very scary. Having a client who is angry or yelling at you is something that triggers for me that same fear. Although we are also taught to de escalate a patient this does not always happen and I have been in some pretty serious situations where colleagues have been hurt. I also agree that I am competing with myself along with others, I think this is a natural tendency for us to better ourselves.

      Reply

    • Julia Irving
      Jun 29, 2020 @ 21:40:08

      Tricia,

      It is unnerving for me to hear that you have experienced a lot of physical attacks by clients. It sounds like this was due to the job/internship placement you were at. I work for an organization that believes in a ‘hands off’ policy; that means that we do not do restraints or even lay a hand on a client. At my internship I did outpatient therapy and never experienced a client becoming violent or acting out in violence. After reading your post, it opens my eyes to the fact that some placements or individuals we work with may be violent. That being said, I will start being more mindful of this and develop my own plan in if a client ever does become aggressive.

      Reply

    • Danielle Nobitz
      Jul 04, 2020 @ 13:37:59

      Hi Tricia,
      I can definitely relate to worrying about aggression from clients, and have had similar experiences to you in my old job where I was constantly worried about clients becoming aggressive with me, due to the population I was working with. I can definitely see why this is a concern for you. I think you gained a lot of experience when working with the DCF referred client you have, and I watched you grow in your ability to empathize with your client, especially in that tricky situation! I think our experiences in really crisis intense populations have made us hyperaware of our surroundings, which I don’t think is necessarily a bad thing. I think it definitely shaped who we are as clinicians, and helped us decide the setting we feel most comfortable in.

      Reply

  3. James Antonellis
    Jun 29, 2020 @ 14:56:43

    I’m currently sitting at my desk cackling at the myth “therapists learn and practice in organizations free of competition”. It is a common troupe in TV shows like ‘Scrubs’ that medical school is a cut throat place, where you are basically on your own. I would, to some extent, say that therapy/counseling programs can be similar, which is shocking, considering we’re all supposed to be empathetic and caring individuals who want to help make people better. Sure, over my time here, I have developed a group of friends who I can count on for moral support and to help guide me in the right direction on an assignment. However, that is not to say, that everyone I have ever asked fro some sort of guidance has always been friendly, or offered helpful advice. A friend from undergrad recently began working on her Master’s degree in counseling at UMass Dartmouth. She was talking to me about her experience practicing administering the WAIS for her assessments course, and that basically it was everyone for themselves. In the workplace, competition is well and alive too. At work, the clinical director position for our unit has opened. The unit I work on tends to get patients with mood disorders rather than behavioral disorders. It is funny to see how clinicians who would not jump at the open director position on the other IRTP unit, are jumping to fill this position. Paperwork is being completed and filed way before the deadline, clinicians are staying late to assist with Zoom calls, anything to make themselves seem like the better candidate is being done. Even I am not immune to competition. At my practicum, I would make sure I was in before the director and left after the director. I made sure all my paperwork was filed that day and that I always had two new intakes completed every week. Why? I want to work with adolescents, and I want to work in a high level of care, like the IRTP. Who funds the ITRPs? DMH. I wanted to make sure I had a glowing recommendation letter from DMH’s director of Youth and Adolescent Services. Well, I have one now, and the clinical department at work is anxious for me to graduate because they have heard how knowledgable, efficient, and professional I am from her. I was the same way at my internship. I made sure, that I looked great, and as much as I hate to admit this, when I offered assistance to the other; it was in part to make myself look good (you are free to judge me as you see fit).

    For me, the most taboo topic is the discrepant record. First, in receiving a client with discrepancy in his/her record. I’ve dealt with this a bit, and this often resulted in me formulating a bunch of different questions, and if the ROI was still open, contact the treatment provider and asking these questions and adding these notes into the file. But I dread the fact the I could potentially misrepresent information in a file. I have been told that my clinical writing skills are excellent, and that I should stop worrying about notes. But, I find that if I do not review the note or whatever it is I’m writing several times before putting it away for the day then reviewing it again the next day, I worry, I panic. Why? Because I worry about how an incorrect progress note can effect future treatment, especially if it is provided by someone else, and also because I worry about how I will look.

    The thing that shocked me most from the appendix was the sexual feelings numbers. Only one word comes to my mind… “REALLY!” 87% of therapist revealed feeling sexually attracted to their clients. I’m assuming this figure goes beyond just being able to state whether or not someone is attractive. To me, there is a huge difference between stating someone is attractive and having sexual feelings towards someone. I’m sorry, if you’re having sexual feelings toward the client struggling with depression, you need your priorities examined, and maybe some supervision. I’m glad to 63% felt guilty, anxious, or confused. I would feel better if that number were a little higher. I’m also disappointed to see that 95% of the male therapists in the study had these feelings. Sure 76% of women did, and that’s not great either, but 95%! As a man, I’m disgusted.

    Reply

    • Lilianne Elicier
      Jun 29, 2020 @ 16:07:54

      James,

      I was also laughing myself when I read that myth lol! As you mentioned every one is a little bit competitive, don’t tell me otherwise. I myself have done things at work to help establish my professional work ethic and in part I also did things that stacked evidence onto that, nothing to be ashamed of or to be judged upon. We all to some point want to get that position that you have been striving for. I am also very shocked to see that 87% of therapist revealed feeling sexually attracted towards their clients. I think this is also a matter of developing this self-awareness and consulting with colleagues and a supervisor on this matter. If this is still how you are feeling seeing this client should be discontinued ethically.

      Reply

    • Julia Irving
      Jun 29, 2020 @ 21:34:58

      James,
      The taboo topic for me was also the discrepant record. That is smart that you would contact the treatment provider to ask questions and to fill in the blanks. I also review my notes several times before clicking save. I want to make sure what I write is an accurate representation of the session. I also want to make sure that if someone else needs access to the chart then they would also understand exactly what happened in session. Especially when it came to transferring clients at the end of internship, I wanted to make sure the new therapists knew exactly what I had been working on with my clients and the progress that my clients made. I was also shocked by 87% of therapists revealing that they felt sexually attracted to their clients. These therapists do need supervision and introspection.

      Reply

  4. Julia Irving
    Jun 29, 2020 @ 21:03:08

    (1) The myth that interests me the most is the first myth mentioned: Therapists learn therapy and practice in organizations free of competition’s influence. Ever since I can remember we have been in competition with others. Whether it be in the classroom or out of the classroom, it seems there is always a competition. People compete for top of the class, getting into undergrad, grad school, GRE scores, internships, getting a job, Etc. I’d be lying if I said that I did not strive and compete to get good grades and to be a good therapist. I also competed to get my internship placement. To say that therapists learn therapy and practice at organizations that do not have competition would be nearly impossible, especially when therapists will be competing to get the job in the first place and then will be ‘competing’ to fill their caseload.

    (2) Although all of these topics are concerning, the ‘taboo topic’ that concerns me the most as a practicing therapist is ‘The Discrepant Record.’ This is concerning to me because as much as I hate the paperwork piece, I know it is very important. In my progress notes I make sure to exactly what happens in session, the interventions used, and how they link back to the treatment plan. If someone is not doing this then it is hard to know what exactly they are doing in session. It is important that the record matches what is being done in the session; if it does not match then the therapist may be under performing or performing unethically. Progress notes also give me a chance to review what I talked about last session with a client and refresh my memory. This helps me prepare for sessions.

    (3) There are some statistics from the findings that I find concerning. 97.2% of the participants feared that a client would commit suicide. This statistic shows that a huge amount of therapists experience this fear. Also, 89.8% felt anger at a client for being uncooperative; this is concerning because we are supposed to work with our clients and becoming angry with them will create a standstill. The sexual arousal statistics are also concerning: 57.9% reported experiencing arousal while in the presence of a client. This is concerning if a therapist is becoming aroused in session. This therapist should do some self-examination and talk with a supervisor. One statistic I can relate to is that 90.9% fear that they will make a client worse. I experienced this fear during internship. This can almost go hand in hand with the fear of a client committing suicide. I believe this is a fear that most of my colleagues have experienced at one time or another. Through supervision I was able to work on this fear.

    Reply

    • Abigail Bell
      Jun 30, 2020 @ 14:08:43

      Hi Julia,

      Competition is such a part of life and it definitely affects me too. Even after we all graduate, some of us may be competing for the same jobs which is awful to think about. I agree that discrepant records are concerning, because notes are the only record of what is going on in treatment. Good notes that reflect what happened in therapy are important not only for the client’s sake, but also for the therapist sake for lots of reasons including preparing for the next session, like you discussed. Thank you for sharing the fears that you had when you started working with clients. I also feared that I would make the clients that I was treating worse because I wouldn’t know what I was doing in session. Good supervision and experience working with clients helped me to dispel this worry as well.

      Reply

    • Cynthia LaFalaise
      Jul 01, 2020 @ 18:44:57

      Hi Julia,
      The high percentage of therapists that said they feared a client would commit suicide actually gave me some relief to know that what I was feeling was normal. Suicide is a scary but real topic to think about especially in our field, so knowing that others are feeling the same makes me feel more comfortable processing that with other colleagues. I wasn’t surprised about how many reported feeling anger towards a difficul client because I think we’ve all felt frustrated at times with a client, but like you said what matters is how we respond to that. We should meet the client where they’re at and work with them at their own pace to reach their goals. As far as the therapists who got aroused in the presence of their clients, that’s grosssss. If you can’t keep your self together in a session then it’s time to re-evaluate your fit int he field because that is completely unacceptable.

      Reply

    • Tricia
      Jul 02, 2020 @ 10:02:27

      Julia,
      Like my blog post, I agree with you about the issues that can arise from the discrepant record. I found this concerning because for billing purposes we already have limited sessions with clients, so not accurately depicting what occurs in sessions and how it relates to the treatment goals is unnerving.

      While not in my blog post, I would say I would have been one of the therapists fearful of their clients completing suicide. During my internship, I worked with an adolescent with moderate depression, binge eating, and NSSI. On two occasions, I was fearful that she would cut, and trying to not take that fear home with me was difficult. I needed to remind myself what is in and outside my control, that we worked on a plan if the client were to experience intrusive thoughts, and so on. None of us want to lose a client to suicide, and I can imagine processing that would be very difficult.

      Reply

    • James Antonellis
      Jul 02, 2020 @ 18:40:54

      Julia,

      The field is definitely competitive. I feel like sometimes, the competitiveness can get in the way of professional development. Paper work is also a nightmare. I feel like how we do our paperwork is part of our professional identity. That our paperwork is potentially how others may judge us.

      Reply

  5. Abigail Bell
    Jun 30, 2020 @ 13:44:09

    [1] I think a taboo that strikes me the most is the taboo surrounding the direct discussion of diversity and multiculturalism in counseling. The book discussed that there is a reluctance to have conversations about the impact of race, racism, homophobia, and social class in the field and in clinical counseling programs. The author discussed an individual’s experience in a program in the 70’s of the faculties reluctance to acknowledge these things and then viewing the individuals, usually students of color, who acknowledge them as hypersensitive or as having a chip on their shoulder. Although I feel like the field has slightly improved since then, cultural competence is at least acknowledged in most textbooks, it has a long way to go. Books and articles continually hint at the importance of race and cultural differences in treating clients, but does not go into any sort of in depth discussion as to how to do that. Even in books that are exclusively about treating diverse communities, they often say “this is not the ideal treatment for this population” and then proceeds to discuss using the treatment orientation with this population. Direct conversations about race and racism are extremely important in counseling especially today. Being open and honest about what is going on in the world and the transference that can occur due to our own biases when working with clients that are different from ourselves is so important. I agree with this author that this needs to be openly addressed more in this field.

    [2] Honestly, all of the possible clues concern me as a practicing therapist. I feel like most if not all of them are things that we will encounter at some point in our careers. I worry that I will notice that one of these things is happening and then automatically get nervous that I am doing something wrong that may be harmful to my clients instead of just using them as an indicator to examine what’s going on further.

    [3] I think what struck me the most is how common fear, anger, and sexual arousal is when working with clients. I expected the number of individuals who reported fear of working with clients who were HIV positive, fear of client violence, and sexual attraction to clients to be lower. But I guess this study illustrates that these feeling are way more common than we assume which is why it is so important to talk about them openly in training programs.

    Reply

    • Cynthia LaFalaise
      Jul 01, 2020 @ 18:36:26

      Hi Abby,

      I’m glad I’m not the only one that noticed that professionals in the field continue to use interventions on minority populations despite having evidence that it’s not as effective. For example we are trained in CBT yet this form of therapy was developed though trials on middle class college education Caucasian people. So how will these interventions translate to minority races who have various inter-sectional identities that impact their life. It doesn’t make sense to me either so I’m relieved that other people are aware of this issue too.

      Reply

    • Kaitlyn Doucette
      Jul 02, 2020 @ 16:22:48

      Hi Abby,

      Thank you for sharing your thoughts about the lack of conversation regarding diversity and multiculturalism within the field. I completely agree with you; I feel like, even when culture is discussed in textbooks, it’s kind of just “thrown in” in one of the last sections or paragraphs, and like you said, usually just explains how the theory/topic might not be applicable to diverse populations. So, we’re left with the question, “well, what is effective with these populations then?” I have felt frustrated by this myself, and question my abilities to work with clients who are not a part of majority white, middle-class, educated populations. At my current job as a recovery specialist, almost none of my clients fit into this population. I question if my interventions are the most effective options for them.

      I think that experiences recently have supported the idea that race and diversity are still considered a taboo topic, because there has been no discussion of the BLM and police brutality issues within our classes or at the organization I work for (aside from general statements via email from higher-ups, which still seem pretty disconnected from the reality of the situation). I think that we should be able to have more open discussions about what this means for our clients, and how we can best support our clients who are directly affected by police brutality and systemic racism. I know as a person who DOES fall within the majority population, I can never fully understand the lived experiences of my clients (and peers) who are directly affected. I think that more open conversations about these “uncomfortable” topics would benefit everyone.

      Reply

    • Chris
      Jul 03, 2020 @ 21:39:40

      Hey Abby,
      I definitely agree that the most striking taboo is the lack and diminishing of conversation about diversity and multicultural counseling. It a huge issue that needs to be addressed more not just by the students of color in the school, but those who have more power in such institutions. It’s crazy too how many treatments say to implement something that isn’t designed for, or could be harmful to the population, especially if they’re people of color. I understand your sentiment in that all of the possible clues are worrisome. I can totally see most of them happening to some degree, but that also might just be me catastrophizing. I also have my own anxieties around client fear and violence that we share. It’s definitely something that’s scary to think about, and I can’t imagine interning at a jail made those anxieties any less prominent. However, it is also something that is not extremely likely to happen, especially depending on your working environment.

      Reply

    • Maria
      Jul 04, 2020 @ 23:50:31

      Hello Abby!

      I totally agree that the discussion of diversity and mutliculturalism in counseling is very important! You bring up a good point that although these topics are SLOWLY getting brought up and discussed, we arent discussing the important parts of how to make this conversation acceptable and make it less uncomfortable for people! And as we have learned in the past, the typical treatment may not work for other people, therefore why aren’t we looking into things and making a change? So much has happened and continuing to happen, yet there is not plan for how to change things. I also found the statistics to be very eye opening and surprised me! I had never really thought about having a fear with working with those with HIV. To me, the other two seemed surprising, but a common thought. I think most of these topics should be addressed, but just like the tattoo topics, we will often avoid them because they aren’t ‘normal’.

      Reply

  6. Cynthia LaFalaise
    Jul 01, 2020 @ 18:27:50

    I thought it was interesting that directly discussing diversity and multiculturism is still considered taboo. Racism is prevalent in every institution of society at the micro and macro levels. Given that more minorities are seeking mental health treatment you would think that the field would be more encouraging about talking about the effects of race and biases on counselors and clients. As a counselor your own racial biases will influence your perception of your client which can be detrimental if there is negative counter-transference. I will say that in class and at my internship, we talked a lot about working with clients with cultural differences so I take that as a good sign that this topic in the field is moving towards positive direction.

    The “clue to taboo topics” that concerns me the most is the “dehumanized client”. As therapists our job is to help the client and that isn’t possible if we deny them human qualities. I think this can happen when therapists or burnt out and no longer have the capacity to show empathy due to stress and other personal factors. It could also happen when you reduce your client to just their diagnosis and not as a person behind the label. Reducing a client to their diagnosis limits the way you view they person as something that needs to be fixed instead of a person with real feelings.

    What surprised me the most about therapists most reported feelings was they amount who said they felt sexual arousal from their clients. I get it, we’re all human and we will find some people physically attractive, but it’s a problem if it goes beyond just acknowledging that a client is pretty or handsome. I think it’s disturbing if there are therapists who are sexualizing their clients given the differences in the power dynamics between a therapist and client. It can lead to gross misconduct and cause harm to client. I’m hoping that the 87% of therapists who admitted that just had those thoughts and did not act on them.

    Reply

    • Chris
      Jul 03, 2020 @ 21:52:39

      Hey Cynthia,
      I was surprised as well that it was considered taboo to discuss diversity and multicultural factors in counseling. Racism is truly systemic and is pervasive throughout all levels of society, including business and academia. I also agree that we discussed these topics in class and internship more, but there are likely still those with prejudices who practice in healthcare fields. I also thought the dehumanized client was a worrisome thought. It’s definitely something to be cautious of combined with burnout. I hope to continue avoiding this in the future as well as I do not wish to reduce my clients to just a diagnosis. I also couldn’t agree more that counselors shouldn’t be sexualizing their clients, and it’s always surprising to hear how common it is. You’re right that it goes beyond just physical attraction because they power dynamic can greatly harm the client. I hope that in addition to not acting on such thoughts, that counselors continuously be reminded not to sexualize clients.

      Reply

  7. Sam
    Jul 01, 2020 @ 20:04:07

    1. I suppose a myth that I found to be, interesting, was that of “if you’re a good therapist the money will come”. For one, many of us in this class have had countless discussions on the discrepancies between the work we do vs. the monetary compensation we receive (i.e., we don’t get paid enough). However, more importantly, under this myth, the authors discuss the lack of knowledge in “constructing a realistic and effective business plan, budget office expenses, market your practice, etc.) Really, what this makes me think of is how often (and rightfully so), many people say: “I wish they taught us how to do our own taxes in high school, or taught us about credit scores and how to manage them, etc.). I often get questions from family members or friends if I ever plan to establish my own practice, and the first thought I vocalize to them is, “That would be nice, but I would have no idea how to run something like that”. I realize that this myth is mostly related to those looking to open their own practice, but regardless, it would certainly be beneficial to know/ understand how to do so. Additionally, I again, would not feel confident in opening my own practice, as I would also have difficulties with how to manage clients who refused to pay their fees or could no longer afford them. As expressed in the myth explanation, money in our field seems to be such a touchy subject, and continues to be in a way, a difficult conversation. Nevertheless, I do feel that many of the skills/ information related to business principles, money, fees, etc., can be partly learned through our internship experience or from colleagues. At my internship, I was lucky enough to have a supervisor, and executive director that would take the time to explain a lot of these concepts, and provide is with some education with regard to the business aspect of our profession.

    Additionally, one other “question(s)” that peaked my interest with regards to “questions we’d rather avoid”, are pretty much any of those listed between pages 58-62. For example, some of those questions include: “Under what conditions would you examine your client’s chest and nipples?”, “Under what conditions would you allow your client to disrobe partially or completely in sessions?”, or “Under what conditions would YOU partially/ completely disrobe in sessions”. To be honest, I believe that if during a self-assessment, you’re answering anything but “never”, to these questions—it is definitely something that should be recognized and discussed. I understand to a certain extent why these questions are avoided because of course, it would be unethical and a detriment to the client to act on any of those thoughts—so you don’t want bring any negative light on yourself, but if thoughts like that are occurring it would be critical to seek supervision and discuss these with someone other than yourself, as they can ultimately lead to malpractice and absolutely harm the client. Even if answering these questions may lead to “striking” answers that signal that you are not fit to be a therapist, it is ultimately better to recognize that, than harm a client while avoiding acknowledging them.

    (2) One “possible clue to taboo topics” that concerns me is that of “Boredom and Drowsiness as protective factors. It makes me a bit anxious for working with clients in the future that I may potentially react to with boredom. Although throughout my internship, I never experienced a time where I was bored and drowsy with a client almost every session, but now after reading this, I’m almost curious to see if it would happen in the future with any clients. I feel like in general, we hear comments about therapists having really “boring” clients or “difficult clients” to work with, with regard to their active involvement in therapy (i.e., a client who is severely depressed may rarely speak in session which can in turn become “boring”.) Would that mean that the boredom and drowsiness you experience with them every session is likely the result of some fight to acknowledge a taboo topic that they may be experiencing? Or is it just because they are in fact, “boring” clients?

    (3)Similar to my previous discussion, with regard to the self-reported behaviors in the Appendix, I find it a bit uncomfortable with the number of clinicians who have reported sexual arousal toward their clients. Again, I feel there is a strong difference between simply recognizing that your client may be physically attractive vs. moving beyond that and thinking about “examining their chest and nipples”. At that point, I would argue that those thoughts themselves have already caused harm in that they will certainly impact the sessions you hold with that client. Additionally, in reading the “complaints” section, I noticed this: “Not surprisingly, therapists who indicated some form of sexual or quasisexual involvement (i.e., client strips to underwear, client being naked above touching the therapist’s genitals, etc.,) had complaint ratings that were four times as large compared to the ratings of the therapists who did not have sexual involvements. UM, you think?! I hope that those “therapists” are longer “therapists”. I noticed the references are rather old…so, hopefully things have gotten better since then, but it’s sad to say that I feel stuff like this unfortunately still happens, and that’s just plain scary.

    Reply

    • Tricia
      Jul 02, 2020 @ 09:42:35

      Sam, I find it interesting that you talk about this myth. I talk to people who are outside of the field, and when I tell them about the expected salaries, they often discuss finding the niche in the field that will bring the money. Mainly, what can you do in the field to bring in the money, that is not done, and needs to be done.
      I found it interesting reading your comments about the taboo topic of reacting with boredom. As new clinicians, I find we are very excited about our clients and working with them. I hope that I do not encounter sessions where I am bored with my clients and not motivated to assist them in counseling.
      Finally, I agree that I am extremely uncomfortable with clinicians reporting sexual arousal to their clients. With the power dynamic that can already be at play in this role, it is disturbing to me the actions that can be set forth by some of these self-reported behaviors. Like you, I hope that these therapists are no longer therapists for the significant harm they likely caused clients. Disturbing to me how a therapist could justify this with clients when they are supposed to be helping them.

      Reply

  8. Lynette Rojas
    Jul 02, 2020 @ 14:58:28

    The myth that piques my interest the most is that therapists learn and practice therapy free of competition. To be able to learn therapy, one needs to attend a graduate program. There is competition to get into graduate programs against other applicants. Then to obtain “hands on” experience, one needs to apply and obtain an internship position and compete against other potential candidates. The same occurs when applying for a job as a therapist. The competition continues when trying to build your caseload and when there’s a possibility of being promoted.
    The discrepant record concerns me the most as a practicing therapist. Documentation is very important and it’s the only form of information on what actually happens during therapy sessions and throughout the episode of treatment. I worry about missing information or documenting in a way that is misleading or incorrect. I am very careful with how I write my notes and always double check and even triple check my notes before I sign them off. This is one of the reasons why documentation is very time consuming for me as I mentioned in a past blog. My documentation has improved over my time at internship and with the help of my supervisors. I think that if this “taboo topic” is a concern it should definitely be talked about during supervision to ensure that all client notes are being documented accurately.
    I was surprised to find out that there is a high percentage of therapists that become sexually attracted to their clients. I would think that this number would have been much lower. I think that there is a huge difference between finding someone attractive and having sexual feelings for them. Learning that therapists have these sexual feelings for clients is very concerning. These sexual feelings can definitely impact the therapeutic relationship and cause harm to the client. Client suicide is also something that I find concerning. Client suicide is one of my biggest fears I have when working with clients. I have no had a client who is suicidal and I’m honestly very scared to. I know all the questions to ask and what I need to do but it’s something that I find very difficult and scary.

    Reply

    • Pat
      Jul 03, 2020 @ 11:47:52

      Lynette,
      I’ve slowly noticed I feel the same way about the discrepant records. I’ve heard talk that sometimes, as beginning clinicians, it can be tough to identify in clinical terms what we did. Sometimes I know what I did in session was part of the theory of CBT, and I know that it works and has an effect on the client from week to week, and yet when it comes time to write the note I’ll blank on terms like cognitive restructuring or schema identification/exploration. I wonder if that seems familiar to you along with the triple check on notes.

      Reply

  9. Danielle Nobitz
    Jul 02, 2020 @ 15:12:39

    The myth that interested me the most within these chapters is that therapists learn and practice in organizations free of competition with others. I, as of most of my peers, have developed a competitive trait throughout my life, especially when it comes to school. Starting when applying for undergrad, you are placed I a competition with others on who has the better grades, more community service, and the better resume. The competition has only continued to grow for me, with getting into my master’s program, getting experience in the field, and getting the best grades I can, and receiving practicum and internship placements at the same time as all my other peers (also signing up for presentation topics, as we all know how stressful and competitive that can be). I have learned that as I continue to find my niche in the field and narrow down my interests, there will continue to be more and more competition for those who are interested in the same field as me. I recognize that finding a job will also be competitive, as well as practicing in the field with others in the same organization or clinic will be competitive as well. Clients can come and go, and some clients might request a colleague or coworker due to their professional identity, which could also spark even more competition. Personally, I believe that competition in this field has made me strive to become better and do better, so I definitely see it as more of a positive, however I do know that it can become an issue depending on the person. I think that it is inevitable that we will come across competition within our field, however it is important to consistently check yourself and make sure the competition is not interfering with your occupational or personal functioning.

    The “possible clue to taboo topic” that concerns me the most from this chapter was the dehumanized client. I think this concerns me the most because I have experienced this in my old job, not personally, but I have observed it through other people. I feel like I bring this up almost every blog post, but working with severe mental disorder like schizophrenia and bipolar disorder (where you see individuals having psychotic breaks), was really stressful and caused a lot of burnout in the staff, especially with the therapists and psychiatrists. It is important that even when someone is in this intense of a psychiatric state, to still treat them as human beings (even if sometimes they are not acting like one). It is so important to continue to check yourself as a mental health clinician in order to monitor yourself, your burnout potential, and your ability to maintain the ability to empathize with your clients in order to give them the best treatment they can receive. I have seen coworkers in that setting completely lose empathy for clients in that situation, and it was really concerning to see and hear how they would act and speak about these patients in the hospital. I learned not only from this chapter but also from my work experience that this happens quite frequently within the field, especially under severe amounts of stress. A client should be more than their diagnosis.

    I could not believe how many self-reported feelings surrounding sexual arousal and attractiveness for clients there were. It was really shocking to me that there was that many clinicians who reported being sexually aroused by their clients. It is understandable that a clinician would maybe acknowledge the attractiveness (internally) of a client and then maybe have that thought in passing (it is inevitable not to notice someone’s physical appearance), however, examining a client’s body and continuously thinking about the attractiveness to the client is definitely unethical and straight up wrong. In this situation I think the best thing a clinician could do is refer out to someone else, because once you pass that boundary of just noting a person is attractive in your mind, and it is effecting the treatment or therapeutic relationship, you are doing more harm than good to the client.

    Reply

    • Kaitlyn Doucette
      Jul 02, 2020 @ 16:07:10

      Hi Danielle,

      I really resonated with your experience of competitiveness within the field. I have always felt the competitive nature of psychology/mental health, especially in the academic setting. During undergrad, I was very competitive about my grades because I knew that these directly correlated with my opportunities for teaching and research assistantships, letters of recommendation, and my ability to get into a graduate program. Though there is less of a need to be competitive in academia now, I believe that this competitive spirit continued through my graduate school career and I still have a strong desire to do well on my assignments and get good grades. While at my internship, I experienced feelings of competition with the other intern that was there, because I felt the need to be the “best” intern, as I knew that this would open up opportunities for employment with the agency once I completed my degree. I agree with you; I think that it has motivated me to become a better student and clinician. I wonder how competition will play a role in my future once I am working full-time as a clinician and am no longer in school.

      Reply

    • Pat
      Jul 03, 2020 @ 11:43:51

      Danielle,

      I think it’s really interesting that you noted, “clients can come and go, and some clients might request a colleague or coworker due to their professional identity, which could also spark even more competition” because I think a lot of us have felt that, or at least I can say I did. Part of it for me was less of a competition and more of a, “I didn’t do well enough,” feeling. I liked that you talked about the professional identity bit because I hadn’t looked at it by that reframe. I think I might steal that from you!

      Reply

    • Maria
      Jul 04, 2020 @ 23:56:27

      Hello Danielle,

      I agree that a clue to watch out for is when people start to dehumanize their clients. I know you and I have had many discussion regarding some pretty concerning placements, but that must have been tough to have it at work as well! I agree with you that this could happen more often when clinicians are burnt out. It is not surprise that at times we may struggle to keep working after hearing so much sadness and pain. I know we have also learned to leave work at work, but realistically we struggle with this. If we dehumanize the client, we are putting them at greater risk and we are no longer helping them. We also learn and develop bad habits and stress becomes our new friend. A client should be much more than their diagnosis! That is why it is so important to look out for these clues!

      Reply

  10. Kaitlyn Doucette
    Jul 02, 2020 @ 15:59:09

    [1] “Do you ever cry or “tear up” during a therapy session? If so, what has the client said or done? Does this seem to happen more with male clients, more with female clients, about equally with male and female clients?

    This question piqued my interest because it is something that I have thought about in the past and I am not sure if I have come up with an answer for it yet. As therapists, I think it is often assumed that we are emotionless, stoic, or that nothing phases us. This is definitely not the case for me. I have always been a sensitive person (sometimes told that I was “too” sensitive), which I think also makes me a very empathetic person. I’m sure this contributed to my initial interest in the field, and why others have thought of me as someone who is easy to talk to. Along with my heightened empathy and sensitivity, I am a crier. When I see others that I care about cry, I immediately feel my eyes getting hot in an almost reflexive way. I worried about this while I began working as a therapist because we aren’t supposed to have emotions, right? (Of course we do, but I believe that this is still a common myth in our field). Still, I would never want my own emotions to impede on my client’s progress or comfortability with me in session.

    The only time I have “teared up” in session with a client thus far was when my client told me that she was pregnant. She had been talking a lot about her desire to become pregnant and her fears about not being able to become pregnant in previous sessions. Her emotions while she told me were very strong; she was elated. I also felt very happy for her, and I felt myself beginning to well up. I don’t believe she really noticed; I didn’t acknowledge my own emotions on the subject, and she was so excited to talk about it that I don’t think much could have interfered. I do wonder how it would have gone if she had noticed or acknowledged my tears. I don’t think it would have made a negative impact on her progress, but would it have been uncomfortable to talk about my own emotions with my client? How could I have responded in a way that was most appropriate/ therapeutic? These questions still arise as I think about this situation happening with future clients.

    [2] The “possible clue to taboo topics” that concerns me the most as a practicing therapist would be avoidance. I have found myself in the past attempting to avoid seeing clients that I didn’t want to see (they were not my own individual clients, but I still worked with them in groups and meals.) I know that it was not the most appropriate thing for me to do as a mental health professional, but I can still acknowledge that it was something I did. Avoidance has also come up for me when I become nervous about bringing something up with a client. My general rule for these situations is, if I feel myself not wanting to talk about something, then I know I need to talk about it. I have gotten a lot better with this over time with practice, but it still seems like my initial reaction when something uncomfortable comes up.

    [3] I was most surprised/concerned with how many therapists reported they had told their client that they were angry with them at least “rarely” or “sometimes.” I think that it is okay to experience feelings of anger towards a client, and I believe I have before, but I don’t know that it is therapeutic to tell a client that you are angry with them. I think it would be okay to tell a client that you are feeling frustrated with a certain situation or outcome, but I think that the “angry with them” part is what concerns me the most. I worry about the therapist’s ability to maintain boundaries with the client in this situation, or how this would affect the therapeutic relationship. Perhaps I am wrong; I am definitely open to hearing others’ opinions on this!

    Reply

  11. Patrick
    Jul 02, 2020 @ 16:53:04

    I think the myth that hit me right away was that “therapists are invulnerable, immortal, and ageless.” It was almost a double whammy; I remember thinking that as a kid when I saw or met therapists, and then after the internship, I felt both my exhaustion or distress, as well as the idea that we are expected somewhat to be immovable – a rock no matter what happens. Suddenly, the feeling of “therapists are invincible” felt like a burden, not a compliment. Most therapists I’ve met tend to lean on other therapists because we get it, but outside our profession, there does feel like there is a certain level of expectancy that we will “have it covered.”

    Seeking repeated reassurance from colleagues was a big concern for me in practicum and internship. Practicum was mostly feeling nervous and unsure of myself, and the internship was that, two heart-related episodes, a loss, and sometimes feeling unfamiliar to a client’s diagnosis and feeling scared I was going to screw up (all of which happen to be mentioned in the book). I know, without a doubt, that I did look for reassurance more than I should have, or more than what was the norm. Mostly it looked like nervousness over not missing any details, but it was a front that quickly became transparent. That “something isn’t right” quote felt very familiar and, in the end, it is another way that I can keep track of myself and how I am doing.

    My biggest surprise was the idea of being physically attacked by a client, a disgruntled family member, maybe an ex-boyfriend/girlfriend who was angry at some of the decisions their ex-partner had made during therapy. It wasn’t that the idea itself was a surprise to me, as much as I realized that I hadn’t considered the little things that can lead to different concerns or worries as a clinician. I’m a tall, somewhat bigger guy. I’ve thought about what would happen if this did occur (what I should do in the situation, are there protocols in the organization I’m working in, etc.) but I didn’t register it as a problem because I usually have a size advantage. It was the consideration as to how the little things (age, size, gender, religion, etc.) can create or minimize certain concerns that a clinician can have that are completely unrelated to the job itself, the paperwork, the legal stuff, the clients, etc.

    Reply

    • Lynette Rojas
      Jul 04, 2020 @ 22:57:12

      Hi Pat,

      I am glad you talked about this myth because like you I also feel like there is that pressure to be invincible because we are therapists. It’s like we are supposed to know all the answers and like you said “have it covered”. I agree with you that it does start to feel like a burden and as therapist we do tend to lean on each other because we understand it.

      Reply

  12. Chris
    Jul 02, 2020 @ 17:11:22

    I think the myth that made me think the most when reading was the taboo around the direct discussion of diversity and multiculturalism in counseling. The authors discussed that there is reluctance to talk about the effects of stigmatized and disenfranchised populations in a clinical setting. This comes as unsurprising to a degree as the institutions of systemic racism are still present in the mental health field. Even though many practitioners may believe themselves to allies or someone who truly accounts for cultural differences, not everyone does. In addition, as counselors we work with other individuals in different healthcare fields. Some of which may not be as empathetically inclined to help those who are stigmatized against. I believe that the healthcare field is slowly improving as we are taught multicultural counseling throughout our education. But this is only the first step as overall as many individuals still do not wish to discuss how to best aid people of color or those of with lower economics. And by shrugging of such conversations, it is allowing the racist institutions to perpetuate. While the conversations to discuss and call out discrimination in any form can be uncomfortable, it is crucial to keep going so that these types of talks aren’t taboo and the best treatment can be given to everyone.

    Many of the taboo topics concern me in all honesty, but the one that I would say I’m the most worried about would be therapy adrift. I think that I’m worried about this happening in my professional practice because of the transition to zoom during my internship. Because of the switch, it was difficult to implement my interventions as I had planned and many clients dropped. With some, it just felt like weekly check-ins to make sure they weren’t too anxious at the start of quarantine. I am just a bit worried about going back to that in my career, but I think it’ll be easier to avoid in person and even more so because I’m thinking about it now.

    When examining the Appendix, I think the information presented on patient violence is the most concerning to me. I think this is something that has been a concern of mine even before taking this class or doing this reading. The possibility of a client attacking me or being aggressive was definitely something I was worried about before internship. During it however, it was much easier to realize that this was not the case. But in all honesty, there were a couple clients I felt as though I needed to be careful with my words as I wasn’t sure if they would react in a physical manner. From the reading, I can see that fear itself plays a large role in how effective counseling can be as it can truly inhibit the both the client and clinician. In the future, I hope to be able to feel safe in my practice, but I don’t think the idea that someone could attack me in session will go away.

    Reply

  13. Maria
    Jul 02, 2020 @ 17:31:20

    The myth that piques my interest is that around discussing diversity and multiculturalism in counseling. It’s one of those unspoken topics because often people feel uncomfortable when discussing it, especially with how the world is. Many of us have taken cultural competencies and have see just how diverse people can be. I learned a great deal of things during this class including the fact that having these conversations are extremely important! By asking someone about their race, culture, or ethnicity, we allows the client to speak about themselves and learn about what makes them who they are. Before taking that class I had never thought of asking questions regarding because it’s not a “normal” question. Also, I worry questions like that could make someone uncomfortable or even angry if not stated in a proper way. Also I find myself feeling slightly uncomfortable doing it, but that is why I found this taboo interesting! I think it is super important for people to become open and unafraid to discuss diversity and multiculturalism. By staying silent, we are not making change for people, especially minority populations!

    The possible clue to taboo that concerns me is around the topic of dehumanizing clients. I would never think of hurting anyone, especially someone who is coming to me for mental health help! Being around some more experienced clinicians, Ive seen the beginning of this. I have seen clinicians speak of their clients as though they are weak, ‘stupid’ (yes, I’ve heard someone call a client stupid), or simply just their diagnosis. This made me sooooooo angry and it concerned me a great deal. I ended up leaving this placement, but I still see it happening. I don’t think (I mean I hope not) clinicians purposely begin to dehumanize their clients, but I think if not addressed or if the clinician does not take care of themselves, it is more likely to happen. I think clinicians sometimes try to ‘separate’ themselves from a certain situation in order to not be triggered themselves, but if we stop seeing our clients as people, that is a dark path to go down.

    Looking at the appendix, I was blown away by some of the statistics that I saw. The first two that caught my eye was that concerning the fear of a client committing suicide or making a client worse. These are honestly two of my biggest fears! I always feel like I am not doing enough for my clients or that I need to know everything in order to protect them. It’s slightly surprising to see just how many other professionals feel the same way. I thought (maybe my new clinician type thinking) that this fear would ease up, but it sounds like something that is always on our mind. The other statistics that stood out to me was that concerning feeling anger towards a client and being aroused by them. I have had days where my client’s caused me slight frustration (kiddos+zoom) and I always felt bad after for feeling that way. Looking at this stat, it made me realize that we are only human and we have our off days! It’s also no surprise that the sexual arousal statistic stood out. We’ve talked about the possibility of a client developing a crush or the other way around, but to have to have those strong feelings and thought… that’s concerning!!

    Reply

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Adam M. Volungis, PhD, LMHC

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