Topic 8a: What Therapists Don’t Talk About {by 3/19}

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 3/19.  Post your two replies no later than 3/21.  *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. Amanda Russo-Folco
    Mar 15, 2020 @ 11:44:38

    Based on Chapters 1 and 4, the particular “Myth” that piqued my interest the most was the myth “Therapists are invulnerable, immortal, and ageless” because as I was reading this section, the story that was told about a client becoming severely dangerous and pulling out a weapon to a colleague is something that therapists should be prepared for even when the therapist feels safe and secure within their center. This is usually overlooked and does not pay much attention too because individuals do not always suspect the worst when they feel safe and secure in their center. Personally, when I feel safe and secure at a place, I do not think about the worst that can happen in a situation, however, reading this section, I should probably be more aware and on alert. As is it stated in the reading, when therapists complete their training, it is important to complete the training with learning how to properly screen new clients, what to do if a client pulls a weapon during a session, how to properly secure a therapy office and waiting room in light of potential violence, etc…This is something that does not always get taught within the therapist training and I never really thought about that until now. Now reading about it, I feel that it also depends on the clinic setting. For instance, therapists in an outpatient setting could have trainings a lot differently than therapists in a residential or hospital setting. All in all, it is important for therapists to receive proper training in terms of at-risk clients and to prepare for any immediate threat or violence in general towards themselves or other colleagues.

    Based on Chapter 5, the “possible clue to taboo topics” that concerns me the most as a practicing therapist is that there were a lot of them that concerned me such as “The Discrepant Record”, “The Dehumanized Client”, “Avoidance”, “Fantasies, Dreams, Daydreams, and other imaginings” however, if I had to choose one it would be “The Dehumanized Client” because this is something that therapists should never be doing in the first place. As I was reading this section, I started to feel irritated because therapists should not be seeing their clients as “that schizophrenic,” or “that borderline personality disorder I’m treating” just so they could help themselves not become “too emotional” if they are helping the client with a topic that reminds the therapist of something in their own life. They should not see their client just as a label or someone who has dysfunctions because they are human as well. Therapists should be seeing their client as someone who is there trying to receive help, not someone based on their labels or symptoms. If the therapist is having trouble giving treatment to a client that has similar problems to them, then they should talk to their supervisor about this client and transfer them if it starts to become an issue that they cannot overcome. Because if not, this is affecting treatment for both of them.

    Based on the Appendix, of all the information presented on therapist self-reported feelings and behaviors, the one that surprised me the most was “Feelings and Context” because I did not realize how high the percentages were for experiencing fear, anger, and sexual feelings were. The most common feeling was fear that a client would commit suicide was 97.2%. I knew that a lot of therapists experience this kind of fear when it comes to their clients, but actually seeing the percentage, I did not realize how high the percentage would be. What surprised me the most was that over half of the therapists (53.3%) felt so much fear about a client that it affected their eating, sleeping, or concentration and I never realized how much fear could affect a therapist.

    Reply

    • Jayson
      Mar 18, 2020 @ 14:29:35

      Amanda,

      I agree with your statement, “Personally, when I feel safe and secure at a place, I do not think about the worst that can happen in a situation, however, reading this section, I should probably be more aware and on alert”. Whenever I am in session or simply in my clinic, I never expect the worst out of my clients and think they are capable of doing something harmful. Realistically, we are in session with this person behind closed doors and I never assume this client will cause me any harm, but in reality, something might happen. Just because they are a client, it does not mean they are not incapable of causing harm to them, to us, or to the clinic. Reading this simply made me more aware and alert that anything can happen regarding any of our clients.

      Reply

    • Sarah Mombourquette
      Mar 21, 2020 @ 20:31:40

      Hi Amanda, I agree in particular with your comments about therapists who dehumanize their clients. It reminds me that we should constantly be asking ourselves “who is this helping” when in sessions. I feel that therapists who dehumanize their clients are predominantly doing that for themselves rather than for the good of the client. I also agree with how therapists should not be further stigmatizing their clients. Sometimes I feel like people in our field are so used to being in the world of mental health that they forget that it can be really hard for people to seek out and attend mental health service due to how much stigma is attached to specific disorders. I can imagine clients will feel when they are also being stigmatized by their clinicians which could result in them not receiving help that they need.

      Reply

  2. Liisa Biltcliffe
    Mar 16, 2020 @ 14:22:12

    1. The myth the struck me the most was “Therapists are invulnerable, immortal, and ageless.” The reason this one struck me was because near the end of what it was talking about, it states that many therapists operate without a professional will or arrangements in the case of them becoming incapacitated or even dying suddenly. I actually had not even thought about this. I wonder how many people really do think about this. I mean, I have thought about it in terms of my personal life, such as what would happen to my stuff, my finances, my cats, etc., but I have a partner and so that makes things a bit easier, but professionally? I had never thought about that. I feel as if this is important to plan for and have backup arrangements in place. It’s not just the clients who are left behind, it’s the clients’ information, the password protected devices, etc. All of that would have to be addressed and it could be daunting, but should not be left to a partner or family member due to confidentiality.

    2. I think the Taboo Topic that concerns me the most is the “Client-Friend” mostly because I feel as if I need to be especially careful of this aspect. Some of the feedback I recently received in internship class was that I am very patient and listen to my clients really well, but that I need to be more directive with them…with one in particular that I am working with. I feel that my tendency to be so patient and listen endlessly could get me into territory where I’m not utilizing my CBT skills in directing clients throughout their therapeutic process. I mean, obviously not to the point where I’m controlling, but just guiding. I think, though, that it’s good for me to just be aware of this tendency and that this will help to start with. I feel as if a lot of these taboo topics are easily intertwined and can be overlapped, and before a professional knows it, they have a bunch of taboo topics happening all at once. And if they aren’t comfortable talking about these topics with others, like a supervisor or colleagues, then these situations will only fester and get worse.

    3. There were a bunch of the statements on the survey that really surprised me that I felt should have warranted a “never” response, such as “giving a massage to a client” or “telling a client that you find him or her physically attractive” (would that be appropriate–I didn’t think it was). Then there was the result of almost half reporting that they became so angry that they did something that they later regretted. I found that disturbing. No one is perfect by any means, and yet what exactly does this mean? Does it mean the professional said something derogatory in anger or was it an actual behavior? I found it really disturbing that 87% of participants reported some sexual attraction to clients. I guess this just means it is super important to have a good rapport/relationship with a supervisor or colleague with whom to discuss such matters so that if/when this happens at some point, one feels comfortable enough to discuss it instead of letting it build and fester. However, I am already uncomfortable with the thought of it possibly happening at all, so I could see how it would be a difficult topic to discuss. This also means, however, being aware that it does happen so that if someone were to come to us with this issue (later in our careers), to not be judgmental and to openly discuss it with him or her.

    Reply

    • Amanda Russo-Folco
      Mar 18, 2020 @ 13:52:48

      Liisa,

      I enjoyed reading your blog post and listening to your opinions about these different topics. I also chose the myth, “Therapists are invulnerable, immortal, and ageless” because that is something I have not thought about as well and reading about it, I can become more aware of this to start thinking about back up plans for the safety of the clinicians and clients. I also agree with you that “Client-Friend” is a taboo topic that needs to be thought about and you make a really good point about how important it is to talk about these issues/concerns with our supervisors or colleagues because that will help give us guidance within our sessions. As you said, if we do not talk about these issues then the situation with continue to get worse and can hinder treatment for our clients.

      Reply

    • Jayson
      Mar 18, 2020 @ 14:34:53

      Liisa,

      I had similar concerns to your statement, “Some of the feedback I recently received in internship class was that I am very patient and listen to my clients really well, but that I need to be more directive with them”, however instead of being more directive with my clients, I need to learn to be less directive. I use my CBT skills I believe a little too much and do not allow my client to talk. For instance, I feel more like a teacher than a therapist. I realized that I need to spend less time talking and more time listening to my client or just find a balance between the two. Overall, like you said, I need to learn how to effectively “guide” the client and our session better.

      Reply

      • Dee
        Mar 19, 2020 @ 14:36:58

        Jayson,
        (Not sure if we can leave comments on comments but this comment really struck me)
        Thank you for your comment. Reading your comment I can totally sympathize. There are sessions where I felt I may have been too directive and too CBT focused and lacked on client validation and active listening. It really is important to find a good balance between CBT and teaching, and listening to clients and giving them the space to lead the session. Dr. V made the point in class that often what we believe to be impactful and what our clients believe to be impactful differ. Clients have told me in the past that the CBT heavy sessions help, but often the sessions with a little less CBT and more room for the client to lead and vent, has been very helpful.

        Reply

    • Becca Green
      Mar 18, 2020 @ 17:20:02

      Yes, Liisa! I was having very similar reactions to the items on the “Appendix.” Why were some of those not complete zeros?? Some of the things really were disturbing, I could never imagine doing those things. In regards to the comments about the sexual feelings towards clients I totally agree that I can’t believe how high the number was. My hope is that if that were to happen to any therapist that they would immediately get consultation or request that the client be transferred to a new clinician. I can’t imagine that someone would be able to give adequate therapy if they were sexually attracted to the client.

      Reply

    • Alyce Almeida
      Mar 18, 2020 @ 21:16:17

      Liisa,

      I too was quite shocked with how high the numbers were for some of the things listed (especially the sexual stuff!). I’m hopeful that if anyone in our field experienced that they would get help around it – but it really surprises you just by what the percentage was on how high some of these were rated. But again I agree with you on how it could be difficult for people to talk about but to stress the idea of not being judgemental if it were to occur.

      Reply

    • Sarah Mombourquette
      Mar 21, 2020 @ 20:23:16

      Hey Liisa, I agree with your comments about being surprised by the therapists who were so angry that they did something that they later regretted. When I first read that, I thought about how problematic that could be for the kids I work with who often experience their parents getting angry and doing things that they regret. I immediately began to process how problematic that could be for the client’s success in therapy as well as further negative automatic thoughts and core beliefs that this could perpetuate. I feel this is true of many of our clients, so that is why it is important to ensure that we are in control of what we say and do in high stress situations with clients.

      Reply

  3. Rachel DiLima
    Mar 18, 2020 @ 13:25:36

    1. Although the myths in chapter 1 were intriguing and promoted some self-reflection (especially for the ethical myth), I was most interested in the questions of chapter 4. Some of the questions made me think, and others made me extremely uncomfortable. On a logical level, I understood that the point of this book is to address subjects that are uncomfortable and “taboo”, however I was unprepared for the level of detail and exactness that the questions, mainly sexual in nature, would delve into. Some (most) of the questions would never OCCUR to me, and it made me wonder in what situations these questions would even come up for a therapist (“Under what circumstances would you kiss a client on the mouth?”, “Under what conditions would you examine a female client’s chest and nipples?”, I’m sorry, WHAT??). The more I read through the questions, the more it became clear to me that I was actively looking for a specific question that I did not see. The question I was looking for was, “have you even felt disappointed by a client you were proud of? How did you respond?” I have a client who I genuinely like. He is timely, respectful, and humorous. He has made a lot of progress in his trauma treatment, and it shows. I look forward to our sessions. During one session, it became apparent that he was racist. I remember feeling deeply disappointed; as if he had let me down in some profound way. I would like to point out that he seems slightly ashamed of his racism, but that may be just me trying to make excuses for him. I have to compartmentalize this aspect of him, and I hate that I need to do that. Worse, I hate that I can do it fairly easily. I believe he noticed some reaction in me when he used the words he did, and has studiously avoided bringing up anything race-related. I continue to treat him, and I continue to like him as a person. People are messy and complicated.
    2. A “clue to taboo” topic that concerns me the most is “isolation of the therapist”, although not necessarily for the reasons that the book describes. The book takes a psychodynamic approach to understanding why a therapist may isolate; specifically, a therapist feels shame for their repressed sexual thoughts/fantasies/desires towards a client and therefore isolates themselves from colleagues so that the topic isn’t addressed. I propose a different reason for isolation. As someone who suffers from bouts of depression, which are usually brought on by anxiety about the future and my productivity, I experienced myself begin to isolate during my internship when I began to doubt my abilities as a therapist. I began to avoid my colleagues (and well-meaning friends asking about my internship) in order to avoid perceived criticism about my work. I was afraid of hearing “you should have…” or “next time, you should…”. Through some self-monitoring and reflection, I realized where these thoughts and feelings were coming from (spoiler: its me) and decided to speak to my supervisor about my insecurities. By doing so, my supervisor was able to normalize my feelings. I was able to take a step out of my brain and realize the benefit of receiving feedback and support from my colleagues. If I hadn’t become aware of my isolating, I wouldn’t have received the feedback and support necessary to become better at what I’m doing. Therefore, for me, paying attention to isolating behaviors is integral to being an ethical, effective, and healthy counselor.
    3. This was difficult to pinpoint. As a counselor, I always try to encompass the “less judgement, more curiosity” standpoint in my practice. I tried to do the same here, and where I fell short the most was when counselors engaged in acts with premeditation. If a behavior was done in the moment, due to rage, overwhelming emotion, or some other compromising situation, I think that I would be less judgmental and more empathetic. As it stands, if a therapist has opportunity to reflect, seek supervision, or any other way of getting help with troubling thoughts or feelings, and doesn’t do so, it disturbs me. We need to practice what we preach, and if someone does something “they later regret”, its something to be on guard about. We are all human, and we make mistakes. Mistakes that can be prevented, however, should be paid more attention to.

    Reply

    • Amanda Russo-Folco
      Mar 18, 2020 @ 14:11:56

      Rachel,

      I had the same initial reaction you did as I was reading Chapter 4. I thought to myself “what am I reading right now, is this real!?” Those questions would have NEVER occurred to me either and I couldn’t believe what I was reading. I was not prepared either. However, I really appreciated how you related what you read to your own personal experience with clients of your own. That must have been difficult for you to learn about your client, but it seems like you have been doing a lot of great work with him. But, I also feel that there will always be clients that clinicians will favor over others and look forward to meeting them over others, as sad as it is to admit it. For your second question, it takes a lot of courage and strength to admit one’s own faults and I feel that is the beginning of solving the problem. I also am in the same boat as you and it is difficult for me to sometimes step out of my own brain to notice what is going on. I am glad to hear that you were able to talk to your supervisor about isolation and you were able to feel better in the end. Sometimes all we need is just a little help and motivation to help us get back to where we want to be.

      Reply

    • Becca Green
      Mar 18, 2020 @ 17:26:39

      Rachel, I had a similar situation with a client recently. As the primary election was approaching one of my clients asked if I could support them in getting resources to help them know each candidate to help them make an informed decision when voting. At first I was so excited, as I love voting and believe that every person should exercise their right to vote, but then they shared what they were looking for in a president. They reported that they wanted someone who did not support Planned Parenthood and the LGBTQA+ population. As a member of the LGBTQA+ community I froze. I couldn’t believe that this client of all of my clients held prejudices against ME without even knowing it. I had to get extensive supervision around this and it took me a bit to be able to process and compartmentalize that part of them to be able to work them. Not really related to the specific question, but I understand the feelings.

      Reply

      • Dee
        Mar 19, 2020 @ 14:48:55

        Becca,
        I have not had this experience myself with a client. But I thank you for sharing it with us. As a member of the community myself, I also worry about how this could affect me if a client had (unknowingly) had some prejudice against pansexuals. I’m very sorry you has this experience but I am really happy to hear that supervision helped you with this.

        Reply

    • Alyce Almeida
      Mar 18, 2020 @ 21:08:52

      Rachel,
      I love your honesty around the isolation that us therapists may find ourselves doing and being able to recognize it and then do the extra (hard) step of confronting it. Everyone battles with their own demons, whether they’re fantasies or insecurities around their role or relationship with a client. But I think being able to admit that and seek the supervision around it to help process and work through it all is not only what holds us accountable as professionals but as people – REAL human beings just like everyone else! (what a strange concept huh? – we struggle too!)

      Reply

    • Mikala Korbey
      Mar 19, 2020 @ 10:33:15

      Rachel, I really appreciated your comments about the questions in chapter 4, and respect you for being so open about the feelings of disappointment you had towards a client. I, too, found a few of those questions as good questions for self reflection, and was taken back by some of them. Basically all of page 58 and 59 are things I would hope a therapist would NEVER be asking themselves.

      Reply

    • Dee
      Mar 19, 2020 @ 14:45:27

      Rachel,
      Thank you for sharing about your experience with a client. I was happy to see that it was clear you learned something from that, but also that someone else has had a similar experience (normalizing really does work haha). I have a client with debilitating anxiety that has made great strides in her treatment and has used therapy effectively to help herself. I find myself very proud of her for using her techniques (and honestly proud of myself for helping her). I did have the experience where she was discussing religion (I will disclose to you all that I am Christian, not without tests to my faith however) and how “disgusted” she was by religion and the “pointlessness” of it all. Obviously I did not disclose anything about my religious beliefs, but it was very hard in that session to hear my beliefs and those of others, and even those that may have found some comfort in their faiths, to be so heavily ridiculed by a client that I have been proud of. A great exercise in learning how to distance ourselves from our clients and their beliefs, and remembering how human we are as therapists as well (not invulnerable to having feelings hurt).

      Reply

  4. Jayson
    Mar 18, 2020 @ 14:24:40

    1. The myth of therapists are invulnerable, immortal, and ageless caught my interest. The authors gave an example about a colleague that was leading a patient to a room when suddenly the patient took the colleague into a room and held the colleague hostage. The authors began to describe how that colleague reflected on the situation after and realized why she was not prepared for a situation like that in that the authors described the colleague feeling too secured and comfortable in the place that allowed her to feel invulnerable. I thought about my internship experience and I would casually walk the hallways not feeling like I would get assaulted or taken hostage by clients that are walking the same hallways. I would sometimes even leave my office door opened for a while when I needed to go to the bathroom. I thought to myself that I feel protected on my floor due to other clinicians being there too and I just cannot imagine anything like that ever happening. There are security guards, but they are only designated to be in the parking lot and around the medical dispensing room. There are no security guards roaming the hallways of where all the clinicians are at with their clients. This myth will influence me to become a little bit more cautious to still consider all the risk that can happen within my internship setting and to be aware that I am not invulnerable just because I have a higher authority than clients. Even though there are not too many dangerous circumstances that occur at my site, that does not mean I should put my guard down and I need to be aware of such steps to take if a risky situation does present itself again.

    2. The one that stood out to me the most was the client and friend. I have received feedback from my supervision as we listened to my recording of my session, my supervisor states that I am not speaking like a therapist. In other words, she told me it feels like she is listening to friends talk more than a therapy session. For instance, during one point of my recorded conversation with my client for a few minutes, we are talking about how Bruce Banner sometimes losing control and turns into the Incredible Hulk. According to my client, Bruce Banner sometimes can prevent himself from turning into the Hulk by focusing on his emotions and breathing. I eventually used that example to describe how doing deep breathing (belly breathing) is kind of like what Bruce Banner does to prevent from turning into the Hulk and is similar to how deep breathing can be used to control my client’s anxiety symptoms before they facilitate more or lose control. According to my supervisor, it was a nice way for my client to understand how deep breathing can be beneficial to reduce anxiety, however I spent too much time talking about the Hulk and her feedback was to continue to be directive, but in an appropriate way that facilitates the therapy session. In other words, I need to learn to remember I am the professional and crossing that friend territory with my client can be hard to not do when trying to make that therapeutic alliance with my clients.

    3. The part that kept my interest was that counselors reported many of them doing something they later regretted. It bothered me, but then I thought about it more and it seems like it is a reasonable percentage. For instance, at my internship, everything is very fast paced and I have seen many of counselors exhausted and stressed that I feel like if there is enough overwhelming work, then it is all natural for a person to experience a burn out and be a little more prone to say or not say something to a client or staff that they later regret. Furthermore, sure whenever a person feels unease about something, that is the whole point of supervision time to talk about it, but in reality, we get about 1 hour of supervision within a 40-hour time frame. Sure, it is ideal to talk to somebody about what a counselor is feeling before they do something they regret, but they may have to wait a while for that supervision time to talk it out. Due to that time frame, the counselor may have done something they regret before supervision. A personal example that I have, is one day I was working a 2nd shift with 2 other co-workers who were not helping me at all, essentially I was working alone, when 1 client asked me to do something, I responded in a very rude way to that client because I was overwhelmed with so much work for the other residents. I later realized that what I did was awful and regret saying that to my client so essentially, I apologized to him later when I was more comfortable with the work. Overall, I think it is pretty realistic for some counselors to experience regretting doing something due to potentially experiencing a burn-out or are just overwhelmed with many of things that they have a hard time staying stable.

    Reply

    • Nicole Plona
      Mar 21, 2020 @ 16:40:26

      Jayson,
      I really appreciated and enjoyed reading about your own personal struggles when dealing with the client/friend taboo topic. It can definitely be hard drawing the line at rapport and therapeutic relationship building with a client versus becoming too “friend-like” during sessions. This is something that hopefully will become easier the more experience we have while working with clients. The additional practice will give us the ability to utilize CBT interventions effectively to improve the progress made during treatment for the client.

      Reply

    • Rachel DiLima
      Mar 22, 2020 @ 12:01:14

      Jayson,

      I appreciated your comment to the 3rd question, as you gave a really empathetic and unique perspective to why counselors make decisions the would later regret. I had mentioned in my own comment that I had difficulty finding empathy for those counselors if they have time to seek help either in supervision or from colleagues, but you bring up overwork and burnout as possible reasons why a counselor may do something they later regret. I admit I hadn’t considered that in my original appraisal, and I wanted to thank you for giving my empathy the little push it needed. Thanks for the insight!

      Reply

  5. Becca Green
    Mar 18, 2020 @ 17:15:23

    1) It felt like a lot of the questions that were asked were about sexual feelings on the client’s part or the therapist’s part. It reminded me of the ethics course and one of the first things that was said in class, “don’t have sex with your clients.” I half found it humorous but then I remembered that people actually do the things that are questions in the list and that is why we have a code of ethics to follow. Because some people just make horrible decisions sometimes. I think some of the questions were using very extreme language (i.e. disgust, hate) which made it a bit harder to relate to. The question, “under what circumstances would you cradle a client’s head in your lap” question was maybe the weirdest one? At least in my eyes. It is just… Weird. Why would this happen? How would this even come up? I don’t know.

    2) There are several different “possible clues” that I find concerning. The first one that stood out was “dehumanized client, “ but then I kept reading and increasingly became more concerned. “Obsession” sounds scary, as I know many instances of stalking and assault come from someone who is obsessing over another person. I also think that fantasies, dreams, and daydreams are concerning, as the relationship should be professional in nature and this can skew treatment (whether it is coming from the client or the therapist). I think some of these bleed into others. By that I mean I think some items influence other items. I think the fantasies/daydreams and obsessions can be connected. That can lead to special treatment, creating secrets, and some other items on the list.

    3) I think parts of the list are scary realities of some of the fears therapists have around their safety. When I was working in a group home one of the residents attacked their therapist and attempted to strangle them. Their office did not have a panic button. At internship that was one of the first questions I asked. What do I do if I feel I am in danger or if I am attacked? The response was basically just to be smart and scream for help. This was not reassuring, however I have been lucky to not have to face fear or threats as a clinician (yet). There were other comments/questions that I was surprised there were any responses above zero, but like I said, some people just make horrible decisions sometimes.

    Reply

    • Mikala Korbey
      Mar 19, 2020 @ 10:36:43

      Becca, I, too, wondered in what world or situations would any of these things come up for therapists. It is a little alarming to think that these situations have happened before and that is why they are included in this self-assessment. Isn’t the first thing you learn in every ethics course, “Don’t have sex with your clients”? Clearly, this part of the ethics code is violated more than we’d like to think.

      Reply

    • Nicole Plona
      Mar 21, 2020 @ 16:33:58

      Becca,
      I also was off put by the taboo topics of obsessions as well as fantasies, dreams, and daydreams. I think it’s really interesting how you mentioned that these topics seem to “bleed into” each other because I definitely agree. They aren’t always their own separate issues but instead can impact and affect each other. A person who is having obsessions about someone would also probably be having fantasies and dreams about them as well so it’s almost like they’re one in the same in that aspect. Definitely an interesting way to look at it.

      Reply

  6. Alyce Almeida
    Mar 18, 2020 @ 21:03:38

    1. With all the myths and questions posed in both chapters and how strange and bizarre some of them were, many obvious made me think: “wow – really? HOW?” But like we always say in class, they wouldn’t be talked about if they didn’t already happen or people admitted to experience these thoughts, fears, fantasies, etc. The thing that stood out to me most from chapter 1 was the idea of lack of preparation for potential dangerous situations for therapists. When I used to work in a “intense” setting with residential, it was (for lack of a better term) “normal” to always be on guard and prepare for the unexpected really since many clients were highly aggressive and assaultive individuals. I think it was more surprisingly to me that therapists may have not considered that – ever. Maybe because of that experience I somewhat always have a plan in my head just in case a dangerous situation was to occur, but then that also made me take a step back and realize would I have that experience if I already didn’t have my experience with working residential? Anyways, with the questions of chapter 4 I too wasn’t as surprised that many questions took a more sexual focus but more surprised on how specific they were. I think others noted this too but the mentioning of seeing body parts naked and such – all things that I thought were pretty obvious questions to avoid were asked. And again like how many mentioned in their posts i thought: “Why in the world would this ever come up – just a big WHAT?”

    2. I think the taboo topics that concerns me the most was the fantasies and dreams, and daydreams – only because I think these can be far more powerful than many can believe (either from the therapist or client). It’s funny because in my perspective dreams or daydreams are really dependent on the person’s subconscious and not necessarily what they “want” to think. When these fantasies start to interfere that becomes scary in the sense that the therapeutic relationship can truly be negatively impacted, just based off of someones dreams! Because individuals could easily fixate on these dreams or fantasies and skew their perception of reality. Obviously we need to be professional, especially with our boundaries and with our clients in general because it will definitely skew treatment and then lead to even scarier scenario’s that were also mentioned like stalking, and obsessing. This definitely gave me the “heebie-jeebies” for sure.

    3. I think again the thing that stuck out to me most was therapists fears of their safety while practicing. Again, not every agency is equipped or even has plans around potentially dangerous scenarios that could occur with clients (which I hope they would by now but we can dream). Don’t even get me started on the research that supported sexual feelings towards clients – these chapters really had me laughing at times but again it makes sense unfortunately because these are real thoughts that therapist have had (not trying to bash anyone who may have had some thoughts themselves). All of it really comes down to appropriate supervision, understanding what could the potential harms of the job could be and making a plan moving forward for whatever could come from the job. Mistakes always happen – but preventing more mistakes to come can be ideal too.

    Reply

    • Marissa Martufi
      Mar 19, 2020 @ 14:45:33

      Alyce, safety while practicing also stood out to me. It’s a scary thing to think of situations that could arise and become dangerous, and I think this is really something that therapists must consider at their agencies. I know when I started my internship, I didn’t necessarily think of safety protocols off the bat, and I realize that this is important to know and understand wherever you are practicing. Like you said, unfortunately not every agency is equipped or has plans around potentially dangerous scenarios with clients and that’s really scary to think about. Having supervision is important in this aspect because you can bounce this concerns/ideas off your supervisor and also get support and learn what to do if a situation were to arise. I would want to be prepared rather than figure it out in the moment, especially if it’s a risky situation!

      Reply

    • Rachel DiLima
      Mar 22, 2020 @ 12:13:13

      Alyce,

      I appreciated how you brought up “fantasies, dreams, and daydreams” as a concern for you, and how the dangerous-ness (I’m sure that’s a real word…) of dreams truly depends on how the individual interprets them. I have a client who is very into their dreams, and can become very distressed by them. When I provided this person with the theory that dreams are our brains’ way of stringing and processing together memories, sensations, and observations, it provided some relief but not as much as I would have hoped. Here’s to hoping its a long time before a client’s dreams interrupts their therapeutic process.

      Reply

  7. Shannon O'Brien
    Mar 19, 2020 @ 07:12:55

    (1) As most of my other classmates stated, the myth that ‘therapists are invulnerable, immortal, and ageless” was super interesting. However, for the sake of a different discussion, I also thought the myth about not falling “prey to basic logical fallacies” was interesting. Personally, I consider myself a logical person. I am not the most creative and thinking outside the box can be difficult for me at time. I enjoy routine and structure and the idea that “if not x then y” definitely appeals to me. So, this myth struck me as I know I have fallen “prey” to basic logical fallacies at times throughout my life. This reminded me of discussions during many classes where we talk about “the majority” or the “norm.” For example, we say things like, “most depressed individuals present this way and when they do the best form of treatment is CBT. And with CBT we need to do a, b, and c for the best results” Sound familiar? We know that CBT works, but it is possible in the beginning there was some form of “appeal to ignorance” and that for every single client it may not be the most effective or safe. I also thought about when I read journal articles. It can be so easy to write a treatment or test off as invalid or not effective based on journal articles that has methodological flaws. Finally, I wanted to touch upon “false dilemma.” I thought this was interesting. Maybe I am interpreting this wrong fallacy wrong or not applying it in the right way, but when first beginning individual/group sessions at my site, I always felt that if I wasn’t sticking to CBT techniques, or my group curriculum, or always talking about substance use/recovery, or other comorbidities then I wasn’t being “scientific” or “therapeutic.” I was stuck in my logical mind that I had forgotten about the importance of building rapport with my clients.
    (2) The first “’clue” that concerned me the most was the discrepant record. I worry a lot about my notes being appropriately detailed. I like the idea of knowing that I haven’t seen tis client in a few weeks, I can look back at my last note and recall where we had left off or what I had planned to do for the current session. Some of our clients end of seeing other therapists for compliance tracking issues and I would also like other therapists to be able to view my notes and see what types of things were working on in our sessions in order to make their time effective as well. For me, if I stopped being so conscientious about my notes and what was being written, this would be a huge clue that I need to consult my supervisor. Like other stated, the obsession and fantasies sections were of course interesting to read about and reflect upon. Personally, I think these are more “red flags” than “clues” as it has become so intimate and intrusive in your mind.
    (3) One very specific thing that stood out to me was not wanting to work with clients who are HIV positive. I do not have any clients who are HIV positive, but with a substance abuse population, it could possible if the client has spent a lot of time sharing works/needles. During intakes, many clients report that that have shared works or exchanged sex for money/drugs while in their active addiction. We have an entire section dedicated to questions about HIV (clients are not required to answer them, but it’s there). Not wanting to work with clients who are HIV positive was just something that crossed my mind. Many of us have a population of clients that we know maybe we don’t want to work with or that would really pose a challenge for us, but this demographic just wasn’t one I had thought of before.

    Reply

  8. Mikala Korbey
    Mar 19, 2020 @ 10:26:10

    1.After reading the chapters, there were two myths that stood out to me most: “Therapists are invulnerable, immortal, and ageless.” and “Learning ethical standards, principles, and guidelines along with examples of how they have been applied, translates into ethical practice.” I think the ethical one stood out to me more because as I’ve gone through this program and have seen things first hand at my internship, people don’t always act as ethical as you think they should. Before I began graduate school, I always assumed that people learn about ethics and why they are important, so that must mean that they uphold the principles. I think in a perfect world, yes that is what that means, however in reality, unfortunately I do not always think that is true. We are all human, and I am sure at one point or another we are all going to do things that are not perfectly inline with the ethics code. But I would like to think that all therapists do their very best to follow the principles of the code, and if things arise that do not exist within the code, then they would consult with supervisors and colleagues to make the best, most ethical decision they can.

    2. Many of these clues bother me, but the clue that concerns me the most is, the one about Isolation of the Client. I felt very uneasy about this occurring. Why on earth would a therapist isolate the client from the social supports in their life, who is that for?? It reminded me of a podcast series I recently listened to called The Shrink Next Door, about Isaac Herschkopf, who was a therapist that did this very thing to one particular client. Hearing the story, it felt like manipulation of this client, and reading this section in the book reminded me of that. The book said, “by attempting to cut the client off from whatever romantic, sexual, or intimate relationships might occur in his or her life, the therapist eliminates all competition for the client and leaves no one for the therapist to feel jealous about.” That line really stood out to me, honestly the therapist should not be feeling jealous of any relationship the anyone has with their client. If the therapist is beginning to get those feelings, it makes me think the therapist is going to begin to develop some inappropriate feelings for that client. Isolating the client should never be something therapists do. Therapists should be encouraging their clients to make positive, healthy social relationships and foster positive social supports.

    3. The thing that concerns me the most from the Appendix is the section title “Therapists’ Feelings, the Context, and Training”. I found it interesting to consider if the therapist and client gender played a factor into the questions that followed. The one I would like to know more about especially is the relationship between therapist and client gender relating to their concerns about client suicides and violence. I wish they had included more detailed information about this because I am very curious. With all this free time now, I will have to read up on it!

    Reply

    • Shannon O'Brien
      Mar 21, 2020 @ 02:51:09

      Mikala – thank you for touching upon isolation of the client! I don’t really remember reading about this one to be honest. So terribly interesting and scary. I can’t imagine feeling jealous of a support in a client’s life. The idea seems to far fetched to me (as many of these scenarios are). However, I can still see how it could manifest. I think taking into consideration some of the other “clues” that were mentioned in the book could be helpful in preventing this jealous feeling from happening. And, of course, proper supervision before and after this feeling occurs will be most beneficial. The podcast you mentioned also sounds fascinating, I’ve been looking for a new one, so I am definitely going to check it out!

      Reply

  9. Nicole Plona
    Mar 19, 2020 @ 11:59:45

    (1) After reading through chapters 1 and 4, the “myth” that stuck out to me the most was “Therapists are invulnerable, immortal, and ageless.” Since I am still young and in good health, sudden death isn’t always the most active or front running thought in my brain. However, it is an important topic to discuss when looking towards the future because we often forget that life is unpredictable. When I have clients in the future, their information and all the notes and documents would be mine to protect in that setting. If ever the unfortunate event of me passing suddenly occurred, I would need a plan set in place to handle all of that information. I would hope that whatever agency I worked for would have a general plan to follow in these types of situations, because planning for your death is overwhelming to think about.

    (2) Based on chapter 5, the possible clue that concerns me the most as a practicing therapist is “dehumanized clients”. It is really important as a therapist to remember that a client is a person, not a disorder. It happens far too often that you will hear someone say “that person is bipolar” or “they are schizophrenic”, etc. This type of labeling can be incredibly harmful to the way a person views themselves. Instead, using different language when discussing the issues (a person dealing with bipolar depression or schizophrenia) can be more beneficial. I haven’t had any issues with this when working with my clients directly. However, in conversations with others in the placements/ profession, I often hear this type of language (my ED client, my bipolar client, my suicidal client, etc.). It may not be intended to cause problems but can be harmful to the treatment process. Along with that, another “clue” that slightly concerned me was the “client friend” topic. I often work with children and therapy looks more playful and exciting when working with a 5/6-year-old. Because of this, I get nervous about the boundaries that might be getting crossed for that child. Though I see this as a therapist-client relationship, the child’s view or thoughts may be different because of all the “fun” and playing they get to do. Because of this, I have had a few different conversations about boundaries with clients to make this type of relationship clear for the child without sounding mean or dismissive.

    (3) Based on the appendix, the information that concerned me the most was that therapists did something that they later regretted. The usual response is that we are all human and mistakes are made, which is true. However, letting a behavior get to the point of regret is slightly off putting to think about. If these behaviors are happening due to burnout or compassion fatigue, then as a professional we need to practice what we preach and use self-care to avoid it getting to this point. We have been told that there are plenty of steps to stop ourselves from getting to that point with our work, and it is important we take them. Little mistakes happen all the time and we can learn from them and move on, but if it’s bad to the point of regret, then changes should have been made to prevent it in the first place. I would also hope that if it ever came to the point of regret that the person involved would take the necessary steps to resolve or mend their past actions.

    Reply

    • Marissa Martufi
      Mar 19, 2020 @ 14:51:17

      Nicole, I agree with what you said about therapists doing something they later regretted. Obviously we are humans and things happen, but it makes me cringe thinking about a therapist doing something so extreme that they regretted it and that it may have impacted a person’s treatment or experience in therapy. I think this is where it is important to talk with your supervisor, avoid burnout, and be mindful of your role as a professional. Having outlets to manage stress or fatigue and having a supervisor to discuss these feelings with is extremely important to potentially avoid doing something you would regret.

      Reply

  10. Dee
    Mar 19, 2020 @ 14:31:26

    (1) Okay so I know almost everyone touched upon similar myths and taboos that stood out to me, but I just can not get past the questions in chapter 4. Some were helpful and good questions to ponder, but others I was DEFINITELY uncomfortable reading (the questions sexual or bodily in nature asking when its appropriate to kiss clients, examine naked clients?!, and other topics that cross so many ethical boundaries). I just had such a hard time wrapping my head around the fact that these questions even need be asked (answer: “HOW ABOUT NEVER?!”) But then again, as we’ve all learned in ethics, there’s a reason these questions are asked, some idiot out there broke an ethical (or even moral) code and/or boundary and the rest of us have to read through this material. Humor aside, I understand the need for it. There’s a reason we have a warning label on things because someone did something that harmed themselves or others. These questions are not unlike that very phenomena. Rather than treat these taboos and questions as “common knowledge”, it is taking away the uncertainty and doing due diligence in training therapists. Unfortunately, there probably are therapists out there that needed the answers to those questions, which I would argue means they probably did not undergo any ethics training or are just not cut out for such work with clear and necessary boundaries. Again, these types of questions are important to have, but definitely made me uncomfortable because the answers were so clear for me personally, but I’m glad that they are there to help those that may be (cringe) uncertain about these types of things (yes I’m judging).

    (2) I relate to Amanda on the taboo topic that concerns me the most, the topic of “The Dehumanized Client”. As an undergrad I learned about person first language. To any unfamiliar (even though I’m positive I’ve heard you all use person first), this means putting the person and/or their pronouns before their diagnosis (e.g. A child with autism, rather than the autistic child). Even when learning this I realized I had inherently used that type of language because I learned very early on, medical conditions and diagnoses do not define people. This is no different in the field of mental health. It does concern me that this is a problem that some therapists do and label their clients as their diagnosis. This outlook is not conducive for treating clients. We are indeed treating symptoms and disorders but first and foremost we are treating the people. People seeking our help. So why are people defining them by their problems? It is so important to recognize this, even though it can be easy to jump to the technical parts of therapy (i.e. effective and efficacious treatments) we can’t dehumanize our clients and forget they are people with needs outside of their problems (social skills, validation, literally just a place and person to vent to). We aren’t just treating disorders and problems, we are reaching out and helping a person, a human being. Dehumanizing clients is so harmful, in my opinion. God forbid a client overhears how therapists can address not only them but other clients, that would be catastrophically damaging. However, I am not ignorant to the fact that slip ups happen (I have definitely accidentally called a client “my suicidal client” or “my MDD client”, but primarily to protect confidentiality, regardless something to work on). I think primarily the book was touching upon intentional dehumanizing. This section still pulls my heartstrings. How can you be in this field and just label your clients their diagnosis, intentionally! Rant over.

    (3) When I saw the statistics for the self-reported feelings, there were some that I was not surprised about (fear that clients would commit suicide), but others…also not that surprised unfortunately, but still concerned. I wanted to say I was surprised that sexual feelings reported were higher than 0. But I’m not. My hopes are that it would be 0. Statistically speaking, I’d expect it to be higher than what was reported, but due to the limits of self-report, we should be grateful therapists were honest enough to report anything. I’m glad these therapists reported these feelings because awareness means that, hopefully, they are working on it and not denying it. We are human and I understand even therapists are not invulnerable to sexual feelings towards people. Nonetheless it makes me feel so uncomfortable that people think of their clients in this way. I understand we are human and it happens. But WHY THE HELL MAN?! Also, the ages of the reporting therapists and clients of which they have feelings for isn’t listed here. So disturbingly, there may be…therapists…that report these feelings…that work with children. That dear friends is something I cannot minimize, but for the time being I am going to repress in my mind because for a few minutes I want to live in a world where there are not therapists that have these feelings towards the most vulnerable of the most vulnerable populations. Good day and thank you for coming to my Ted Talk After Dark edition.

    Reply

    • Liisa Biltcliffe
      Mar 20, 2020 @ 17:12:55

      Dee, I really liked what you had to say about the dehumanized client, about the person first language. I know that when I hear people in my life call others by their diagnoses, I completely cringe and I find myself just gently finding a way to correct them. And what you said about how we talk about clients, say outside of therapy, like in supervision or just in general, is so important. It’s a reflection of how we see these clients and how we might be treating them subconsciously. And like you, I was also really surprised (and yet part of me not) at the statistics for some of the questions in the research at the end of the book. I hadn’t thought about ages of the clients they serve and that thought was even more disturbing once I read what you wrote.

      Reply

  11. Marissa Martufi
    Mar 19, 2020 @ 14:34:22

    Based on Chapters 1 and 4, a particular myth that piqued my interest the most is that “therapists are invulnerable, immortal, and ageless”. I think sometimes it is easy to think “that will never happen to me” or to read/hear of stories and gain awareness of situation that can arise, but may not take it as seriously as we should. After reading this myth, it really emphasized for me the importance of being aware and recognizing that there we can be extremely vulnerable in the work we do and that can possibly put us in a risky situation. Therefore, it is important to remember that we are not ‘invulnerable’ and that these things could potentially happen to us; stressing the importance of preparedness and attention to detail in the therapy setting. Also, I thought it was interesting that in this section of the text they mention having a will in place, in the event that something happened to you. I’ve always understood the importance of having a will in place, but I never considered how this is so important especially as a therapist in a practice. This also made me consider the importance of organization and maintaining a system that individuals can follow in the event that you (the therapist) were no longer there.

    A possible clue to taboo topics that concerns me most as a practicing therapist is the client-friend. I think that as therapists when we are working with a client, we learn things about that individual and develop a professional relationship in which the client may feel particularly comfortable with you and share things with you that they may not with anyone else. I think this can become a challenge as clients may begin to lose sight of the client-therapist relationship, and see it more as a friendship. This is where I think it is critical for therapists to be aware of and pay close attention to. For me, I know that I tend to be very caring and the type of person that wants to help everyone, even in my role as a therapist. However, something I try to always be mindful of is the client-friend dynamic that we often hear about. In my internship, I quickly learned that I have a difficult time appropriately cutting a client off and instead allow the client to talk and talk without any direction or feedback. I realized I was doing this out of care and wanting the client to feel like I was really listening to them and that they were heard, but I didn’t realize how this can affect the therapeutic relationship as well.

    Based on the appendix, of all the information that was presented on therapist self-reported feelings and behaviors, the thing that surprises me the most is therapists fear, specifically fear of assaults. I will not lie- this is something I’ve always feared and kept in the back of my mind so when I read this, I felt like I wasn’t the only one. Obviously fear is a normal human reaction, but I thought it was interesting that fear reportedly including assaults/attacks by patients, malpractice suits, reporting child abuse, helping older people, helping people with HIV/AIDS, and client reactions to difficult interpretations. I think these are all reasonable things to be fearful of when practicing. Prior to reading, I didn’t really consider the fear of malpractice suits so now this is something I’m a little fearful of too. These things are obviously factors that can happen when practicing as a therapist so I guess the best thing we can do is recognize that and be aware.

    Reply

    • Shannon O'Brien
      Mar 21, 2020 @ 02:40:54

      Marissa – I really like your comments on the client-friend topic. You mentioned that client may tell us something that they have never told anyone else and I think that is such a powerful thing for a few reasons. First, it is powerful for the client as they have decided to open up to someone about something private. What an experience for them! But, I also think about the impact on the therapist. It’s exciting to know that a client is willing to be so open and honest, but I also think it can be a lot to process, especially for new therapists. The first client I ever called at my internship said something along the lines of, “The world works in such weird ways and I am so happy you called because a few days ago I found out I was pregnant. You’re the first person I’ve told.” I remember feeling both flattered and overwhelmed that she would already trust me with this information. So happy you brought up this point!

      Reply

  12. Sarah Mombourquette
    Mar 19, 2020 @ 22:09:56

    The myth that piqued my interest was the myth that therapists are invulnerable, immortal and ageless. When considering the ramifications of this, I am struck by how harmful this mentality could be for clients. Working with kids who have trauma histories, any change in structure and routine can be incredibly triggering for them, especially when it comes to figures in their lives who they have come to trust. I feel that if a therapist holds this myth as true, it will prevent him or her from effectively preparing for transitioning clients to other services should unpredictable circumstances occur. Furthermore, this myth is also harmful to clients who believe or perpetuate it, because it could make any sudden changes even more challenging, further validating negative automatic thoughts and core beliefs about the self in connection with a therapist “leaving.” As much as I want to believe that therapists don’t support this myth, I think that I have commonly seen in others and in myself that therapists often feel invulnerable when in sessions. I think that we all can become comfortable with our clients and our therapeutic relationship where we don’t expect clients to put us or themselves in harms way during sessions. However, reading this chapter reminded me that it is always good to remain aware that circumstances can arise that we are not prepared for that can jeopardize our safety.

    The topic that concerned me the most was the dehumanized client. I feel that many of us joined this field in the hopes of promoting social justice. The action of dehumanizing someone for any reason is going against all that social justice promotes. I think the part that is most concerning to me is that many of our clients have already felt dehumanized in some extent or another by experiences outside of therapy. Further dehumanizing them by simplifying their experiences into a disorder or bloem behaviors takes away from the individuality in treatment that our program has heavily promoted. I also think that dehumanizing clients can be harmful for the clinician as well. I could see therapist making the argument that dehumanizing a client makes it easier for him or her to take in difficult content, but I feel that you can’t dehumanize someone without taking out your own empathy and compassion at the same time (both of which are integral pieces to our jobs).

    I think that the information that made me think the most were the descriptions of therapists’ thoughts related to fear of assaults and the information about therapists’ fears about clients committing suicide. The first thought that I had related to the therapist fear of assaults contradicts my first statement. In reflecting on this, I further thought about how important it is to consider the population that you are working with. I work predominantly with children 9 and under, so my fears related to being harmed are most likely less intrusive than a therapist who is working with older children or adults. While I recognize that children can certainly be aggressive too, I have more confidence in my ability to protect myself in those situations and therefore the thoughts and concerns are not as prominent to me. In reflecting on fears related to clients committing suicide (a fear that I also share) it further emphasizes to me that our ability to care for individuals in these situations is a flaw within our practice. I feel that in order for us to better serve these populations with confidence (appropriate confidence rather than overconfidence) requires additional research. Although I recognize and understand why we all share this fear, I wish that there was a way for us to know exactly what to do and feel confident in helping people who are actively suicidal.

    Reply

    • Liisa Biltcliffe
      Mar 20, 2020 @ 17:00:51

      Sarah, I really liked what you said about how dehumanizing the client is harmful to the clinician as well and how by dehumanizing the client you take away your own empathy and compassion. I didn’t really think about it from that aspect, but that makes total sense. And doing that with one client, who’s to say it wouldn’t be done with another and another? Also we work with different clientele in that I work with all adults, and I can honeslty say that I was nervous working with a client who had a history of aggression. But what you said is so true…that additional research is needed, and I don’t mean just in the typical sense. I mean research in the sense of getting to know each client individually, actively seeking out their positive attributes and strengths to build upon, because I feel that these things will give us more confidence, at least in the short term.

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Adam M. Volungis, PhD, LMHC

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 54 other followers

%d bloggers like this: