Topic 9: What Therapists Don’t Talk About {by 3/25}

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 3/25.  Post your two replies no later than 3/27.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

39 Comments (+add yours?)

  1. Ashley Foster
    Mar 19, 2021 @ 00:23:17

    1.The third myth in chapter 1 is “therapists are invulnerable, immortal and ageless”. As therapist, we are human just like our clients, we are just as vulnerable, immortal, and age just like any other person. There is this divide of us versus them in the field of the helping profession. There is this thought of a sense of power and superiority while working with clients as we are stereotype of the know it all’s but realistically, we are not. In session, our job although it is directive in nature, it is also very much so a collaboration with the client. Furthermore, in many ways, we are in a position to be extremely exposed to vulnerabilities, immortalities, and aging in the nature of work that we do. Our job as a helper is one that can be unforgiving at times and burn us out between the work, we put in but also what we are faced with while working with clients. It is easy to take on the baggage as our own and let it pile and build up making us numb, worn-down, or even jaded with how we go about our work. It is important to understand as new therapist that we can break down just as fast as our clients if we do not take care of ourselves as well. I find this particularly interesting as many of times, I think I am in many way “invulnerable”, that my clients, my experiences, and my work will not affect me, until it does. Reminding myself that I am human in many ways is something I need to work on in my path of dealing with my own avoidance tendencies.

    2. One taboo in chapter 5 is “isolation of the therapist”. This where a therapist cuts themselves off and out of other social aspects of their life due to anxiety or feeling overwhelmed. This is one area I see myself struggling in. When it comes to being at Spectrum, I will close my door even when there is a no show or a cancelation just to have time to decompress, I also do the same thing on my unit at Butler. When things are “too much” I will either go to the back or take a walk. When I had my daughter and went back to school, in many ways I did this as well, I pushed my friends away because there was so much on my plate. I’ve always had a high level of stress and mix with some anxiety and depression that isolation can take over and can leave myself stuck in my head. This is important to identify as this method of “coping” is maladaptive and can lead to burnout and leave individuals jaded.

    3. In the appendix, one thing that sits with me and is concerning is fear. In particularly, fear of assaults is one that lingers with me. Working in an locked inpatient psych ward, assaults from clients/patients happen, and has happened to me many of times. You give “feedback” to someone and things escalate. One thing though that I have found is even though I’ve never been assaulted outpatient and numerous times inpatient, my fear of assault while working outpatient is greater than my fear of being assaulted inpatient. Working with high risk clients, I have rationed some of these fears out. For one, inpatient I know and I can trust my team to have my back and we can call for additional staff at any time. I can leave these individuals at the end of my shift and they do not know my last name or any other identifying information about me. In outpatient, all is left out in the open. I’ve had clients from Spectrum find me on Linkdin or know what car I drive because I’m the only one with Rhode Island plates and they have seen that. In outpatient, there is no walking away or a team to help you if a client decides to retaliate after I make a call to DCF or hold their dose. That fear is one thing I need to work on and not knowing the unknown of what could happen.

    Reply

    • Zacharie Taylor Duvarney
      Mar 21, 2021 @ 10:18:26

      Ashley,

      You and I share the same concerns regarding assault. Of course, I will always do what I can to ensure the safety of my clients, but what of myself? As I stated in my blog post, I have established some systems as a precautionary measure for dealing with client aggression. Despite this, I am still worried about what may happen should a client become violent. Thankfully, our Spectrum office in Southbridge is located next door to the police station, which does alleviate some of the fear.

      Reply

    • Kelsey Finnegan
      Mar 22, 2021 @ 17:33:58

      Ashley,

      I’m sorry to hear you have been assaulted by clients multiple times. I think I’m still very naive in that respect because I haven’t worked in an inpatient/high-risk setting yet. Part of my reason for not having worked in that environment yet is due to that same fear, so I admire the fact that you have continued to work in that setting despite that fear coming true at times. You also make an interesting point that the risk of being assaulted in outpatient is greater in some ways because there are less protections in place and the client may have access to more identifying information.

      Reply

    • Anthony Mastrocola
      Mar 25, 2021 @ 08:13:50

      Hi Ashley,

      I’m interested in your connection between the myth of being immortal and invulnerable to the natural power dynamic of session. I very much agree that this notion certainly contributes and even reinforces the idea in therapy that clinicians are above the clients, which we work hard to denounce in the form of collaboration as you noted.

      Reply

  2. Jess Costello
    Mar 20, 2021 @ 20:25:26

    1. One of the myths that caught my attention was the idea that therapists don’t fall for logical fallacies. This seems to go back to the idea that counselors should be blank slates or experts to whom the client goes to for advice, when as we all know we really work as collaborators with the client on their concerns. Similar to what Ashley pointed out above about therapists actually having many vulnerabilities like any other person, we do not possess “the answer” in every single situation.

    2. Based on the list in Chapter 5, one of the “clues” I am most worried about noticing in my own practice is redundant or repetitive therapy, where regardless of orientation, progress seems to go in circles because of unwillingness on the parts of both the client and therapist to confront the deeper issues. It is important to identify when therapy is drifting from the goals so that clients can have the best outcomes.

    3. I also worry about the fear of retaliation or assault from a client. As most of my internship has been over telehealth, there are many factors I haven’t had to consider that would become more apparent in the shift back to working in an office, like the layout of the room, etc.

    Another thing that surprised but reassured me was the relatively low frequency of formal complaints against therapists cited in the book (less than 10% of clients reported filing a complaint with a relevant ethics board). As a beginning therapist, it’s easy to worry about doing something wrong, even with good intentions, that leads to ethical violations, expensive lawsuits, and a career ruined before it even really starts.

    This was not mentioned in the book, but I also think about my personal information clients could find on the Internet, not in terms of being friends on social media which clearly blurs a boundary, or photos that would compromise a job search like we discussed in class, but simply by googling me or any other therapist–such as what they could find on public records websites with personal phone numbers, addresses, names of family members, etc. One of my clients recently found an obituary of someone with my same name.

    Reply

    • Zacharie Taylor Duvarney
      Mar 21, 2021 @ 10:15:55

      Jess,

      I too worry about redundancy in therapy. As I outlined in my blog post, I have one client where it seems that “therapy adrift” is influencing treatment. It is very difficult to know how to respond to this situation and facilitates a lot of anxiety. I believe we are all motivated to make the most of the time we have with our clients, but this is not always possible. I am still trying to figure out how to solve the issue of “therapy adrift”.

      Reply

    • Katrina Piangerelli
      Mar 21, 2021 @ 14:42:20

      Jess,

      I can really relate to what you said about us not having all of the answers. I have had a few clients who have acted on the assumption that I have all of the answers when in reality it isn’t that simple for a lot of issues. I think it is also important to note that we do collaborate with our clients as well and the things we suggest may not work for everyone.

      I like how you also talked about therapists sort of moving in circles with their clients rather than addressing the deeper issues. I think this kind of relates to us working in collaboration with the client and when the client avoids deeper issues this can be more challenging. I have had clients that just sort of talk in circles and talk about the same superficial issues they are experiencing rather than what the real issue or issues they are dealing with.

      Reply

  3. Zacharie Taylor Duvarney
    Mar 21, 2021 @ 10:13:12

    1. What particular “myth” piques your interest the most?

    Of all the taboo topics outlined by Pope and colleagues, I find the “invulnerable therapist” to be most intriguing. This is concept I have already begun to grapple with. In our field, we are expected to remain healthy, objective (as much as possible), civil, and content at nearly all times. Furthermore, it is in our ethical code to practice within our limits which includes considerations related to age and emotional stability. Also, it is suggested that we seek out our own therapy in our free time to ensure we are remaining psychologically stable for the sake of our clients. Frankly, the threshold set by the concept of the “invulnerable therapist” is one that is impossible to meet. It is simply too difficult to account for all the aforementioned variables, never mind executing the necessary tasks to maintain this “invulnerability”. We are working class human beings with a finite amount of time in our day. Just as our clients are prone to distress, so are we, and we will not always be capable of effectively coping. As such, it is likely that our work will be impacted by the emotional difficulties that transpire in our personal lives. Even if we do seek therapy, we will likely still see a shift in our work with clients as we attempt to cope. Furthermore, our interactions with clients carry serious emotional connotations as well. It is naïve to think that our clients will not impact us emotionally in some way. It is important to establish boundaries and self-care regiments, but these things do not assure that we will never become emotionally distraught from conducting therapy.

    2. What “clues to taboo topics” concern you the most?

    It is difficult to say which of the therapeutic complications highlighted is most concerning, so I will speak to what I have personal experience with. One of the concepts outlined by Pope and colleagues is “therapy adrift” which is when there is no progress being made toward treatment goals. Rather, therapy is in “idle” with no clear direction forward. In my own practice, there is one client I have where this seems to be the theme. I have been working with this client since August. He has made some progress but is generally resistant to therapy and attempts to deflect most ideas or prompts. As such, I struggle to make therapeutic gains with him. I have attempted numerous interventions and methods such as MI and CBT. We have spent several sessions doing relatively unstructured self-exploration. Despite my attempts the client remains ambivalent about doing therapy. I feel much anxiety prior to each session with him because I am unsure of what to do (I have sought supervision in this respect). Consequently, I can personally vouch for uncomfortable “therapy adrift” is.

    3.What self-reported concerns and behaviors from the Appendix concern you most?

    I find retaliation by a client and liability to be the most concerning concepts. Regarding the former, I worry about how I should respond in the event that a client becomes aggressive and attempts to assault me. I have constructed my office space in a way that is conducive to safety (my desk sits between myself and the client and I am positioned closer to the door), but this does not negate the concern. What should I do if I am in the office alone and I am assaulted? Of course, I would call 911 and attempt to use de-escalation, but who is to say if these methods will work in certain situations? I believe the idea of client retaliation and the “invulnerable therapist” are closely related in that we are expected to remain calm and make all the “correct” decisions in a violent situation. While I believe this approach to be a good benchmark for how to react, I also believe we should be given some freedom in how we choose to protect ourselves from harm. For example, I believe we should all consider carrying pepper spray, however, most organizations do not permit therapists to do so.

    Concerning the later, I worry about liability and what may happen to me if a client’s wellbeing is jeopardized. I should preface this statement by saying that I diligently follow all of the necessary protocols related to client safety and the fiduciary responsibility. However, one can still deal with negative consequences even when their intentions are good, and they follow the rules. This is something I think about a lot, especially given how many high-risk clients are on my caseload.

    Reply

    • Katrina Piangerelli
      Mar 21, 2021 @ 14:33:29

      Zach,

      I chose the same myth topic as you did. I also think it is important to incorporate self-care and appropriate boundaries so that we talk care of ourselves. This also helps us to be better therapists as well. I think many people tend to think that therapists are people who like to help people and don’t really consider the fact that we may struggle with different things ourselves.

      As for the next topic, I think it is hard when we experience a client who is not making any progress especially if they are resistant to therapy. Rolling with resistance can be really challenging when the client doesn’t really care about making progress or maybe doesn’t really believe in the therapeutic process. It is also really good that you have been seeking supervision for this as well. It sounds like you are working with what you have and are trying to make progress despite this resistance.

      Reply

    • Jess Costello
      Mar 21, 2021 @ 21:08:19

      Hi Zach,

      I’m glad you pointed out that we as therapists are not invincible or immune to the effects of emotionally-taxing work, no matter how much self-care we build into our routines or how much personal therapy we seek. Expecting therapists to be invincible or experts at our own mental health, especially in times of stress and crisis, can be extra detrimental to our work and overall wellbeing and create extra pressure that we put on ourselves.

      Reply

    • Melissa Pope
      Mar 25, 2021 @ 12:42:13

      Zach,

      You could have not worded the “invulnerable therapist” more eloquently. I completely agree and find it to be preposterous that either clients or we as therapist would believe that our career choice is not inevitably and probably on repeated occasions be impacted by our relationships with our clients. That is the point, in a way- because to be impacted on some level shows empathy and compassion, which are central virtues to being a good therapist. In your second response you mentioned the frustration of not making progress with a particular client. I do not know the situation and if the client is mandated to see you or coming of free will, but if it is the later and he/she shows up then maybe you are making more progress than you think. It is interesting that we are trained to measure progress, but never delve in on a deep level of how the client may perceive progress. I have a client right now whom quite honestly very little CBT or “therapy” has happened- however what has happened is great rapport, empathy, validation, and reflection and with just this I and the school are seeing great progress. You are probably doing more than you think. Lastly, liability scares the %%5! Out of me. I see myself as a good person, with great intentions, that follows the rules, and still with all of the that someone could seriously harm my career and worse my motivation to want to continue to help others.

      Reply

  4. Katrina Piangerelli
    Mar 21, 2021 @ 14:22:58

    1. Based on Chapters 1 and 4, what particular “Myth” (or Taboo/Secret/Question) piques your interest the most? Explain.
    One myth that stood out to me was, “therapists are invulnerable, immortal, and ageless.” I think this interests me for a few different reasons. First, being a part of this field it has become clear that many of us enter this field due to past experiences whether this be our own mental health, trauma, or experience with a mental health provider. With this, we are not invulnerable and we have our own history that drives us to help others. This may not be true for everyone, but even individuals who do not have this history also have moments of being vulnerable and may have lost loved ones, experienced hardship, or something else that has been difficult. It is always interesting to me when people think that we don’t go through similar experiences as them. I also think that people often think our relationships are perfect with other people. We are therapists and mental health professionals so therefore we must have perfect boundaries with the individuals in our lives. In reality, we have all been in situations that we look back at and think, “why did I react like that?” We are not perfect individuals and make mistakes at times. This section of the chapter also discusses the risks associated with being a mental health professional such as the possibility of someone pulling out a weapon. This is something that I think is probably pretty unlikely, but could definitely happen especially working with more high risk individuals. Of course, this becomes a concert and I have thought about the way I would set up an office as well as have mentors or professors speak to this topic as well.
    Overall, I think it is important for people to know that we are human and we make mistakes and react to situations just like everyone else.
    2. Based on Chapter 5, what “possible clue to taboo topics” concerns you the most as a practicing therapist? Explain.
    Many of the topics discussed in chapter 5 were concerning to me so I will pick one of the more concerning ones to talk about. One taboo topic that was concerning to me was “The Dehumanized Client.” This is something that has always really frustrated me especially when I hear people in the field refer to a client as “that schizophrenic” or “that borderline person.” I have actually had professors that spoke like this and I was horrified that I would be learning from someone who dehumanizes a client so easily. I think some of it is ignorance, but being completely oblivious is not an excuse. This section of chapter 5 discusses that professionals do this because they feel too emotional or overwhelmed by the client or the client’s needs, but that is not an aspect I think I have really seen in this field. I have mostly seen people say these things almost not even realizing that this is a negative thing to say. The example given in this chapter is that one therapist does not really realize why he feels so disconnected from the client and has never experienced something like this with another client. I can’t imagine feeling so disconnected from someone due to their beliefs or thoughts or feelings that you dehumanize them. I think at this point, the therapist needs to address this situation ASAP in supervision and possibly transfer this client to someone who can be more understanding and supportive.
    3. Based on the Appendix, of all the information presented on therapist self-reported feelings and behaviors, what concerns (or surprises) you the most?
    One thing that concerns me is the section on anger and hate. I think anger is something that I can understand. I have had client’s that have made me angry, especially working in a residential setting. One thing that I can’t really understand is hating a client. There have definitely been client’s that I wasn’t necessarily a fan of, but hating them is kind of a stretch especially when considering the history or mental health struggles of the client. This section of the chapter discusses that it is difficult to acknowledge these feelings at times, these feelings may have devastating consequences, and these feelings could serve as a therapeutic resource in the right situation. I can understand where anger and frustration could be hard to acknowledge and work with, but I really don’t understand hating a client. I could also understand hating working with a particular client if they are especially difficult in some aspect, but not hating them as a person. I think that our client’s (especially the more difficult ones) have been through a lot and may have some serious mental health problems as well.

    Reply

    • Jess Costello
      Mar 21, 2021 @ 21:45:16

      Hi Katrina,

      I appreciate that you pointed out feeling horrified by the notion of dehumanizing our clients to the point where they are no longer flawed people but a collection of symptoms and the diagnoses that we are responsible to treat. It is concerning that some people in our field think this way and use this language, and I think it may reflect a sad degree of burnout in their own lives that they can’t bring themselves to identify with their clients.

      Like you said, I also find it hard to see how someone could ever truly hate their client, someone who is coming to them for help. Certain clients have definitely been frustrating to work with for me, but I think that speaks more to my status as a new counselor and little about them, certainly not anything about their worth as a person.

      Reply

    • Kelsey Finnegan
      Mar 22, 2021 @ 17:47:07

      Katrina,

      I agree with your thoughts about the dehumanized client. It upsets me when I hear people in the field refer to clients this way. As you said, even if it is because the individual is oblivious to the negative impact this has on our clients, that is no excuse. I agree with Jess in that this is probably a reflection of burnout. At least I would hope it is due to burnout rather than the other possibility that someone who truly holds that dehumanizing view of people chose to enter this field.

      Reply

    • Anthony Mastrocola
      Mar 25, 2021 @ 08:10:24

      Hi Katrina,

      Your part about dehumanizing clients resonates with me. I always cringe when I hear clients labelled as their diagnosis as you noted. I think these experiences have imprinted in my brain to the point where person-first language is so natural.

      Reply

    • Monique Guillory
      Mar 25, 2021 @ 13:37:04

      Katrina,
      I also find it interesting how people paint a certain picture of what a therapists life is like, and the misconception that we are somehow immune to the casualties and hardships of life.

      Reply

  5. Kelsey Finnegan
    Mar 22, 2021 @ 17:17:30

    (1) I found the myth that therapists have a firm grasp on logic and don’t ever fall prey to irrational thinking patterns to be particularly interesting. Obviously, therapists are human too, and no human is immune to illogical thinking no matter how mindful they are of common thinking traps. I think this myth can be potentially dangerous for a couple of reasons. 1.) If a therapist believes this myth, then they will end up neglecting to do important work on themselves and not be aware of their own limitations, which can be harmful to clients. 2.) If a client believes this, then they may mistakenly believe the goal of therapy is to completely rid themselves of all forms of illogical thinking. This is obviously unrealistic and sets the client up for failure.

    (2) Many of the “possible clue to taboo topics” concerned me as a practicing therapist. However, the one that concerns me the most is repetitive therapy because it is one that I have already noticed in my own work with a couple of my clients. I’m not sure yet whether it is due to taboo topics, or simply because some repetition is necessary for progress to occur, or perhaps more likely the answer is somewhere in between. Either way, it is something I am now going to monitor more closely and seriously consider whether a taboo topic may be at the source of this repetition.

    (3) The therapist self-reported feelings and behaviors that personally concerns me the most is probably anger/frustration toward a client. I don’t think I have actually been “angry” with a client yet, but I have definitely had several instances when I have felt frustrated with a client (usually for showing up very late to session, or not showing up at all). Fear of client committing suicide is another one that concerns me, and I know I need to work through this fear if I want to be able to work more effectively with clients with suicidal ideation.

    Reply

    • Adam Rene
      Mar 24, 2021 @ 15:58:36

      Kelsey, you and I had a lot of similarities in what we found interesting in these readings. The simple statement ‘therapists are human too’ really stood out to me – it IS that simple, we are not immune from irrational thinking like a person who works in technology may forget how to operate his microwave sometimes. I’ve worked with suicidal ideation a little bit in my internship and I have to say, the training and education we’ve recieved from Assumption really does help in those moments – when the time comes, you’re going to handle it well. I’m sure of that!

      Reply

    • Melissa Pope
      Mar 25, 2021 @ 12:56:40

      Kelsey,

      To your first point- I completely agree. We are human too, the different harms that your brought up that can result from this myth are very disheartening, for both sides. I also thought of the stress and negative impact it would cause on the health of a therapist who felt they needed to be “perfect” and would chastise themselves for having irrational thoughts. To your second point, I am happy that you have noticed this in your practice because it means that you are already a mindful therapist/person. The fact that you are going to monitor it that much more to discover if there is a potential alternative root says volumes about you as a profession. Keep up the good work.
      And lastly, I am curious if you are comfortable enough to reflect and ask “what would it mean to you if a client committed suicide?” Or to explore the fear behind it more thoroughly.

      Reply

  6. Melissa Pope
    Mar 23, 2021 @ 16:27:28

    1. I am very interested in the questions that follow of theme of physical touch, and intimacy. I find that when you read a good portion of the questions, your initial instinct is to say “I would never cross that boundary.” Or “how could anyone consider a circumstance in which they would do that?” However, if you sit for long enough, it is amazing the amount of situations that one can come up with that may have once consider some of these questions appropriate and ethical. Two examples: under what circumstances would you kiss a client on the cheek or forehead, or under what circumstances would you have dinner with a client? I want to work with trauma and palliative care, if I got to know a child or family well enough- there may be very hard nights, while the child is dying where I support them by having dinner in my office or at a hospital, any maybe when I say goodbye at the end of the night kiss a child, or caregiver on the forehead or cheek to show affection, and compassion.
    2. The “possible clue to taboo topics” that are most concerning to me are; Isolation of the client and therapist, and creating a secret. All of these scream “there’s a rapidly waving red flag above your head!!” As therapists, we counsel in order to benefit others functionality and wellness in life. Do no harm, is being breached if one is cutting their client off from others in their lives to no benefit but that of the therapist. This appears to me to exploitation and, I am sure some would argue abuse. Creating a secret is another one, which to me aligns with isolating the client, because if a client is reluctant or fears talking to other people in their lives about therapy and how it is benefiting them- something is wrong. When done correctly, therapy is about opening up the world to the client, for them to function better in life, and to feel more balanced and whole. In order to do this successfully, other people need to be involved in their lives- with whom they can trust and be vulnerable with. If, they are relying solely on “you” the therapist, the world is still closed, and they are not functioning to their full potential.
    3. After reading the appendix, I am a bit concerned with the statistics that surround the feelings of fear and violence. Although I am not surprised about the statistics, it is concerning that as counselors we are entering into a career where our health and safety could be impacted so drastically while in service of helping others. The information that I guess scares me the most is having malpractice suits filed against me, or being attacked by a client.

    Reply

    • Adam Rene
      Mar 24, 2021 @ 15:56:12

      Melissa, I feel like you touched on a lot of good topics here. In particular, I like that you mentioned the topics of isolation and creating secrets. There’s a great podcast called ‘The Shrink Next Door’ about a therapist who just threw ethics out the window in how he treated his patient – his patient ended up giving him his mansion and the patient became a groundskeeper FOR the therapist. That one really stood out to me the importance of the power dynamic between therapist and client as well as how isolation from friends and family can lead to increased reliance upon the therapist.

      Reply

    • Paul Avolese
      Mar 25, 2021 @ 09:13:31

      Hi Melissa,

      I had similar thoughts in relation to client touch. Desiring to work primarily with adults, I do not see myself engaging in touch very often (if at all) with clients. However, I thought about children too and the idea of giving someone a pat on the back or a high five to praise them. Also, working with children in the past, I am used to being surprised with a hug or accidentally being called, “Dad” by children. I think these are potential teaching moments as well. I think touch is a taboo boundary we can use therapy to explore, regardless of the age of the client.

      Reply

    • Monique Guillory
      Mar 25, 2021 @ 13:34:22

      Melissa,
      You made a great point in reference to “isolation of the client”, in that one of our roles as clinicians is to encourage clients to reach their fullest potential, and be able to generalize learned experiences outside of therapy sessions.

      Reply

  7. Adam Rene
    Mar 24, 2021 @ 15:52:54

    1. The myth that really stood out to me, like others, is the idea that therapists are invulnerable. I think to some degree a big reason why this one hits home in particular is when we consider the shadow of 2020 and what that did to our clients, but more importantly what 2020 did to us as counselors and students. By far I have never struggled with insecurity, health issues, anxiety, and depression like I have over the last year. As therapists we are expected to put our own baggage aside, be emotionally available and invested in clients who are experiencing similar troubles (or worse) to what we are experiencing, and then put that feeling away and focus on the next person in the Zoom waiting room. This led me to a season of burnout, where I felt like my flaws were on full display to me and to all to see and that made me feel like a crappy therapist. In some ways it humbling in that I am no better than the clients I serve, but it also puts me in a perpetual state of working on empty and showing more compassion to my clients than to myself.

    2. Repetitive therapy is definitely a place of concern for me, as I’ve seen it from an outside perspective with colleagues as well as with clients in the past. Some times a client is stuck and when you only meet once a week for an hour, it can take time to realize and address a client’s ‘stuck-ness.’ Sometimes it takes my supervisor to point out that my client doesn’t seem to be progressing. In those moments I can feel some guilt, that I didn’t catch on immediately, address it, and get back to making progress. On the therapist side of repetitive therapy it can speak to beginnings of burnout, some anxiety around meeting with this client, and those are all things that should be addressed in supervision.

    3. I found several topics to be concerning for me. When working in residential, there were several times in which I had to physically restrain adolescent teenage males from harming one another and have been threatened with violence many times. So, in some ways, fear of retaliation from a client is not something I experience when I reflect on this topic. I believe that’s large in part from successfully negotiating or restraining these situations in the past – but I can understand how that topic can be quite upsetting for someone who hasn’t experienced it. And I hope you all never have to! With regard to anger & hate, this is one that I am struggling with in that a parent I interact with in my other job is someone whom I have ill feelings towards. It is something I am working on in supervision and with my colleagues, as I am trying to address what is in my control and how I can shift my own perspective.

    Reply

  8. Anthony Mastrocola
    Mar 25, 2021 @ 08:04:28

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

    Based on chapter 1 and 4, the myth that interests the most is “if you’re a good therapist, the money will take care of itself”. There are a number of reasons why this myth interests me most out of the rest provided in chapters 1 and 4. First, I don’t understand why money is such a hush hush topic in this field. If anything, if clinical/counseling psychology wants to further legitimize itself with the utilization of scientific evidence for treatment, then we as a field need to charge as such. I find that by accepting lower rates (in comparison to physicians amongst other medical-based professions) we discredit the monumental work we do on a daily basis.
    The idea that “the money will take care of itself” is hilarious. I’m not sure about any of you, but I can’t think of any person who is looking to pay a premium for a service. In a capitalist society, if you have a skill, you look to maximize the profit you can make for providing the service of that skill. The best surgeon in a state would demand to be paid like the best surgeon in a state. No hospital would willingly pay a top rate if the surgeon was like “oh I don’t care what my salary is, I trust you will be fair”. Even in sports, athletes constantly go through long periods of contract negotiations to advocate (often with the help of an agent) for a certain wage. Why are therapists any different? If a clinician is able to effectively implement and follow a treatment plan based on a sound competence of applicable theory and practice, then he/she should be compensated to reflect those skills and abilities. If COVID has taught this country anything it’s that therapists are in demand right now. Why are we unable to capitalize on this opportunity to apply pressure to insurance for higher reimbursement rates? If you’re still reading my post at this point I’m sure you can tell how much I disagree with this myth.

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

    Based on chapter 5, what concerns me the most as a practicing therapist is ”repetitive therapy”. This concerns me the most because from my minimal experience it seems to be extremely prevalent. The prevalence is so high that I often question if it’s the norm. At least during my experiences shadowing other clinicians in my agency, there is little direction. Often therapists do not follow a certain path guided by the treatment plan. This concerns me a lot, because like the chapter noted, clients may frequently experience weekly mini crises. I remember learning in 708 how we need to be collaboratively selective with our clients in determining which “crises” should be addressed without deviating from the treatment plan. I find from my own experience that modeling this process to the client has been extremely beneficial. By being selective, clients improve their ability to determine which problems are more significant than others. Also, when larger themes are confronted as per the treatment plan, there seems to be a trickle-down effect in which the client’s efficacy in tackling their mini “crises” improves.

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

    Based on the Appendix, what surprises/concerns me the most is ”fear of assault”. I’m a bit surprised and confused by this section of the Appendix. I’m surprised because I have never been concerned for my safety, but that also could be because I’ve only done telehealth (going to be great floating in the back of my brain when we return to in-person!). I’m also surprised because I did not realize that there are so many assaults on clinicians. That is terrifying, which is why I’m also concerned. I remember for my internship my position was intended to be home-based. I’m very happy I did not have to do any home-based sessions because of COVID. This is part of the reason I was looking for a new job post-graduation. Being in someone else’s home involves a great deal of trust and vulnerability. After reading some of the statistics in the chapter, I’m not sure if I would do home-based services. I would like to learn more about why the number of assaults are as high as they are, what happens after an assault in terms of clinician support, and what is changing to better protect clinicians.

    Reply

    • Paul Avolese
      Mar 25, 2021 @ 09:30:38

      Hi Anthony,
      I agree with your concerns about the financial side of therapy. Even though I am in this field to help other people and promote the development of humanity, I would still like to be compensated fairly. Like you mention, it seems like physicians and athletes are compensated for their talents, whereas counselors are provided a flat rate regardless of ability (unless they are in private practice). My hope is this will change as more and more people see the value of our work. It seems like an uphill climb: in order for others to recognize and compensate us for our talents, as clinicians we must first recognize and promote the talents of our clients. Eventually, we reach a tipping point in which enough people see the benefit of self-love and the culture as a whole changes. This is just a theory, but hopefully something changes at some point.

      Reply

  9. Paul Avolese
    Mar 25, 2021 @ 09:08:25

    There were a couple of topics I found particularly interesting in Chapters 1 and 4. In Chapter 1, the concept of logical fallacies caught my attention very quickly. I have heard about different types of logical fallacies in the past, but to see them listed was new to me. This section is one in particular that I can see myself reviewing regularly until concepts become engrained enough for me to reflexively reflect on when engaging in my own critical thinking. Understanding these fallacies on a deeper level seems imperative for my growth as a counselor, social scientist, and human.

    A second “taboo” topic repeated several times is the topic of sexuality. I think, at least in culture within the United States, this is an area in which most people engage in extreme and maladaptive thought processes. Many psychotherapy clients will most likely utilize such thought processes. Because of this, it is important for counselors to do personal work around understanding and accepting ideas related to sexuality. We would then be able to model behaviors that allow clients to more comfortably explore their own sexual thoughts. Additionally, counselors can form better boundaries when feeling sexually attracted to clients.

    To be honest, all of the “possible clues to taboo topics” concern me. I have a difficult time deciding which is the most concerning. Throughout the entire reading for the week, the theme of boundaries kept recurring for me in my personal reflections. I realize that it is easier said than done (I am definitely still learning myself), but understanding ourselves and our role helps to keep perspective on what is realistic for our work. Our primary concern is our clients’ welfare. If our own discomfort interferes with our work, it is an opportunity to grow as a counselor and ideally provide better quality of care. I do not believe that any topic needs to be off limits in treatment; it is more of a matter of how we navigate it effectively while using consistent and appropriate boundaries.

    Similar to what others have stated, fear of client violence is an area that concerns me. These concerns are mostly related to face-to-face therapy. At this time, I am only engaging in telehealth with clients. Theoretically, clients can learn clinicians’ addresses if they really felt the need to engage in violent behaviors. However, the idea of being assaulted at the office, in the parking lot, or even somewhere in Worcester is frightening.

    Reply

    • Kara Rene
      Mar 25, 2021 @ 13:30:39

      Paul,

      Your reflections about taboos and personal boundaries remind me of the importance of utilizing supervision to process effectively and even seeking therapy to provide even more space for processing our own feelings about being therapists (as well as keeping ourselves as emotionally healthy as possible so that we can continue to do our work well!)

      Reply

    • Taylor O'Rourke
      Mar 25, 2021 @ 16:47:14

      Hi Paul!

      I am also only seeing clients via telehealth right now, so I have concerns too about transitioning to seeing clients in person in the future; especially those who have a history of violence or anger. Though we can oftentimes see our clients by using a webcam, we are still only able to pick up on some of their behaviors and not really any of their nonverbal behaviors. I have a bit of anxiety about starting to see clients in person, so hopefully all goes well for all of us!

      Reply

  10. Paola Gutierrez
    Mar 25, 2021 @ 12:57:52

    1. The myth I found most worrisome was “Therapists are invulnerable” and “If you’re a good therapist, the money will take care of itself.” Based on my own experience, therapists make mistakes, and don’t always know all the answers. Thinking that we are “invulnerable” puts a lot of pressure on us to never mess up, to always present “perfectly” and to push down that empathy and openness that is so necessary in therapy. Another very closely related myth that I have to challenge myself on is that “Therapists can’t struggle with any of the same concerns/problems that our clients face.” I tell myself that it’s okay for myself as a therapist to feel depressed or anxious at times, and that I have learned the skills to help myself.

    2. Although many of the “possible clues to taboo topics” concerned me, one that struck me was “avoidance of the client.” When I’m feeling particularly overwhelmed or anxious about meeting with a particular client, sometimes I wish that the client wouldn’t show up for session, which I would consider a cognitive avoidance. I’ve addressed this with my supervisor and she normalized these thoughts and feelings, and I’m addressing it in order to be more “present” for these clients. I don’t go out of my way to avoid the client intentionally (like cancel sessions or reduce treatment). I think this clue particularly concerned me because oftentimes, we’re trying to address anxiety and avoidance with many of our clients, and as a result we need to be able to expose ourselves to our anxieties.

    3. As others have stated, fear of client violence is concerning to me. When I was doing in-home therapy, there were safety trainings at my agency. We were given alarms to use in the event of a threat, and we were taught to sit close to the door to be able to easily escape a dangerous situation.

    Reply

    • Kara Rene
      Mar 25, 2021 @ 13:26:20

      Paola,

      I can relate to your concern about avoidance, especially your point about cognitive avoidance. I find myself hoping that certain clients will cancel or no-show as well. Good for you for addressing this with your supervisor! I recognize that these are very normal feelings, but you are right that it is important to find ways to address these feelings.

      Reply

  11. Kara Rene
    Mar 25, 2021 @ 13:19:21

    (1) The myth that piqued my interest the most was “therapists are invulnerable, immortal, and ageless.” I have been learning this throughout my internship and to be honest, I’ve had a hard time with it- probably because of my perfectionist tendencies. It can be intimidating to acknowledge that since the work we do is so human, we will at times experience intense human emotions- and make mistakes. Just this week my supervisor was telling me about the therapeutic value of making mistakes, as it gives us information about how clients react real-time to difficulties, and allows for real-time teaching opportunities about the importance of self-advocation, apologizing and forgiving, and problem-solving. It is difficult as a new therapist, I think, to find the line between showing our human-ness to our clients while also remaining a safe and impartial space.

    (2) Many of the possible clues in Chapter 5 were deeply concerning, particularly the ones that can lead to abuse- secret keeping, isolation, and the client-friend. Personally, though, I think the one that concerns me the most is avoidance. Not acknowledging a possible taboo topic with a particular client and coping through avoidance might seem innocent enough (unless the therapist is purposefully canceling sessions with no good reason or purposely miscommunicating session times), but in the long run it can lead to neglect and improper termination.

    (3) By far the feeling that concerns me the most is fear. I am lucky to have not been assaulted by a client like some of my classmates have, but the fact that this is even a possibility scares me. I had an open-access client earlier this year with an extensive criminal history that asked during intake. “If I tell you that I murdered someone, do you have to report that?” Although I knew the ethical answer (thanks, Dr. Weagraff!), getting this question was scary, as it made me aware of the possibility that I may end up in that situation one day! My supervisor urged me to process this in staff meeting, and I learned that one of the therapists in our clinic has once worked with a client who killed his last therapist- that didn’t exactly make me feel better! In addition, I find myself afraid of a client hurting themselves or committing suicide. I trust that as I continue to work and grow more confident in my abilities, this fear will subside somewhat, and know that unfortunately, sometimes the only way to learn how to deal with something is to go through it (although of course I hope that won’t happen!) I will definitely need to continue processing fear during supervision as I continue to grow as a therapist. I think overall, Pope’s work has reinforced that supervision is a safe place to process “taboo” subjects, and that it is important to do so.

    Reply

    • Ashley Foster
      Mar 27, 2021 @ 18:11:52

      Hi Kara, I can relate to your fear of being assaulted by a potential clients. As you know I have been assaulted by my patients and there’s no good way to get around that. The one advice I could give is don’t let it take control of what you were doing. The anxiety can be a lot but don’t let it get in the way of your work and your goals. Luckily enough, most places have protocols in place to protect us and like Dr.V said the likely hold in outpatient is slim compared to inpatient.

      Reply

  12. Monique Guillory
    Mar 25, 2021 @ 13:28:37

    1) One myth that piqued my interest was “Learning ethical standards, principles, and guidelines, along with examples of how they have been applied, translates into ethical practice. Therapist may have ample training and understanding of ethical practice but may not realize how much effort is involved in practicing what has been taught. As my understanding of ethical practice has increased during my graduate studies, I have often found myself looking back at the mental health facilities I have worked at over the years, and I am identifying many ways in which ethical practices have not been practiced. I recently had a conversation with an old colleague of mine expressing some of their concerns about the level of care needed for individuals and the inability of a mental health facility to provide that level of care due to staffing and lack of training, yet the facility made no effort to refer out. This situation has seemingly increased in the aftermath of the pandemic, as the mental health field is unable to meet the demand of mental health needs across the board. As a future clinician I worry about landing a job in an organization that may not abide by the ethical standards I hold myself to, and I wonder how I can navigate such a situation in a helpful and meaningful way if the ethical standards of the organization were not evident during the interviewing process.
    2) As for “possible clues for taboo topics,” boredom and drowsiness as protective reactions concerns me most. I’ve found myself a few times over the past year, while conducting teletherapy sessions, lose focus or find my mind wandering. Not that the boredom stemmed from a taboo feeling per se, but rather my disbelief that I could not conduct efficacious therapy through a computer screen when working with children. I’ve spent about a decade working hands-on, in-person with children and adolescents, and for the first time I had to figure out how to engage virtually. In the beginning I struggled a bit to stay focused on the computer screen, and have since discovered creative ways to feel more engaged with the clients I work with. Currently it seems as though telehealth is going to stay, and the probability that I may be continue conducting telehealth services is very high. I realize that my mind can wander more easily when conducting sessions virtually, and upon discovering that about myself throughout the internship I am more self-aware of how to bring myself back to the present moment.
    3) Based on the Appendix, of al the information presented on I did not find the statistics to be surprising. Working in a residential setting with high risk children and adolescents who often displayed very aggressive behaviors, physically, and verbally, I’ve learned to not take things as personally. What I found to be most helpful is having a supervisor or coworker to debrief with after crisis situations, or situations when I had been a target of someone’s anger. This isn’t to suggest that I never get angry, or feel insulted, but I found that I value working with a supportive team to be very helpful to diffuse the emotional responses to challenging behaviors. I also found that having consistent and firm boundaries also helped keep my emotions in check.

    Reply

  13. Mariah Fraser
    Mar 25, 2021 @ 16:12:00

    The myth that really stands out is the one about therapists’ inability to be vulnerable. I found this to be interesting because of this possible false perception that therapists are just these shells of people, who don’t have feelings of their own. It seems as though this past year has really proven that this is actually not the case; as everybody likely struggled with mental health at one point. I could see how this would be a falsehood, believed to be true by most people because of the ability to put aside our own feelings and beliefs during sessions; this can definitely come off as robotic if nonverbals are lacking; however we’re all human at the end of the day.

    Much like other people, repetitive therapy is a concern for me. Especially when dealing with clients with poor insight; I have found that there have been times where there is a lot of circular thinking, and it can be challenging to intervene and redirect. The population I am currently working with, adults with dual diagnosis, certainly can struggle with variations of the same problem, such as lacking interpersonal skills, thus discussing much of the same conflict but within different relationships. Meeting clients where they’re at can be challenging at times, especially if they are not at a place where they are willing to keep an open mind.

    For me the fear of violence also stuck out to me more than anything else. I haven’t necessarily worried about my safety before, but I have overheard/ had a few interactions with individuals who are aggressive with their words and very intense with their body language. Luckily at my placement, there are always clinicians around as well as security guards downstairs to step in if need be.

    Reply

    • Taylor O'Rourke
      Mar 25, 2021 @ 16:42:21

      Hi Mariah!

      I can definitely relate to your surprise/shock factor with violence and anger in clients. Especially because we have started our field experience in counseling virtually through telehealth, it is interesting to think about what it will be like when we start seeing clients in person. I assume that my fear may rise a bit when I start to see clients, especially those with a history of violence or anger.

      Reply

    • Paola Gutierrez
      Mar 26, 2021 @ 13:28:58

      Hi Mariah – I completely relate to your comment about repetitive therapy. I find this happening more often with particular clients with poor insight/judgment into their behavior. I have a client with psychosis who has very disorganized thinking, so I have to redirect very frequently and with mixed results. It’s definitely tough, though.

      Reply

    • Ashley Foster
      Mar 27, 2021 @ 18:08:06

      Hi Mariah I agree that this past year has opened up the eyes of many as well as individual in the mental health field. When it comes to vulnerabilities, I think we get wrapped up and helping others that we forget about ourselves. Like you mentioned, taking things not so personally and leaving them at the door is one way of tackling these vulnerabilities. I think a part of this too is setting boundaries for ourselves and making sure we indulge in self-care.

      Reply

  14. Taylor O'Rourke
    Mar 25, 2021 @ 16:39:57

    The “myth” that piques my interest the most is that “if you’re a good therapist, the money will take care of itself.” I think there is this common misconception that all of us therapists are just out here to save and help the world free of charge; that if we are helping others then the money is not the important part. However, we too want to make careers for ourselves. So the money aspect is of course important too. Aside from this, I know there are many of us that are interested in starting a private practice after we are licensed, and this is not something that is very talked about as far as the business side of things. Money does not just “take care of itself” because we must navigate how to be business owners and work through late payments, paying for services through insurance, etc.

    The “possible clue to taboo topic” that concerns me the most as a practicing therapist is the client-friend. Many of my clients thus far have been very similar in age to me and have very similar interests. Because a therapeutic relationship is one that is very much one-sided, my clients know very little about me but I know a lot about them. At times, I have felt like the relationship is one that is more friendly just because of the topics discussed, and this is a concern because we are not in a session to be friends, obviously.

    Of all the information presented on therapist self-reported feelings and behaviors, the thing that concerns/surprises me the most is fear. I found it interesting that most studies in the past have looked at therapists’ risk of attack with their clients rather than their level of fear. Having started my journey in counseling virtually due to the pandemic, I can definitely relate to the fear of actually seeing clients in person. Being attacked by a client is not something that has really ever crossed my mind, so it is surprising to me that so many clinicians have thought this. However, I know that this is a real possibility depending on the type of clients I may be seeing.

    Reply

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Adam M. Volungis, PhD, LMHC

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