Topic 9: What Therapists Don’t Talk About {by 6/30}

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 6/30.  Post your two replies no later than 7/2.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

16 Comments (+add yours?)

  1. Monica Teeven
    Jun 25, 2021 @ 11:04:23

    1. The question that interested me the most was the question about the proportion of men and women in my clientele, and if these distributions were due to the geographical area or another factor. I found this interesting because I had more male clients than female clients and the reason behind this was that more males abuse substances than females do. Another part of the question was whether or not I wished to have more males or female clients and at this time. I think I would want about an equal number of both males and females. I think I would never want to have substantially more clients of one gender than another if at all possible. This is because I think it would be better for me as a mental health professional to feel equally confident in working with both genders if my clienteles’ gender was about 50/50.

    2. Based on Chapter 5, the “clue or taboo topic” that concerns me the most as a practicing therapist is the “Dehumanized Therapist”. There were a few times while at my internship where I began to realize I experienced features of a “Dehumanized Therapist”. I said and expressed what a clinician would say to a client, but emotionally I was like a robot. There were multiple reasons why I experienced this at my internship. These reasons included: large caseload, family mental and physical health issues, understaffed, and lost paperwork. When I began to realize I was becoming dehumanized I knew I had to take a step back and take a day off because my clients deserved a humanized therapist and I was emotionally drained. Since, I have already experienced this taboo topic, I am concerned that I will experience it again later in my career.

    3. What surprised me the most was that for the item “Feeling angry with a client because of late or unpaid therapy bills”, there was a huge discrepancy of rating when compared to gender. For female clients, 4.9 % of therapists often felt angry with a client because of a late to unpaid therapy bill. Whereas for male clients, 23.5% of therapists often felt angry with a client because of a late to unpaid therapy bill. This could be partially due to other factors, such as women who are single and are raising children on their own. These female clients may not anger the therapist as much as a male client who may not be financially responsible for any dependents.

    Reply

    • Jenna Nikolopoulos
      Jul 01, 2021 @ 13:23:01

      Hi Monica! I agree with what you said about being a “dehumanized therapist.” There were some days where I felt completely drained and not interested in meeting with clients because of all the other things I had going on in my life. And in those moments when I realized I wasn’t being as attentive or as empathetic as I usually am during sessions, I had to take a step back and reflect on why I was acting the way I was. It’s not fair to us, and especially not our clients, to try and engage in therapeutic practices when we aren’t our best selves! Those days helped remind me that it is okay to take breaks as they are not only good for us, but also for our clients. Our clients deserve therapists who are in a good head space to be discussing whatever they want to talk about. We don’t want to give off the impression they are inconveniencing us just because we have other things going on in our lives that we need to handle ourselves.

      Reply

    • Shelby Piekarczyk
      Jul 02, 2021 @ 10:56:00

      Hi Monica,

      As we discussed in class your response about late bills really makes me sit and wonder. I am surprised that the numbers differentiate so much between females and males. I would imagine that clinicians become more upset with male clients who have not paid their bills because in our society men are seen as the “superiors” and “bill payers”. Because of this I can see why clinicians would imagine them as being more able to pay bills. Additionally, like Bobby said as a society I do believe we have more excuses for women of why they couldn’t pay a bill or their reasoning behind it. Whereas for men, we almost pin them as not working hard enough or not “doing their job”. This in a way I guess doesn’t surprise me but on the other hand it really does surprise me.

      Reply

  2. Robert Salvucci
    Jun 27, 2021 @ 19:57:47

    1. The questions regarding what I disclose and discuss with my supervisor made me think more about were I have guilt and hesitation in my practice, and how I approach and discuss these feelings either with other professionals or in my personal relationships. I think we all have a tendency to edit/sugar coat information or details in a way that we think preserves our self-image or invites minimal criticism. Having co-workers and a supervisor that I trust being vulnerable with has been a huge part of my internship experience, and really allows me to process some deeper emotional responses I have during group or individual sessions. As I’ve done this I’ve definitely noticed that I start feeling more confident and accepting of myself while approaching difficult topics with clients or noticing difficult thoughts/emotions within myself during sessions.
    2. I’ve found myself very aware of when therapy seems repetitive and thought about what factors are contributing to that. Sometimes it’s a result of a client ruminating or worrying and being in a sort of “thought loop”, and its an opportunity to point out the process of rumination or worry. I’ve also noticed this happen when a client starts focusing on a political position or social critique, and I find myself stuck in how to approach it, as I often have strong feelings about the topic but want to try to remain focused on their thoughts and emotions rather than starting a discussion about a broader social or political concern. Another thing I’ve noticed is that when this happened, I am most likely to become lazier in session, and tempted to focus on less emotional content or discuss something light like an interest the client has rather than remain in a therapeutic mindset.
    3. Having a client commit suicide is always something that has created a lot of worry for me, as it would obviously be very emotional and would also implicitly call into question if the work that I’m doing is causing people harm rather than helping them. I also found it strange and a bit random how many people have a fear of working with HIV positive individuals, given that it’s only transmissible through blood or sexual contact. I imagine that fear is rooted in ignorance of the transmission process.

    Reply

    • Monica Teeven
      Jun 30, 2021 @ 13:28:25

      Hi Bobby! I also found it odd that people were fearful of working with clients who have HIV since it is only transmissible through blood or sexual contact. I had some clients who were HIV positive when I was interning at the methadone treatment center and I think the clinicians fear may not be related to their ignorance of the transmission process fully. I could be wrong, but there are other potential reasons why they were fearful of working with clients with HIV. Some other potential reasons include: the stigma of having HIV and clinicians not knowing how to discuss it with clients, clients not receiving proper treatment for HIV when they should, clients not telling loved ones or sexual partners that they have HIV, deciding to focus on the client’s lack of treatment for HIV or their mental health issues that could be preventing them from receiving HIV treatment first, and potentially risky behavior which is how they got HIV in the first place. As a clinician, I was not fearful of working with clients with HIV. However, it concerned me when clients did not receive treatment for it since it could negatively affect their treatment success with their mental health and methadone treatment.

      Reply

  3. Jenna Nikolopoulos
    Jun 28, 2021 @ 14:21:41

    1. The question that interested me the most was the one about if me or any of my peers discussed feelings of incompetence, being in over our heads, or feeling overwhelmed and confused in our graduate program, practica, or internship. I found this interesting because whether we like to think about it or not, imposter syndrome can feel very real for us graduate students, especially during our practicum and internship where this is our first real experience applying some of the skills we have learned in class to current client situations. When I first started working with clients in my practicum, I remember feeling like I had no idea what I was doing and doubted my abilities in being able to help my clients. It wasn’t until I shared this thought with peers and realized that they felt the same way too that this wasn’t something I was experiencing alone, which helped validate my negative thoughts. I think discussing these feelings with others really helped reduce the stress I was experiencing and allowed me to recognize that we are all in the same boat, which helped me feel better about myself and my abilities. These discussions also reminded me that I am doing the best that I can and to not be so hard on myself since I am still learning and am new to the field.

    2. Based on Chapter 5, the “possible clue to taboo topics” that concerns me the most as a practicing clinician is “Repetitive Therapy.” This is because it reminds me of a client I worked with in my internship who had a history of abusing alcohol and would go “on and off the wagon” periodically throughout treatment. When I had first met him, he had been almost 4 months sober and then one day in session he told me he had a drink and had been drinking the whole week since the last time we talked. As a first time clinician, I wasn’t sure how to handle this and brought it to the group I was working with. Even though they validated my concerns, they informed me this was a common occurrence with him where he would go through periods of staying sober and then go back to drinking. This was evident throughout our time together. Every time this would happen we would discuss the instances that precipitated his drinking, his thoughts and feelings surrounding his drinking, and what he could do to stop drinking and maintain his sobriety. Sometimes it felt like a never-ending cycle because he would make good progress and be able to engage in activities that helped keep him from drinking, but then something would happen and it was like starting over from square one. So repetitive therapy can hinder progress if the same thing is being worked on in therapy repeatedly, which is something I’m worried about will happen with future clients.

    3. What surprised me the most was from the item “Feeling sexually attracted to a client” where 30.9% of therapists said they sometimes felt this way towards female clients and 13% sometimes felt this way towards male clients. This was surprising to me because I guess I didn’t expect the percentage of therapists who sometimes felt sexual attraction towards their clients would be so high, especially towards female clients. We are taught to be aware of these kinds of feelings if they happen to arise with clients, but I guess I didn’t expect them to happen as often as they actually might.

    Reply

    • Monica Teeven
      Jun 30, 2021 @ 13:29:22

      Hey Jenna! I also had some concerns about Repetitive therapy as a practicing clinician when I was at my internship. I experienced the “never-ending cycle” with clients doing well with their sobriety and then, they begin to use again. I did the same thing as you did with thinking about thoughts and alternative activities with they had cravings and such. I believe in my case doing nearly all of my sessions via tele-phone, made it harder for me to really grasp where some of my clients were in their substance use treatment and their other mental health disorder because I was unable to see any physical cues or reactions expect for their voice. I also wonder if the clients were able to see me in person or at least via zoom, they would have attempted to complete some of the homework assignments more often. Maybe not, but I think them being able to see me try to help them and care visually, it would have been a motivator for them to try a bit harder.

      Reply

    • Shelby Piekarczyk
      Jul 02, 2021 @ 10:58:57

      Hi Jenna,

      I resonate and agree with your comment 100% on feeling out of place or that we were not ready to be doing therapy with real clients. I believe talking with our peers and others in our program did help this a lot because it made us feel not alone. Because we are such young professionals and we are just starting our careers it makes sense that we feel not adequate enough or that we have no position being in the clinician role. However, I do agree with you that talking with our peers and verbalizing these concerns helps to diminish them and realize we are all in this together. I have made really great friends through Assumption and these friends have helped me not only in my professional career but also in the many personal life struggles I have gone through.

      Reply

  4. Madison Armstrong
    Jun 29, 2021 @ 13:23:19

    1. The myth that piqued my interest the most was that “therapists are invulnerable, immortal and ageless”. This one caught my attention mainly from the description the author used for an example of a therapist letting their guard down once they begin to feel comfortable in their work environment and resulted in a safety concerning situation for the therapist. I think I often forget the safety concerns for therapists of working in counseling with clients who are either distressed, aggressive or even unpredictable. I think it would be beneficial to take some sort of training on maintaining safety in counseling settings and warning signs to look for in clients.

    2. Repetitive therapy is the possible clue to taboo topics that concerns me the most as a practicing therapist. This one concerns me the most because at this point, I have worked with some clients for over a year now and I find at times with certain clients, therapy can become repetitive. I have found this could be due to a number of reasons such as a client not ready to address certain topics, crises that happen during the week that change the direction of session, low motivation for change, etc.

    3. Patient suicide and violence is what I find to concern me the most on the therapist self-reported feelings and behaviors. I think that reading over 18% of therapists had reported a client being violent towards them was surprising to me because I did not expect it to be this high of a number. I was also concerned to read therapists experiences with client suicides. This is something that I find myself worrying about when working with this population and I think they made a good point to talk about how a clinician’s experiences with this might differ with grief and self-doubt.

    Reply

    • Melanie Sergel
      Jun 30, 2021 @ 10:06:46

      Hi Madi! I had not written about this particular myth but this one had also caught my attention. I agree that it would be beneficial and also important for trainings on maintaining safety. I think that it would help for companies to continue to give refresher trainings on this whether it is every year or two because like the example said, the therapist became very comfortable forgetting about the safety concerns. I had also identified patient suicide and violence to be a concern of mine. I don’t know if I was as surprised to see that the 18% of therapists had reported a client being violent towards them as there are many settings that aggressive behavior can occur.

      Reply

    • Jenna Nikolopoulos
      Jul 01, 2021 @ 13:11:08

      Hi Madi! I totally agree with what you said about being concerned about patient suicide and violence. Especially, as a woman, the thought of being attacked by a client can be very scary and unnerving since we are there to help them. Sometimes I think about what I would do if I happen to be in a situation with a violent client, and honestly I’m not sure I would be able to defend myself. Part of me feels like I would freeze in the moment because I would be taken off guard from the attack. In regards to patient suicide, I had a client who had in the past experienced suicidal ideation and when they brought that up to me in session one day, I got nervous because this was my first encounter with a patient who had openly admitted they were experiencing thoughts of suicidal. I did my best to remain calm in the situation and explore those thoughts further with the client while making sure I wasn’t overstepping. After the session, I discussed it with my supervisor to make sure I had approached the matter appropriately, which made me feel a lot better with my interaction and confident for future discussions about suicidal ideation.

      Reply

  5. Melanie Sergel
    Jun 29, 2021 @ 18:38:27

    1. The question that interested me the most was the question “Could you still work effectively with a client with whom you were upset?”. I found this interesting because when I switched to working with adolescents from adults, I was prepared that there will adolescents that may not be nicest to work with, but you actually do not know how you are going to react to some of their comments until you are in that situation. I have had heard a handful of rude comments not just towards me but towards my coworkers also. We are human so at times yes, it is normal to feel upset about something a client said towards you but how do we let this effect our work? I have found with my clients that the majority of them will apologize if they say something rude, but I have had several adolescents over the years that have been hard for all staff to work with because they would make rude remarks, racial slurs, assault staff constantly, etc. I have found that working with your coworkers and supervisors to debrief about these clients plays a role in how you will move forward working with that client. If you do not utilize your team members to work together in finding the most effective approach for the client, I definitely think being upset with a client will impact your work with them.

    2. The “possible clue to taboo topics” that concerns me the most as a practicing therapist is repetitive therapy. This concerns me the most because I had worked with a family during my internship that continued to be repetitive. I had felt like a broken record and would constantly bring this to supervision to find ways to overcome this but my supervisor had provided me insight that it was because the mom would not follow through with what she was learning or she would for one week and then fall back into the old/same pattern. Repetitive therapy can prevent progress from being made and that is concerning for me in the future. I am glad that I was able to recognize this and bring it to supervision so I can learn what I can do better to try to prevent repetitive therapy.

    3. The most concerning therapist self-reported feelings and behaviors for me is having a client commit suicide. This is something that I worry about and I think a lot of others in this field may worry about too because this is a very emotional experience. It is definitely something that would make me question how my work impacted not only that client but how it is impacting others.

    Reply

    • Robert Salvucci
      Jul 02, 2021 @ 13:47:47

      Hey Melanie!

      You make a good point about how it can be uncertain how we will respond emotionally to clients being rude/hurtful. Sometimes our buttons are pushed for reasons we may not be aware of, or we can be sensitive about certain parts of ourselves and react more strongly than we may anticipate. Being able to process those interactions is super important as you said.

      I’ve also had the experience of realizing that the same conversation is occurring from previous sessions. Sometimes it can be helpful to revisit topics, other times I feel as though it’s indicative of not making progress. It’s important to recognize the reasons for this occurring and how to work through it. Client suicide also is high up there for my concerns, I can only imagine how that might impact me and the way I approach therapy.

      Reply

  6. Shelby Piekarczyk
    Jun 30, 2021 @ 09:47:15

    1. The question that peeked my interest the most was the question of if a clinician can work with a client that has upset them. I found this very interesting because within our field I think it is important to understand and know our own boundaries and what can or does make us upset. Throughout our professional careers I am sure that there will be a multitude of clients that we do not “fit” well with or clients that make us upset. I found in my internship when I would assign clients homework and they would not complete it time and time again I was becoming upset over this. However, in this situation I think it’s important to remember and ask myself why isn’t the client completing this. Additionally, we are all different human beings so if I have a completely different view than one of my clients and I become upset over this, how do I effectively move forward and still give them the best course of treatment.

    2. Based on chapter 5 the “possible clue to taboo topics” that connected with me the most was “Repetitive Therapy”. The reason this resonated with me the most was because throughout my therapy I found many of my clients going through the same cycles, resulting in completing the same treatment steps over again. Since I am a young professional this could become very discouraging and seemed like a never ending cycle of the same therapy and me not knowing where to go with the client or if I was being helpful. This also led to me feeling discouraged and a level of burnout with these particular clients. At my internship site I was lucky to have a supervisor who was helpful in these circumstances and one that continued to give me advice on which direction I should go in with the client.

    3. The biggest clinician self-report feelings for myself is clients committing suicide. This has always been a large area of concern for me and at times made me question if this was the field I wanted to pursue. Having a client commit suicide is something I deeply worry about because I will always feel that I failed that specific client. This would also heighten my own personal emotional state.

    Reply

    • Melanie Sergel
      Jul 01, 2021 @ 11:30:18

      Hi Shelby! I had also identified working with a client that you may have been upset with. You make a good point about how it is important to know our own boundaries and limits. I think that this is the first step to prevent us from struggling to work with a client who has upset us. If we are able to identify what makes us upset, we can work through this ahead of time to ensure that we are not letting our emotions impact working with the client. I also think it’s important that when a client upsets us that we debrief with our coworkers and supervisors.

      Reply

  7. Robert Salvucci
    Jul 02, 2021 @ 13:52:37

    Hi Shelby!

    Your point about assigning homework made me reflect on when I’ve been in similar situations and how I’ve responded. It can be difficult to entangle how much of wanting clients to complete homework or “do well” in therapy is a result of egoic concern about our competence, and genuinely wanting them to be well. As you mentioned its important to be able to address this therapeutically and move forward.

    The repetitive nature of some sessions has been discouraging for me as well,
    especially when I was starting out. It can feel like we don’t have a plan or direction, or aren’t truly helping the client. I think there are many ways we can become unstuck, and being direct in pointing this out with clients has been helpful at times. I agree with the sentiment of fear regarding suicide with clients. It is something I worry about when clients express ideation, and something we likely can’t ever fully prepare for.

    Reply

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Adam M. Volungis, PhD, LMHC

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