Topic 9: What Therapists Don’t Talk About {by 7/7}

Based on the readings due this week consider the following three discussion points: (1) Based on Chapters 1 and 4, what particular “Myth” (or Taboo/Secret/Question) piques your interest the most?  Explain.  (2) Based on Chapter 5, what “possible clue to taboo topics” concerns you the most as a practicing therapist?  Explain.  (3) Based on the Appendix, of all the information presented on therapist self-reported feelings and behaviors, what concerns (or surprises) you the most?

 

Your original post should be posted by 7/7.  Post your two replies no later than 7/9.  *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. Alison Kahn
    Jul 06, 2022 @ 21:31:27

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

    I found the questions in chapter 4 regarding being upset with, afraid of, or disliking a client to be particularly interesting in this weeks readings. I think it was mostly because when I was reading through the questions and came to those I could instantly recall experiences that I have had in my current and previous roles as well as my internship where I was genuinely afraid of a client or a client made me very upset. It took me a bit longer to ponder whether I did/could effectively work with those clients. In terms of getting upset with clients, I think I’ve gotten a pretty good hold on my own personal reactions to a clients behavior and I’m usually able to check myself and consult with my supervisor or in DBT consult group for empathy building and validation. I notice that naming or labeling my disappointment or anger over a clients behavior tends to be helpful in and of itself. I also feel like I have had a lot of great sessions with clients following a behavior that personally affected or upset me because it can be a great opportunity for interpersonal effectiveness training and building therapeutic rapport. In terms of being frightened by clients, I have definitely found myself in some scary situations with extremely escalated and physically aggressive clients. I find it a lot harder to navigate the feelings of fear than those of anger or upset over a clients behavior. In those situations, setting boundaries and being transparent about my limits has been somewhat helpful.

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

    
I think one of the most concerning possible clues to taboo topics for me is avoidance. In particular, it made me think about avoidance in the context of feeling “imposter syndrome” or incompetent in my ability to adequately work with a client and therefore avoiding the client and the negative feelings associated with being an ineffective counselor. I have noticed avoidance patterns in myself in the past with regard to work and internship when I’ve been faced with really challenging clients or presenting problems that are out of the realm of my experience. Although I feel like I’ve improved in my ability to notice avoidance behaviors, I don’t feel super confident in my ability to prevent future instances.

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

    While a lot of the content in the appendix concerned/surprised me, I think I was most surprised by the numbers related to physical contact and flirting with clients. I assume that its based on the context of the situation and the job (i.e., working with small children versus adults, working in congregate care versus outpatient, working with individuals who have cognitive or physical limitations, etc.) but it did strike me that one fourth of participants reported holding hands with a client. I was also pretty surprised that 1 in 10 participants reported flirting with clients (doesn’t feel like that would be appropriate in any context..)

    Reply

    • Tayler Weathers
      Jul 07, 2022 @ 11:52:47

      Hi Alison! It’s really interesting that you say naming or labeling your feelings over a client’s behavior leads to a great session. This sounds like what the book indicates when it says your feelings can be a therapeutic resource, and something we talked about in one of our classes that was along the lines of “you may be reflecting how others respond to the client too.” I think having those conversations can be intimidating, because it feels (at least to me) weirdly unprofessional to share your own emotions – we’re not supposed to be robots, obviously, but our feelings aren’t really supposed to be expressed unless it’s therapeutic to do so. It also skirts a line of self-disclosure that could be really easy for some to blur, as the chapters of this book talk about with complimenting clients. I’m impressed that you have handled it in a way that went well! I hate to hear you were frightened though – even though it is sometimes a part of our work, and boundary setting is also therapeutically useful, it isn’t ideal to think “oh what danger might I be in at work today.”

      Reply

    • Connor Belland
      Jul 07, 2022 @ 19:13:03

      Hi Alison,
      There was definentily some times where a client did something that upset me or frustrated me, and I think it will happen here and there inn the future and it can be very hard sometimes to keep mouth shut and keep biases out of therapy. It can be hard to do but trying to see something from there point of view is what I try to do.

      Reply

  2. Beth Martin
    Jul 07, 2022 @ 02:25:41

    1. I think the myth that piqued my interest the most from the reading is that therapists are invulnerable, immortal, and ageless (if only). With the topic of burn out being seemingly ever present at the moment, I found it really interesting that we don’t prepare for it as a field. We pay lip service to it being common and point out the warning signs in supervision and in classes, so we’re always aware it’s a possibility, and we come face-to-face with horrible things that can happen in life and that can be planned for. We’re also a field that loves its contingency plans, so I’m baffled as to why contingency planning for burn-out related absences, and any other absences, isn’t something we do by default. Maternity/paternity leave seems to be better planned, but I think/hope with people being in and out, and getting really sick, with COVID-19 helped highlight the need for some form of system in place. I hope a plan of action for if we’re incapacitated becomes more common. It’s not fair on other clinicians who have to step in without any guidance, and it’s definitely not fair to clients for us to fumble around. It also made me think about the invulnerable side of things too – both physically and mentally. I’m sure I’m not the only one that gets casually trauma-dumped on by random acquaintances when they find out what I’m in school for, and there does seem to be an assumption, both from ourselves and others, that we can just… sit with it because of our job/training.

    2. The taboo topic clue that concerned me the most as a practicing therapist myself would be the need for reassurance from other clinicians. I really enjoy consultation, both about my own clients and other clinicians’, and I found supervision extremely helpful in learning to approach problems from a different perspective. So I worry a little that the benefit I get from talking about cases with others could easily slip into reassurance-seeking without me knowing. I’m now hyper-aware of that, in retrospect it’s not a reason I’ve sought supervision, and will likely be monitoring for it until I retire, but it’s still a concern. I found the isolation clue generally concerning; not as something I am concerned about on a personal level, but that entire section made me feel extremely yucky. It echoed to abusive control tactics, and it’s concerning to know that that’s common enough in the field that the writers felt the need to mention it.

    3. I think fear concerned me the most. I have always known that verbal and physical abuse are a risk when working in this field, but looking at the sheer amount of practitioners who’ve reported being assaulted made it very, very real. I suppose I was hoping the numbers wouldn’t be that high, but a quarter of your sample reporting they’ve been assaulted in the past year is alarming. Statistics like that make me pause, just a teensy bit.

    Reply

    • Tayler Weathers
      Jul 07, 2022 @ 11:53:05

      Hi Beth!
      I totally agree – I love supervision and consultation, but it can sometimes devolve into a reassurance-seeking echo chamber. I think this can be especially prominent for new therapists, since we aren’t sure of ourselves just yet, so it’s good to look out for! Hopefully, this can be a drive for all of us to not only seek appropriate (i.e., not reassurance-seeking) consultation, but also to be good consultants for others – sometimes, I wonder if the reassurance seeking comes from asking legitimate advice and others struggling to provide it. In those situations, it might be better to ask “what is your real question here” or something similar, to get to the heart of the request. Maybe there is a question we just haven’t identified yet!

      Reply

    • Maya Lopez
      Jul 07, 2022 @ 13:09:42

      Hey Beth,

      I love that you talked about the need for self-care reform/ contingency plans on the systemic level! We always talk about being so aware but what are we actually doing with that information?! nothing tangible! This is something me and Anna touched upon in our presentation, that agencies and systems need to begin to make change to help avoid burn out in real ways not just pizza parties and need to put effort and resources into sustaining our good health and preventing burn out.

      Also side note: Yes I totally know what you mean about peoples reactions when we tell them what we are going to school for. 🙄 People will either 1. trauma dump or expect you to diagnose them on the spot or 2. tell me I’m going to work with the crazies.

      Reply

    • Abby Robinson
      Jul 07, 2022 @ 15:52:01

      Hi Beth!

      I too was really concerned about fear! The number of those who have been verbally or physically abused is concerning and makes me weary. Yes, having a good, supportive clinical team can be there to help prevent this from happening but it still seems pretty scary. This is something that we can really prepare for either, which is worrisome.

      See you in class 🙂

      Reply

  3. Yen Pham
    Jul 07, 2022 @ 11:27:43

    1. The question piques my interest the most is that “are there any client physical types, characteristics, or disabilities that make you uncomfortable in any way? (p.57). I have met one difficult client during my internship who yelled at me and questioned my competence. She has depression and substance abuse disorders. I still clearly remember feeling very uncomfortable at that time. This client raised her voice at me at a library. She brought her son to our meeting. The child cried and ran around the library. She compared my abilities with my co-worker, who asked me to work with this client during two weeks of her vacation. She blamed me for not helping her manage her baby’s emotions, as my co-workers do for her baby when he cries. At that point, I knew she was very upset because of the crying baby, so I tried to calm her down. But she intended to speak louder for everyone around to hear. Besides, some clients are rude, so they challenge my patience and self-empathy. They are in court-mandated treatment or pushed into therapy by spouses or parents, so they just don’t want to be in therapy.

    2. Seeking repeated reinsurance from colleagues is a possible clue to taboo topics that concern me the most as a practicing therapist. In my own opinion, I find it essential to seek help and consult with colleagues in certain situations when I have to deal with difficult clients or in an area where I feel like I lack expertise. However, if I don’t know how to behave and if I rely too much on the help of colleagues, I will become passive. In the same way, discussing with many colleagues about an issue can be very misleading and destroy the inherent good relationship.

    3. I have many concerns when working with a client such as my client will get worse, angry at a client for being uncooperative, and fear that a client will attack a third party. However, the issue that I fear most is that a client would commit suicide. I have some experiences when I was working with a female client who attempted suicide two times but was not successful. She tried to cut her hand by a razer and wanted to jump down from her window. That is an emergency case, so I have come to see her twice a week. At the first meeting, I assessed her suicide. She shared with me some reasons that she wanted to end her life and she stated she had no present plans to kill herself. For two months, before my internship ended, I worked with her, I was always afraid of her condition worsening, so I am asked to always report her progress to my supervisor after each meeting and every two weeks with the representative of DCF staff. Fortunately, she turned out to be better than I expected, when I turned her case over to a colleague, she got a job at a Burger King and signed up for an online class. to complete the GED program.

    Reply

    • Anne Marie Lemieux
      Jul 07, 2022 @ 16:56:52

      Thank you for your candor in your blog post. I think it is important that we talk openly about clients that challenge us and elicit strong emotions in us so that we can become more open in our work with them. We are human too! I think that discussing concerns with colleagues should never be avoided and they are our allies in the field.

      Reply

    • Connor Belland
      Jul 07, 2022 @ 19:25:18

      Hi Yen,
      It can be really hard to deal with those clients that do not want to be in therapy, it can feel like a waste of time at some points, but it can also be an interesting challenge to see if you can get someone like that to be engaged while keeping your own feelings out of therapy.

      Reply

  4. Tayler Weathers
    Jul 07, 2022 @ 11:52:22

    1. The myth that is the most interesting to me is “if you’re a good therapist, the money will take care of itself.” I have noticed a similar myth in our society, that someone who makes more money must be exceptionally good at their job or have some other edge that we don’t have. Sometimes, this is true – and sometimes, it’s not. This is often used to make people feel inadequate, especially when they don’t have money – like they’ve done something wrong or are lacking, and that’s why they’re not successful. Like the authors mention, this is rooted in our industry, in the lack of adequate (or any) pay during training and while starting out. Plus, the areas where the need is the greatest (outpatient, in home, etc.) are not the money-makers either – this seems a little messed up! And with the shift to private practice, I wonder how damaging it is to think that money is correlated to skill – how might this affect low income or other populations?

    2. The clue that concerns me the most is the “repetitive therapy.” I have seen sometimes that clients, especially “crisis of the week” clients, can end up in cycles of behavior. I worry that this might be clinically difficult to differentiate from true progress with setbacks versus “something’s missing” from therapy. This clue, in comparison to the other clues, is the most concerning to me because it seems to easy to slip under the radar. Especially when treatment planning happens more rarely, like every 6 months or so, I wonder how easy it would be to just “not notice” that you’ve fallen into a pattern with a client. I think this can be especially true since people like routine and habits, so it might even feel comfortable to have a predictable session type/cycle of behavior! But of course, this is not helpful to the client, so I think it would take a lot of self-reflection and diligence in looking over paperwork etc. to avoid this. Which can be overwhelming, given all the other things we have to do!

    3. The reported behavior that surprises me the most is the statistic regarding HIV positive clients. I noticed these surveys are from the 1990s, so I guess it makes sense that that was a concern at the time. However, I wonder how many other illnesses might be stigmatized now – especially in light of the pandemic and how that affected our society. I sometimes worry about germaphobia and how it’s become very mainstream. This seems to follow on the tail of the HIV/AIDS epidemic, and the attitude has probably not gone away all that much, even if it may have shifted. So, I really wonder what the stats would be like today.

    Reply

    • Maya Lopez
      Jul 07, 2022 @ 13:13:00

      Hey Tayler,

      I like that you thought outside of this field and more from the societal aspect. Perhaps this idea that we will get paid good if we are good at our job comes from the “Just world” fallacy. Like you said it does seem like in general people do assume if we do good work we will see that in our paycheck however unfortunately this isn’t the case. Maybe it is because we think if we do what we are supposed to and are good people and do good at our job we will be rewarded, and in a just world that would happen and perhaps that is what they push when we go to school. “do your homework study good and you will be rewarded with good grades” etc.

      Reply

    • Cailee Norton
      Jul 07, 2022 @ 13:48:17

      Tayler,

      Great points about repetitive therapy! I think it would be really easy for things to go unnoticed, especially if you aren’t having consistent treatment plans to really take note of progression in therapy and what goals are being achieved. I think “crisis of the week” patients can be very difficult to direct, and being able to redirect their crisis into the overarching patterns that are occurring will take time for us to really get the hang of, but ultimately can be used as opportunities to connect to the bigger picture of their therapeutic journey. You also bring up great points about stigmatized illnesses and how they have changed over the years. HIV status was something we consistently asked in our intakes, and it was interesting to me that when we met an individual seeking more information on it we were so ill-prepared for it! There were no brochures, referrals, or really any information we could provide to them. It feels like some of that stigma continues on in various ways even if we are “checking” with clients about their status, and how this can lead to some of these feelings being reported even on the tail end of the epidemic. I wonder if those stats and stigmatizations have simply shifted to other illnesses as you mention, and that data will be interesting.

      Cailee

      Reply

    • Alison Kahn
      Jul 07, 2022 @ 15:03:56

      Tayler,

      I thought the exact same thing about the statistic regarding working with HIV positive clients. I decided to go with something different only because I recognized that the study took place a pretty long time ago when that was relevant, but it is still striking. It made me think about what the reasoning for the fear could be. Very interesting!

      Reply

    • Anne Marie Lemieux
      Jul 07, 2022 @ 17:01:30

      YES! I have found that often times people with money often have a stereotype that people who are making less are sometimes working less, which is not always the case. A lot of what our society values sets the course for which fields and positions pay the most. There is a lot of qualified professionals providing quality care to children but kids are often funded minimally for services. I am hopeful that there is a shift occurring in which the mental health field is being recognized as being as beneficial as the medical field and compensation will follow.

      Reply

  5. Maya Lopez
    Jul 07, 2022 @ 13:03:49

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

    The Myth of: “If you’re a good therapist the money will take care of itself” in chapter 1 peaked my interest because as we discuss often in class there are ways to grow in this field and receive larger compensation however it is not always the case and it is not dependent on how skilled we are as a therapist. As we know there are many people in the field mainly in in-patient settings receiving unfair compensation and on the other end making 6 figures in private practice. This large discrepancy does not have to do with being “a good therapist” it more has to do with networking and the the setting in which you work in.

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

    Avoidance is one of my largest concerns because it is a very powerful protective tool we tend to ingrain in our lives. When something is hard or bad we tend to avoid it so going against this instinct and even realizing a pattern is occurring seems hard for me but also necessary. Obviously we do not want to be canceling sessions on clients but I also think avoidance is easy to rationalize when we are feeling burnt out. We may tell ourselves “well I wouldn’t have been much help to them anyway, I’ll just see them next week” and before we know it haven’t seen our client in a month! I don’t necessarily think this will be an issue for me but I think it is interesting since avoidance can be so deeply rooted. Obviously this is why it is helpful to have a supervisor who is holding you accountable and checking in about difficult clients.

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

    Having sexual feelings surprises me the most, it always does because our clients are emotionally vulnerable and it boggles my mind that people become attracted to this. Similarly if a client was in the hospital and in a physically vulnerable state it would be disgusting for a nurse or doctor to hit on them! It certainly reflects more about the individual themself and why they are attracted to someone who is vulnerable.

    Reply

    • Cailee Norton
      Jul 07, 2022 @ 13:41:43

      Maya,

      You bring an excellent point up about the large discrepancies in pay in our field, and how it is so often dependent on our skill level. I think a great deal of it also has to do with education level, as we see such a stark difference in pay for individuals who have a bachelor’s degree in Psychology and being limited to certain positions, while Masters and beyond are open to a wider range. Those types of degrees are not always accessible, but that does not negate the individual’s ability to be a good therapist as you mention. I also agree with you that it’s shocking how many instances of sexual feelings clinicians have towards therapists, especially the vulnerable nature our careers entail. Great points in your post!!

      Cailee

      Reply

    • Alison Kahn
      Jul 07, 2022 @ 15:20:50

      Maya,

      I love your explanation of avoidance as being so deeply ingrained. I definitely have had to tackle that in my own work and it can be incredibly challenging!

      Reply

    • Beth Martin
      Jul 09, 2022 @ 15:41:18

      Hi Maya,

      I also felt really yucky about the general concerns with the abuse of power dynamics in the chapters we read this week! Isolating clients or being attracted to someone who’s emotionally vulnerable with you are behaviours that are waving several massive red flags, so I found it really surprising too that it happens often enough for them to comment on it. It’s a little concerning!

      Thanks for sharing~

      Reply

  6. Cailee Norton
    Jul 07, 2022 @ 13:37:31

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

    I think for me the Questions section of Chapter 4 struck me the most. I think that many of the questions are very much relatable (what’s the hardest thing you’ve told a supervisor, what has a client said or done that upset you the most, have you ever worked with a client you hated, etc.), but some of the questions really hit those taboo subjects that in some ways I feel we’ve discussed but perhaps only to a surface level space rather than really deep diving. One of the questions asks if our program discusses specific issues of sexual orientation and whether those conversations were adequate, helpful, or honest. I think this question can be applied to many other areas, but the progressions (and regressions) of our society have greatly influenced these issues being addressed more so in the classroom. However, I think there’s always room for improvement in these topics being addressed. I feel like in undergrad there is a beauty to having so many classes available as we’re able to really explore. One of my favorite classes was gender across cultures for example, and even though that was an anthropology class I feel I learned so much from it that can help me in clinical settings as well as impacting me in a human way to be more empathetic towards others (a vital clinical viewpoint). In many ways that freedom of exploration and unique class structures to discuss those matters really lacks from masters level arena. I know there are many factors at play, but as we continue to make these developments, and especially during times of regressions, understanding the clinical application and treatment of individuals facing discrimination, exploring their identities, or just scratching the surface becomes more critical.

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

    From the list I think that the most concerning topics are probably theory-obliterated therapy and repetitive. The obvious reason being that it runs the risk of being counterproductive for the client or even worsening their symptoms, which is something I believe no therapist intends to do. I think isolation of the client could be a link to this topic, as it could be another red flag to us as clinicians that something is going on and needs intervention. Other concerning ones are dehumanizing client/therapist, obsession, fantasies or daydreams, and interesting slips. These are very much hinting on the taboo subject, and while it’s always the “that would never happen to me” mentality, it unfortunately does happen. The discomfort of these instances requires serious self-reflection and supervision, and being open and honest about it is the only way to prevent any kind of next step measures. I do wonder about the seeking repeated reassurances from colleagues, as this is something I’m sure we will do especially as new clinicians as we are still gathering our bearings and adjusting to our new roles and positions. Ultimately it can become negative in if it continues beyond appropriate assurances or supervision, but it’s not something I would necessarily expect to see from this list.

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

    I feel that fear is definitely a big concern for me. I can’t say that I haven’t had instances at my site that I was necessarily fearful, but there were times where it was approaching that feeling. To see that happen at my internship experience makes me a bit concerned moving forward, but knowing there can be small ways for me to feel more secure and safe. The numbers for instances of violence are astonishing, and clearly more needs to be done to address these concerns in making clinical settings safe for patients as well as practitioners

    Reply

    • Abby Robinson
      Jul 07, 2022 @ 15:47:28

      Hi Cailee,

      I love your points about needing better application clinically to current progressions and regressions of our society! Its great you were able to touch upon it in your undergraduate studies. I wish we had more available in the grad program as it is something so relevant and important to have these skills. It would be beneficial to have clinical and/or hands on skill building with this topic.

      See you in class 🙂

      Reply

    • Yen Pham
      Jul 08, 2022 @ 12:06:16

      Hi Cailee,

      I agree with you that “fear” is a big concern for us as therapists. Like you, I fear the rate of domestic violence per client will increase. Besides that, I am also afraid of their condition will get worse or they will become uncooperative. As a home therapist during my internship, I sometimes dread going to the home of a Marijuana-addict client or other clients with a high temper.

      Reply

  7. Abby Robinson
    Jul 07, 2022 @ 15:43:16

    (1) Based on Chapters 1 and 4, what particular “Myth” (or Taboo/Secret/Question) piques your interest the most? Explain.
    For me, the myth “if you’re a good therapist, the money will take care of itself. This myth really peaked my interest especially since we will be entering the field soon as working clinicians. I think that as interns, we never really had to deal with session payments, insurance reimbursement, invoicing, etc and all of that was handled by the administration. I don’t want to start a private practice and assume all the finances will be taken care of, I will know how to set sessions rates, understand how to get insurance payments, because I actually know very little about this. An old supervisor told me once that “you’re not in this field for the money” and it was a bit jarring since I figured as an individual with a master degree would likely do well financially. But to be successful it is really more than just being a good therapist.

    (2) Based on Chapter 5, what “possible clue to taboo topics” concerns you the most as a practicing therapist? Explain.
    I think that the topic that worries me the most is Repetitive Therapy. This is concerning to someone who has a lot of CBT training knowing that the goal is to get to a point where the client doesn’t need therapy anymore. With repetitive therapy, though, it will be hard to get to that point. If my client doesn’t make progress or I keep having similar sessions with no gains I think I would be worried about how to continue treatment and what their goals would be. I think repetitive therapy makes me feel like it would be really hard to have long term goals.

    (3) Based on the Appendix, of all the information presented on therapist self-reported feelings and behaviors, what concerns (or surprises) you the most?
    After reading all of these behaviors, fear was the one that worried me the most. I hadn’t really thought of working clients that I would be afraid of.

    Reply

    • Beth Martin
      Jul 09, 2022 @ 15:45:33

      Hi Abby!

      Fear was really concerning for me too – as we both mostly work with teenies, it’s not something I was expecting to encounter either! I’m also really hesitant about private practice and the financial side too! We don’t know what we don’t know, and I worry that I’ll miss something big. It seems like there are a lot of courses and services we can use to help with that in the future, though, which is giving me a bit of confidence!

      Thanks for sharing 🙂

      Reply

  8. Alexa Berry
    Jul 07, 2022 @ 15:51:49

    Based on chapters 1 & 4, the myth that was most interesting to me was that if you’re a good therapist, the money will take care of itself. This one stuck out to me because it felt very relevant to both personal and class discussions that have revolved around going into private practice/ charging fees for no shows/ managing business costs. I am interested in eventually going into private practice, and thus I try and learn from other professionals who have already done so themselves, as well as from what resources are available. It seems that information and content on getting a private practice up and running and managing business costs are becoming more available, but it is definitely noteworthy that it is not the most easily accessible information (which is corroborated by this section of the book clearly!) The comment the authors included in this section regarding therapy coming off as a service that is not done for money is something that might not occur to someone (an alien) based on the literature was thought provoking. I think there is some hesitancy within the field to acknowledge the fact that although it “feels weird” to be making money off of the clients we are supposed to be helping, it is like any other profession in the way that it is how people make their livelihood. I’m sure there are people in other professions who never question their fees for services provided, but the nature of aiding others with mental health needs somehow makes money a taboo subject. I wonder if doctors ever worry about the costs their patients pay to be able to see them such as it seems is the issue for many mental health counseling professionals. I think this topic opens doors for discussion on money-based topics in the field such as no-show fees, sliding rate scale for sessions, and private pay.

    Based on chapter 5, the possible clue to taboo topics that concerns me the most as a practicing therapist that has also been pointed out by many others is seeking repeated reassurance from colleagues. Something that I actually really enjoyed during internship was the emphasis my supervisor placed on “bringing it to the group” and seeking approaches to treatment from other interns. I valued the different perspectives and interventions that I had not considered and would like a similar structure as a new clinician. However, I can see how it is a fine line between appropriately seeking out input such as during a group supervision, to the point that you are reassurance seeking and second guessing yourself on your treatment plan and interventions. I definitely think it is important to follow the guidelines of the organization you work at before seeking support from other professionals as to not cross the boundary into seeking repeated reassurance.

    Based on the appendix, the therapist self-reported feeling/behavior that surprises me the most is the percentage of therapists that are angry a client threatened or attempted suicide. Although suicidal ideation or intent is not all that uncommon to encounter in the mental health field, it is something I am very worried about as I have 0 experience with it in treatment. I would be scared to death to lose a client to suicide, so I was surprised to see another emotion other than fear listed and endorsed.

    Reply

    • Anna Lindgren
      Jul 07, 2022 @ 16:52:41

      Hey Alexa,

      I like what you said about seeking reassurance. I feel like towards the end of internship, I was getting to the point where I was more comfortable with my decision-making, but I think I did seek reassurance from our supervisor a few times. I also really appreciated the group supervision dynamic we had of talking through issues with the group. Finding the balance of being confident in our clinical decision making and knowing when to ask for consultation is key!

      Anna

      Reply

    • Yen Pham
      Jul 08, 2022 @ 12:15:35

      Hi Alexa,
      To be honest, I am also terrified of working with a suicidal client. I don’t have much experience in this, but what I have in this area is learning and guidance from my supervisor when he assigned me to work with a client who was contemplating suicide. I have read a lot of documents and used all the knowledge that our program provides us to help this client. I see her every two weeks and after two months of working with her, I find her to be more energetic and have found a suitable job.

      Reply

  9. Elizabeth Baker
    Jul 07, 2022 @ 15:59:12

    1) The question from chapter 4 that piqued my interest is conversations about incompetence. I seriously feel my classmates and intern-peers are rolling their eyes at this point, but we held discussions about feeling incompetent and all that jazz, with me being the star athlete. I seriously felt everyone was confident in their clinical skills, whilst I was drowning in self-doubt. These discussions were held in small groups, with other friends, and with my supervisor. I believe these discussions were handled well as I heard similar responses and could release that worry, while feeling really silly because I was making great progress with my clinical skills and my clients. The intern environment was extremely encouraging, which alleviated a lot of distress and reminded me why I chose this field, I am grateful for that! I have learned to trust the process, allow myself to make mistakes, and know it will not ruin the therapeutic experience; My clients were even laughing with me when I tripped over my words, but still respected me as a professional/new clinician.

    2) The topic of concern for me is repetitive therapy. I live by the rule of “go at the speed of your client,” but with a specific client I felt I was ‘not observing’ any changes. It felt we were dancing around the same issue without getting to the core, and I had switched directions to see what they responded to, but still felt we were not making any progress. I put ‘not observing’ any changes because I was actually observing a slight change in their response to therapy. A lot of our time together was them moderately engaging in sessions but not trusting and/or understanding the therapeutic process. There was a lot of back and forth discussing the purpose of therapy, their therapeutic goals, their diagnosis, and how different interventions could support their progress…but it felt that was ALL we were doing and not moving towards their goals. As I became more patient with their speed, I realized their change in mindset regarding the acceptability of therapy. They slowly became more talkative, even laughed during a silly activity (they never laughed during sessions, which was definitely another sign of change), and explained how their understanding of therapy changed. Initially, I was weary of repetition, but now I understand subtle changes during these types of sessions.

    3) Self-reported feelings of sexual attraction intrigued me the most. This concept is funny to me because people, maybe even ourselves, think therapists are not subjective to having some sort of attraction to our clients (or vice-versa) because we are professionals. Therapy is an emotional transaction, confused feelings and admiration can rise. If this does happen, it is important to use our immediacy skills to address the matter and understand if it will be a barrier to therapy. It was also funny how many questions were tailored to this, it was shouting, “THIS CAN HAPPEN. PLEASE PROPERLY, PROFESSIONALLY, AND ETHICALLY HANDLE THE SITUATION.” The slim amount of times we talked about potential attraction to clients (or vice-versa) in class, it was just a “yeah this can happen,” and we quickly moved on, so it was funny to me how in-depth this book was. It brings awareness that yes it happens, here are ways it can happen (mild to extreme responses to this sexual attraction), to be aware of it, and how to professionally deal with it.

    Reply

    • Alexa Berry
      Jul 09, 2022 @ 21:21:22

      Definitely not rolling my eyes! I always admired your ability to be open about how you were feeling in your clinical journey 🙂 I liked what you had to say about repetitive therapy. I think especially as new clinicians it can be so frustrating when it seems like clients aren’t making progress and it can be difficult to differentiate between repetitive therapy and going at the pace of the client. I found that one of my clients who was constantly in that state of unrelenting crisis fell into the repetitive therapy pattern- luckily they responded well when we processed this during treatment!

      Reply

  10. Anna Lindgren
    Jul 07, 2022 @ 16:08:47

    One myth that really interested me was that “therapists are invulnerable, immortal, and ageless”. The story about the clinician who was held hostage by a patient was alarming and made me want to give greater consideration to safety. I think that this will somewhat depend on the population I’ll be working with, but I am potentially interested in doing in-home therapy and it has crossed my mind what I would need to do to keep myself safe when in someone else’s home. It’s an interesting myth to me because I think that we do tend to assume the best of people that we are trying to help, but also we should be aware that our helpfulness can be manipulated or used against us, especially since the field is now mostly women. I’m interested in finding ways to keep myself safe without making assumptions or negative judgments about my clients. I think finding easy habits that I’d use for everyone like always sitting between my client and the door might be a good first step.

    I would say that theory-obliterated therapy concerns me the most as a therapist. I tend to be a pretty conflict-avoidant person in my personal life and so I’ve had to work on my ability to discuss difficult topics and address things directly with my clients. I feel confident in my abilities to do that now, but I can see how therapists may avoid the main presenting problem if it is something really threatening to them, and they would need supervision to work past it or perhaps even referral to another counselor if the therapist is unable to address the referral question topic.

    From the appendix, the therapist self-reported feelings and behaviors that concerned me most were the high percentage of therapists that are attracted to their clients at some point. This tells me that this topic needs to be more openly talked about in professional settings and supervision so that therapists can process and shift their feelings about the client before an ethical line is crossed, or refer the client to another therapist if needed.

    Reply

  11. Brianna Walls
    Jul 07, 2022 @ 16:38:57

    1. Based on chapter 1, I found the most interesting myth: “therapists are invulnerable, immortal, and ageless.” The reading provided an example of how a therapist encountered a patient who began to hallucinate and threatened to kill her. Regarding the myth that “therapists are invulnerable, immortal, and ageless,” the reading goes on to inform therapists that this myth is reflected in the number of therapists who complete their training but fail to learn how to set up an office with an eye toward safety. Especially in today’s world where violence is common (unfortunately), I think this is more important than ever. No human is invulnerable, immortal, or ageless and as future therapists, I think we should be required to become educated on how to protect ourselves from possible threats.
    2. Based on Chapter 5, one “possible clue to taboo topics” that concerns me the most as a practicing therapist was “Boredom and Drowsiness as Protective Reactions” This worries me the most because as a therapist it is your job to be alert and aware during your sessions with all clients. However, if you are becoming bored or tired during a session you may miss important information your client is trying to inform you about and this is problematic for several reasons. I think this clue to taboo topics is the most important to me because personally, I find myself becoming uninterested and tired when having uncomfortable conversations with a friend or family member so I should be extra cautious if this were to happen in session with one of my future clients.
    3. Based on the Appendix, of all the information presented on therapists’ self-reported feelings and behaviors, the one that concerns me the most was fear. Yes, I was aware physical and verbal abuse occurs in this field of work but after seeing the numbers presented, I was shocked by how many people reported abuse. This makes my point for question one even more relevant.

    Reply

    • Alexa Berry
      Jul 09, 2022 @ 21:27:39

      Hi Brianna-

      I like how you pointed out that some therapists fail to learn how to set up an office for safety. I am definitely guilty of this. I don’t think anyone ever mentioned that we as therapists should sit closest to the exit, and I only learned this as I was wrapping up my internship. I am grateful that I never encountered a situation where I did need to get out of my treatment room because I surely was not set up for success in the way of safety precautions. Also- something I found that works well if you notice yourself getting tired in session is readjusting your posture or having a sip of water/whatever your drink of choice is!

      Reply

  12. Anne Marie Lemieux
    Jul 07, 2022 @ 16:53:02

    The myth that with extensive education and training, therapists have a firm grasp of logic and, whatever the limits of their knowledge, do not fall prey to basic logical fallacies was interesting to me. I found it interesting as I have seen many therapists jump on board with the latest “purple hat” therapies. These are intelligent, well educated professionals that are able to take pieces of therapeutic models they find interesting. They focus on aspects of it that they find intriguing and interpret them as facts without evidence based support. Also, it is difficult to challenge their thinking as they are often steadfast in their thought process about it. For example, they have argued that just because an intervention has not been proven to work, doesn’t mean it is not effective. Which is a challenging argument but it is not best practice to be providing interventions that have not been researched to be effective and in some cases can cause harm as seen historically with rebirthing therapy and conversion therapy. These outrageous practices were often conducted by well educated and trained therapists.

    I am the most concerned about repetitive therapy. I think it would be difficult to acknowledge that a client is not making progress without personalizing it as a failure. I think it would be easy to have a client avoid doing the work of therapy and easy to join them in their avoidance, especially when there are genuine other “crises” happening regularly.

    The self reported feeling that surprised me the most was sexual attraction that therapists have towards their clients. I remember in ethics thinking that we spent way too much time discussing this topic because it was so unlikely to happen but in reviewing this it is apparent that it happens more frequently than I originally imagined. I also think that it is such a taboo topic that it is difficult to process with a supervisor openly and therefore can often fester or grow making it more likely that boundaries will be crossed.

    Reply

  13. Laura Wheeler
    Jul 07, 2022 @ 18:40:37

    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?

    The idea that piqued my interest the most were the questions regarding being afraid of or disliking a client. I feel like in my current role I am having to very deliberately check in with myself and re-focus when working with some difficult clients. Ultimately in working with very difficult children, I find myself feeling exhausted of working with them when their parents are not following through at home. I know that this usually has nothing to do with my direct client (the child, though of course a lot of the work is with caregivers, too) but I still need to take a step back and go into the work with a clear mind and the most patience I can muster.

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

    The biggest concern for me is avoidance, largely because this is something that I personally find a bit difficult to identify in the moment. I have found that sometimes I don’t realize until after the fact that a feeling or circumstance was subconscious avoidance, and that is obviously not productive (or professional).

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

    The topic that surprises me the most is therapists being sexually attracted to their clients. I have found that for me, boundaries are so firm with clients that I can’t imagine how a therapist (who is professionally trained, licensed, and aware of ethical standards) can blur such a concrete line with a client. I understand that everyone is human… but, it was still surprising to me.

    Reply

    • Brianna Walls
      Jul 09, 2022 @ 20:57:41

      Hi Laura, I too found myself having to check-in with myself when I found myself disliking a client or not being too fond of them. I worked with clients who had co-occurring disorders and sometimes we would get a client who was court ordered to attend the program so they had no intentions on getting or staying clean and I found myself frustrated with these people because they’re were others in the program who needed to get clean just to stay alive. I would find myself sometimes getting annoyed or frustrated after a group either because they did not participate or pay attention or were disruptive/disrespectful during a group. I thought this was unfair to their peers. So, I agree it’s important to check-in with yourself and refocus on why you are here and your role.

      Reply

  14. Connor Belland
    Jul 07, 2022 @ 18:46:50

    1.) What piqued my interest the most was the Question: Does your sexual orientation affect your responses to clients physical attributes? Does it affect your responses to client’s discussion ns of sexual feelings or behaviors?, I would say that this has affected me in session with clients before. Seeing many adolescent clients, they often come into session with confusion or strong feelings about self-image, sexual orientation or behaviors. Highschool can be an emotional place for a lot of adolescents and I had multiple talks with clients about sexual orientations and self image. One thing with self-image is building confidence in the client which initially my mind would think to pay them compliments whenever they come into session to build rapport but I am afraid to do this especially to female clients as a straight male counselor as to not make anyone uncomfortable. I usually feel the need to not refer to physical appearance at all with my clients as to not make them uncomfortable when in some cases it may be necessary. I try to avoid it.
    I would say one of the clues of taboo topics that I notices working in my internship was “Seeking Repeated Reassurance from Colleagues”. When I am presented with a tough case or a client brings up a taboo topic I am often unsure what the right way to proceed is, so I ask my colleagues. But often times I do have good instincts on how to handle these things but I lack the confidence and go and check with my colleagues anyways and possibly rely on them for advice too much when I should be more sure of myself.

    I think the feelings of fear in therapists are very real. Although many reported this and other feeling, as a therapist I feel fear most about the unexpected. What going to walk in the door on any given day, but with time and experience this will get better but it surprised me to see that so many other therapists also have similar feelings, I guess that makes me feel better maybe.

    Reply

    • Brianna Walls
      Jul 09, 2022 @ 20:51:02

      Hi Connor, I never thought about it from a male perspective until your post. Working with adolescents is tough enough but when you bring in self-image issues it gets even tougher. As a female therapist I feel like I would be able to relate to female adolescents and self-image issues but you are right it is difficult for a male because you don’t want to come off as “hitting on” or “flirting” with your clients when you complement them. So I agree, being a male therapist seems extremely difficult when dealing with self-image issues especially if the client is female.

      Reply

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Adam M. Volungis, PhD, LMHC

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