Therapists often fear manualized treatments in psychotherapy. If the therapy process is boiled down to a script, the fear goes, the actual therapist becomes interchangeable with anyone else following the same script. Taken to its logical end, if therapy is just a set of manualized techniques, we could easily be replaced by robots.
My first six months of seeing clients while in graduate school felt pretty crazy, though at the time I didn’t realize how crazy. When we are on a significant growth trajectory and learning curve, it’s challenging to see through the fog of all the factors involved in adjusting to becoming a therapist. It seems whenever we are in an important and difficult phase of life — potentially transformational — it’s hard to see what growth is actually occurring.
Looking back on those first six months of clinical work has taught me some valuable lessons. When I was seeing my first clients, I wish I had known how to intentionally let go of the pressure I felt to make something happen or employ technique.
Tyra and I both hear a lot of horror stories. It goes with the territory. Therapy is hard work, and community mental health work is especially challenging. Clients may have severe mental health problems, other major health concerns, substance use struggles, inconsistent employment or housing, and a wide variety of other social and environmental problems — all overlapping. The therapists doing their best to help clients in these settings are themselves often overworked and underpaid. Many are in the early stages of their careers, making it more difficult to know what’s normal in that kind of work setting. How can you tell when a work environment in community mental health is need of fixing? How can you tell when it’s better to just leave?
It’s fairly common knowledge that the gender balance of a profession and the pay in that profession are correlated. Jobs populated primarily by women pay less, on average, than those populated primarily by men. But it’s rare to get a clear sense of why that’s the case. The therapy world offers a rare exception. It used to be that most therapists were men. Today, the overwhelming majority are women — and pay is meaningfully lower. But we actually know which change came first.
Therapists and counselors are increasingly required to formally gather outcome data on their work. This is good: The more data that we have on our work, the more intentional and effective our clinical decisions can become. Regularly collecting and attending to outcome data, therefore, suggests constant movement towards improvement.
Many therapists struggle, however, with questions about what data to gather, and how to best gather it. Even among those who philosophically agree that regularly collecting outcome data helps to more meaningfully direct therapy, they often don’t do it.
Thankfully, there are a number of easy ways for therapists to collect outcome data. Many come at no cost. The following are just three of the many different tools/assessments therapists can use to collect and interpret outcome data.
Language fascinates me. As therapists, we use language to reframe situations, craft metaphors, and ultimately instill feelings of hope. We recognize how powerful this tool is, so we carefully select our words when in sessions with clients. If only we did the same outside of sessions.
I love speaking with associates, trainees, and students at various events and settings. I’ve heard about the highs and lows of the journey to licensure, the successes and struggles, the hopeful and (seemingly) hopeless situations. One of the statements that always gets to me is “I’m just a(n) ___” (student, trainee, associate).
“Just.” As in “simply,” “only,” “no more than.” Imagine how quickly you would point out the use of this word to a client, drawing their attention to the potential consequences of viewing themselves in a negative light. Unfortunately, we’re not always good at catching ourselves when we do this.
It is advised early on in our schooling to practice self-care as a means to prevent and combat burnout. Preventative self-care is usually along the lines of making sure you are staying healthy. This can mean eating right, working out, or finding something you enjoy in every day, like listening to music or reading before bed. Ideally when you are burned out, self-care would include taking a day or two off to recharge, maybe going on a weekend getaway, or getting a massage.
Realistically, for many therapists that isn’t possible. As Ben discussed here last week, far too much discussion of self-care ignores the practical and financial reality of being an early-career therapist. This recent Counseling Today cover story is a great example of talking about burnout in ways that put responsibility for it on counselors’ and therapists’ own shoulders, without mentioning several of the systemic reasons why mental health professionals early in their careers actually get burned out.
We’re big fans of Scott Miller and his Top Performance Blog around here. Miller has allowed his career to be guided by emerging research, a trait that is surprisingly rare in the psychotherapy world. It has led him to some very useful conclusions about how we can become more effective. Deliberate practice and using outcome data are two specific things that we all could do that would almost certainly improve our outcomes.
There are many things about his work to admire. But what I appreciate most is his skill at walking the difficult line between being alarmist — it’s kind of a big deal that therapy outcomes haven’t gotten better in 40 years — and being supportive and uplifting for therapists who are doing their own part individually to improve. So it was an honor to meet him at the 2017 Evolution of Psychotherapy Conference, and to have him interview me earlier this year for his blog.
From the time you were in graduate school, your instructors and supervisors have likely emphasized the importance of self-care. Burnout is a real risk in the world of counseling and psychotherapy, and you have to be able to take care of yourself in order to avoid it.
These messages come from a good place. But they ignore reality for many therapists, especially those early in their careers. And those messages often come with dangerous assumptions and a dark undercurrent: If you’re having a hard time, it’s your own fault.
In late 2017, I sat down with my friends at LA-CAMFT for a wide-ranging discussion of issues that impact prelicensed therapists. Advocacy is sort of my jam, so we knew that advocacy would be a big part of the discussion. But we also got to talk about interviews, health insurance, employment, exams, and a lot of other issues relevant to early-career therapists.