Why good therapists suffer from exploitation

Barry Duncan has an article in the current Psychotherapy Networker asking, “Why would anybody become a therapist?” The job offers low pay compared to other jobs with similar training requirements. Workers in community mental health are often stretched beyond the breaking point. And as we’ve covered here regularly, employer abuses of therapists are unfortunately common. When even a single therapist pushes back against exploitation, it makes a real difference. But that doesn’t happen very often.

Duncan’s article offers some interesting overlaps with our past coverage here. It can explain fairly well why even the best therapists can be easy targets for exploitation at work.

We experience the job as a calling

Duncan writes that “above all, [therapists] value connecting deeply with clients and helping them to improve.” So when faced with ridiculous productivity or billing standards, massive paperwork burdens, and a variety of other indignities, we tend to endure them. Sure, we grumble about them. But when we are in a job where we’re actually experiencing that deep connection with clients, we tend to value that connection above the more irritating parts of the job. Some of us even make martyrs of ourselves, pointedly showing the world how we are suffering so that others can heal.

KPBS in San Diego did an excellent documentary in the early 2000s called Child Protective Services. In that film, a CPS worker details how emotionally difficult the job is, and then pivots to why she keeps going to work. “It’s the children,” she says. By the end of the film, she has left CPS, citing burnout.

She’s not alone. Discussions of burnout and self-care are frequent in this work, precisely because we all agree that it’s a tough field to be in. And even those very discussions often come with a subtle and damaging message for therapists: If you’re suffering, it’s your own fault. You should endure the bad so that you can get the good, and just take better care of yourself. I think that’s nonsense, but many therapists firmly believe it. We experience the work as a calling instead of a typical job. So we see our suffering as necessary, even noble.

The research Duncan cites is compelling, and certainly matches my experience with colleagues. No one I know got into this work to get rich. But that doesn’t mean we ought to be OK with suffering exploitation. We still have our selves and our own families to take care of. And as I’ve said before, if a clinic serves one vulnerable population (its clients) by exploiting another (often early-career therapists desperate to get hours for licensure), they need a new business model.

We avoid conflict

More times than I can count, I’ve heard stories of employers or supervisors committing severe violations of legal or ethical standards. Almost always, the story is immediately followed by, “But I don’t want to get them in trouble.” It makes sense. Many therapists enter the field precisely because they are so skilled at resolving conflict. We don’t often come in with an equally well-developed skill set for actively choosing to engage in conflict, or even purposefully starting conflict. And yet, that’s precisely what professionals in other fields do when something isn’t right in their line of work.

Simply put, most therapists aren’t good at pushing for legal changes, standing up on matters of public debate and controversy (even when the underlying science is convincing), and taking on powerful interests that work against us or our clients. That’s not meant as criticism, just as an acknowledgement of where our skill sets are. Graduate school for therapists generally isn’t geared toward helping us be more effective fighters. It’s geared toward collaboration, with clients, colleagues, and others involved in a client’s life.

When we can’t fight, of course we don’t win. There are a lot of potential battles where I believe we as therapists have both the moral and legal high ground, especially around employer abuses. But we need people who have suffered direct harm from those abuses to actually file complaints and see them through. And our avoidance of conflict, which can help a great deal in the therapy room, here simply allows employers to go on abusing the rest of their workers.

We’re trusting

Good therapists tend to take clients at face value, and believe in the goodness within those clients. We seem to do the same with people in general, including employers, and even those who would do the profession harm. We can have a hard time accepting that supervisors, employers, clients, and even some colleagues are not our friends. Their interests do not align with ours. It isn’t our job to protect them, and it isn’t their job to protect us. When we trust or assume that they will do it anyway, we put ourselves at risk.

As a general rule, trusting is not a bad way to live. I’ve often said that I would rather offer people the benefit of the doubt, and sometimes be proven wrong, than maintain a consistent level of distrust and sometimes be proven right. That may well be part of why I’m a therapist. But it’s worth noting how different that mindset is from how other professionals approach their jobs. As just one example, consider the journalistic credo “If your mother says she loves you, check it out.” Trusting a single source of information — especially when that source might have their own reasons for spreading false information, just like our clients and employers might — is considered bad journalistic practice. We might do well to adopt at least some of their skepticism.

We don’t know what to do

Good therapists are defined by their clinical skills. For better or worse, to survive in this field requires more than simply being clinically strong. You need to know how to find a good job, differentiate yourself from other therapists, negotiate for pay, protect your legal rights, advocate with third-party payors, and much more. Each of these involves, in various ways, fighting. But the people who are most drawn to therapy often aren’t especially skilled at fighting. And therapist training typically doesn’t teach these other skill sets.

On our end, we’re working on it. If you are suffering (or have suffered) exploitation in this field, there are specific ways you can learn to fight and win. Have a look:

Ask employers to #PostThePay
How to fight for back pay from an unpaid internship/associateship
Negotiate for more pay
Fighting illegal labor practices as a prelicensed therapist

We’ll of course keep adding to this library, helping therapists fight more effectively. We don’t think it’s right that good therapists suffer precisely because of the things that make us good therapists. If there are other topics where some knowledge of how to fight and win would be helpful, shoot us an email.