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Blog Psychotherapy Clinical Issues

We Are Our Product and We Take Things Personally

We are Our Product and we take things personally

Dear therapists,

We are our product and we take things personally.

When I look at this sentence now, my response is “well, duh!”

But several years ago, when my family was dealing with the crisis of my dad being diagnosed with dementia, one of the resources we used was an attorney to help understand the legalities of protecting my dad in various regards.

Now this is what was so profound…

The attorney stated that she is her product. We are paying for her knowledge and experience to guide us.

Let me say that again in a different way dear therapist,

YOU are your product. Clients are paying YOU for your knowledge and experience.

If this is a new concept to you, please pause a minute and let it sink in.

YOU are your product. Clients are paying YOU for your knowledge and experience.

You see, unlike other types of providers, we can’t rely on bloodwork, CT scans, etc. to treat our clients. We need to pull from our years of schooling, supervision, peer consultation and experience to provide the right assessments and treatment to clients.

Now let’s up the ante a little bit.

We take things personally.

That’s right. When a client terminates unexpectedly, we have a no show, we have trouble filling our caseload, or we get difficult feedback from a client or colleague about our product (us!), WE take it personally.

For each of us, the things that activate shame, guilt and imposter syndrome, to name a few, are different. But the feelings we experience are pretty similar for most of us in our field.

I was recently at a networking event with other therapists and we were discussing imposter syndrome. I casually threw out the remark…”You know you need support from peers when you are sitting with a client and find yourself thinking that they could really benefit from therapy. And then you realize, they are in therapy…with you!”

It was amazing to see the head nods and smiles as this thought resonated with my peers.

Some of them may have even been allowing themselves to acknowledge this for the very first time (thanks shame button).

If you believe you are alone in any of these feelings, I can assure you you’re not.

Spending time with peers, and in supportive peer consultation groups, is a game changer in understanding how we bring our humanity to our work.

  • We NEED to hear other therapists talk about these issues.
  • We NEED to have colleagues not only normalize these experiences but also provide support so we can move beyond them.
  • WE NEED to put our product’s needs and reactions into the equation when we show up at work. (Hint, hint…remember I’m talking about you as your product.)

What are some ways you are struggling with the way your work impacts you?

What are you doing about it?

Categories
Blog Psychotherapy Clinical Issues

Is This Field Right for Me?

Is This Field Right for Me?

Therapists continue to spiral in overwhelm…
 
too many clients,
openings but not getting referrals due to limited networking capabilities,
huge issues with progress note writing,
compassion fatigue,
self-doubt, etc.
 
Along with that, I am hearing many therapists questioning if this field is right for them these days.
This is fairly typical for newish therapists facing overwhelm, but y’all, this is happening with more and more of us…even seasoned clinicians.
 
So what to do?
1. Take a breath and allow yourself to lean into the feeling. It’s ok that it’s there.
2. Give yourself some time off if possible. If you cannot afford that, there are alternatives to taking a full break from clients. Hear more about that in this video (jump to 4:18 in the video).
3. Reach out to peers who know you and can help you talk through your options.
4. Take a look at how you are caring for yourself.
5. Take a bird’s eye view of your life to see if there are other areas that are overly taxing.
6. Assess your budget. Are there places you can trim back to allow for a lower caseload.
7. Think about your passions. Are there ways you can leverage your clinical skills to work in a different way?
8. Understand that ‘passive income’ is mostly a myth. Branching out in new ways will take time and effort. Effort with a different focus may feel more expansive, however, so shifting your efforts might be a relief.
 
Please know you are not alone in this.
 
You have colleagues who are also struggling who can understand how the pandemic is impacting you in a way that those not in our professional do not.
 
Be kind to yourself.
Get support.
Your clients need you to be ok but YOU need you to be ok as well!
 
If you are looking for support in the form of peer consultation, now is a great time to reach out to me. I have a few openings in our small groups and would love to chat with you about what you are looking for.
Categories
Blog Psychotherapy Clinical Issues

Pandemic Stress and how it is Impacting our Sessions

Pandemic Stress and how it is Impacting our Sessions

As the toll of the pandemic continues on, therapists are seeing the effects becoming more and more present in their sessions. One issue that is being discussed regularly in recent months in our peer consultation groups is difficultly managing emotional regulation by the therapist. 

 

As therapists, we are used to compartmentalizing our lives during our sessions to keep the focus on the client and how to best serve them.

 

Many of us have experienced a time when something going on in our personal life would at times intrude into our thoughts during sessions.

 

Since the onset of the pandemic, more and more therapists are struggling to stay emotionally regulated during their clinical work.

 

I was horrified a few months ago when I found myself being questioned by a client about the vaccination status of our family before the upcoming holidays. Instead of exploring why they were asking, deflecting or using another therapeutic technique, I found myself feeling defensive and activated due to the way this issue was playing out in our family.

 

I have been practicing a loooong time and had not had that experience in many, many years.

 

When processing it later, I felt shame, concern for the therapeutic relationship and disappointment in myself.

 

Here’s the thing though, it is happening to a lot of us right now! 

 

For example, therapists with anxiety are reporting increasing symptoms before and during sessions as their clients discuss the very issues the therapist is also experiencing.

 

So what is a therapist to do when encountering this in their work?

  • Take a moment to center yourself and decide how the session should continue…addressing it, moving on or something else.
  • Be kind to yourself after the session. You are not the only one experiencing this.
  • Remember that we are hyperaware of our function during interactions with clients but what feels huge to us may not even be of note to the client.
  • Get peer support!!!! Now is a great time to reach out to your colleagues, consultation group or therapist besties for support.
  • Remember that even on our worst days, we are likely showing up for our clients in a beneficial way. Have you ever revisited something from the previous session with a client that felt concerning to you but they were unaware or unfazed by what happened?
  • Assess if this is a one-off happening or if it is occurring more often. This will guide your next steps.
    • Maybe you need to schedule your day with more time between sessions
    • distribute your sessions differently throughout the week
    • or if it’s an option, take some time off.
    • Canceling even just one or two clients during any given week can provide some much needed respite without a complete loss of income. (And yes, I did not there! Deciding to cancel a session factors in the needs of our client but in private practice, it also should factor in our finances and well-being, and it's OK to name this. You are still a caring professional.)
  • Plan ahead. Before sessions, take time to check in with yourself and think about the client you are about to see. Are there topics or reactions that could be activating to you based on what you know about them? If you are virtual, do you need a sticky note on your monitor to remind you to breathe? Do you need to allow for additional self-care or time to yourself after the session?
  • Go wash your hands after the session. Focus on the warm water and foam of the soap on your skin. Take deep breaths, relax your shoulders and jaw, pull your tongue off the roof of your mouth, and rotate your head from side to side. Don’t forget to keep your favorite lotion nearby to apply for further comfort.
  • Talk to your own therapist to get help establishing a plan to address the increased feelings, reactions or burnout you are experiencing.
  • If you are a newer clinician, please understand this is not a typical scenario in our field. There are many overwhelmed newbies as well as seasoned therapists out there questioning if they can do this work. I will address this more in a future email.

 

As much as we don’t like to think about it, 

therapists are humans and our own needs have to be a part of the equation of our client work.

 

Long gone are the days when the sole focus is on what is best for the client. Sure, they are and should be our main focus but if we are compromised in any way, there is the potential for harm instead of good.

 

And as I have been saying for about a year now, we are looking for OK right now in terms of how people are doing. We need to lower the bar on what we are capable of as we approach 2 years of pandemic living.

 

None of us knows what our new normal will eventually be but the reality is that getting mental healthcare is becoming more widespread and normalized. While this has been a blessing for those of us working with populations of people who have previously never considered accessing therapy, it also means more clients are seeking services without more therapists to provide it.

Categories
Blog Psychotherapy Clinical Issues

Two Types of Therapist Self-disclosure

2 Types of Therapist Self-disclosure

If you asked a dozen therapists their views about self-disclosure, you’ll likely get a dozen different answers. For most of us, our training and treatment modality informs whether or not you think this is a good or bad thing. But have you considered that there are 2 types of self-disclosure?

Let’s break it down…

1. Voluntary self-disclosure

This occurs when a therapist shares something personal with a client. Those who do this, hopefully, assess the benefit to the client for the sharing it, and recognize the shift in the relationship that can occur because of it.

Most therapists I know who have been in practice a while, will tell you their views on this has changed over time. And the view may be client specific; you will disclose with some but not others. And that’s ok.

Keeping the therapeutic value in mind seems to be the common denominator with those who do occasionally self-disclose.

2. Involuntary self-disclosure

This type often occurs when there is some type of visual or auditory clue that the client picks up on. For example, your growing belly is likely a good sign you are pregnant or having something going on with your body.

Some other examples include moving into a new office or changing practices, traveling while working, a change of hairstyle or other outward feature, going on medical leave or being in the media (in a good way or not so much).

So what do you do about the involuntary-types of self-disclosure that sometimes occur in our work?

First, it’s important to think ahead about these types of things so you can determine how you want to respond.

You may choose to share some or all of the details or you may choose not to. In either case, it’s helpful to come up with specific language around your decision so you don’t have to figure it out on the spot.

For example, early in my career I got a very different haircut than I had previously had and was wholly unprepared for the deluge of comments and opinions I received from clients.

Wardrobe choices at times have fallen into that same category. “What carpet did that dress get cut from?” (On the upside, no matter how you handle those situations, it might be an indicator that you have developed trust with the client and there can be lots of therapeutic value in how you respond.)

Next consider that you will likely benefit from discussing this with colleagues. Consider the type of involuntary self-disclosure you will be experiencing and how you plan to respond.

When you run it by your colleague, they may have input you find helpful which can either help you feel confident in your decision or help you decide you want to handle it in a different way.

It’s hard to do this work in a vacuum so if you don’t have colleagues to bounce things off of, you should consider ways to meet other therapists and/or join a clinical consultation group.

After a few encounters, assess how it is going. If you get unanticipated responses, you may need to rethink your position or how you are conveying the information.

Again, this can be a great time to reach out to a colleague.

Like it or not, we are in a field that relies heavily on our relationship with our clients. That can make our exchanges with them more personal than we anticipate or desire.

By having an awareness of these types of possibilities, you give yourself the advantage of planning ahead, considering both your needs and those of your clients, and hopefully, you won’t experience feeling shell shocked in a session by something you didn’t see coming.

If you have experienced involuntary self-disclosure, comment below. I'd love to hear about it and how you handled it.