Helping People

Me: “Why do you want to enter this profession?”

Intern: “I want to help people”

Me: “How do you plan to help people?”

Intern: ….blank stare….

The answer to this question is pivotal to the rest of one’s journey into making a career as a therapist. Of course we first think about defining how we help people by the methodology or theory we plan to use as a therapist. The answer is actually much more complicated.  What it takes to ‘help people’ is so much more than what Hollywood would have us to believe, as a simple formula of

 listen + give advice/opinion = helping people. 

To start down the road of ‘helping people’ one must be prepared for the journey.  To be prepared one must know what to pack.  The answer might surprise you.  It has quite a bit to do with the therapist themselves.  The literature tells us that the following are the top factors that determine client success and ultimately satisfaction:

Ø  Therapist participation in own therapy

Ø  Experience as a therapist (years in practice)

Ø  Regular attendance of trainings on latest treatment methodologies

Ø  Flexibility in treatment methodology to target specific client problems

Ø  Availability between intake and subsequent appointments is high

Ø  Expectations about the therapy process communicated beforehand

Ø  Agreed upon central problems

Ø  The use of Client informed feedback at the end of sessions (see link for researched format on Client feedback).

Research tells us, to ‘help people’ we need to care for ourselves by attending our own therapy, learning all we can so we can feel confident in what we do, and take the guess work out by asking the client more about ‘how am I doing?’.  Looking at each of these a little closer here are a few ideas on why these are important and how to accomplish them.

1)     Therapist participation in own therapy- We learned all about counter-transference as we attended school and endured licensure supervision.  In short, this is when our own history and experiences come into the therapeutic process and cloud our judgment or guide us to make decisions in treatment that may not be best for the client.  Therapist participating in their own therapy minimizes this and strengthens the therapists core self so that the therapist can accurately meet the needs of the client.  How to get your own therapy: So our world gets really small when we are trying to find a therapist and realize most of our friends are therapists and cannot ethically meet with us, or we may see our personal therapist at local trainings and conferences.  With this in mind there is a growing population of therapist who solely develop their practice on working with other therapists.  They have specific guidelines they follow to minimize confidentiality breeches and increases comfort of therapist clients.  You may look for clinicians in your area who do this.  Consider asking other professionals if they have gone and who they saw for therapy.

2)     Clinical Experience- This seems self explanatory, however we all have to learn somehow.  What is very important is that as we are learning and getting this experience we are in constant, effective, self explorative, growth developing supervision.  Good therapists get the experience and learn from it.  Some ideas of how to get experience: apply for local community health organizations, volunteer for a local non-profit counseling center, volunteer at a local free health clinic, apply for internships, and consider apprenticeship with local clinician who may allow you to do co-therapy with them.

3)     Regular attendance of trainings- Become a member of your local professional association so that you can be made aware of the most up to date clinical treatments. This will allow you to also get discounts on any trainings they offer through their association.  You can also go to google scholar and type in meta analysis or literature review of best treatment practices in psychotherapy. This will give you evidence based practices to focus your trainings on.  Scott Miller’s website is also a good resource for up to date bestpractice.

4)     Flexibility in treatment modalities- You don’t have to know all treatment modalities, but be well versed and clearly trained in a few best practice modalities that allow you to feel confident in working with client’s that may not fit one particular modality or another.  Consider the population you see the most or get the best results with and find all the modalities with empirical backing and get trained in them.

5)     Availability- It’s great if you are good, and even better if you are booking up your schedule, however it is not good for your client if you squeeze them in for an intake appointment then cannot see them again for 3-4 weeks.  Consider your availability over the next month when scheduling your intakes.

6)     Expectations about the process discussed beforehand- It is hard enough for a client to reach out and make that initial phone call, but what is also hard is arranging your schedule and finances to be able to make the appointment.  If the client isn’t made aware what your regular availability, fees, policies are ahead of time, it could be a very frustrating wasted trip for them.  Consider having an outline of expectations and general policies available on your website or for email prior to the initial session.  You may consider offering a 30 min. reduced rate consultation to make sure you are a good fit with a client.  This would also allow you to review all expectations and get agreement ahead of time.

7)     Agreed upon central problems- To retain clients you must be working towards their treatment goals, which in turn results in client satisfaction.  So first step is to identify what are their goals for therapy.  Most times this is pretty clearly defined by the client, on occasion it is more ambiguous and takes a little more work; either way your first goal in treatment is to identify client goals.  Next, collaborate with the client on identifying which goal should be approached first.  Then work towards that goal until you and the client both identify it has been met.  I recommend some form of measurement be used as a pre and post to help give an objective overview of met goals.

8)     Client informed feedback- The research tells us the more involvement a client has in their treatment process from the beginning, the better their outcomes and overall satisfaction with treatment.  One of the primary ways to involve clients in their treatment is a regular feedback process.  This feedback process can rate weekly symptoms increase/reduction, client satisfaction with clinician, and/or both.  Some examples of how to do this range from a formal process such as the SRS, ORS forms found on the link listed above.  Less formal would be to simply ask clients at the beginning of treatment session about symptoms, using likert scales, and then asking at the end of treatment if they got their needs met.  Some phrases I use “Did you get what you needed today?” and “is there anything you needed that we did not get to today?”

Completing all of the following brings us to what qualitative research tells us truly works in ‘helping people’ and that is “A relationship with a wise, warm, competent professional first….then symptom relief”.

For more information about how to ‘help people better’, see articles listed below. 

More to come:  How do I retain clients?

References:

• Gearing, R. E., Townsend, L., Elkins, J., El-Bassel, N., & Osterberg, L. (2014). Strategies to Predict, Measure, and Improve Psychosocial Treatment Adherence. Harvard review of psychiatry, 22(1), 31-45.
• Goodman (2013) thesis:    https://etd.auburn.edu/bitstream/handle/10415/3899/Goodman.Rebecca_FinalThesis.pdf?sequence=2
• Roos, J., & Werbart, A. (2013). Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review. Psychotherapy Research, 23(4), 394-418.
• Swift, J. K., & Callahan, J. L. (2011). Decreasing treatment dropout by addressing expectations for treatment length. Psychotherapy Research, 21(2), 193-200.
• Best Practices : http://www.scottdmiller.com/category/evidence-based_practice/