Becoming a good therapist

How do I become a good therapist?  I remember asking myself this while I was in school (truth be told I still ask myself this). Of course this is part of who I am….all about being good or even the best I can be at something.  Sometimes in my life this drive can get in my way, but in my profession it’s really helpful.  It helps me keep being better at what I do, moving forward, changing what I do and looking for different ways to do good therapy.

The longer I work in this field, the more I know “not all therapists are created equally”.   You may be saying….well duh Alice…but really, the community doesn’t always know this.  When you are hurting and you are desperate for help, you reach out trusting you will get that help.  The truth is, there are some in our profession that are not helpful at all.  And then there are some that are very helpful.  Luckily, there are researchers out there who have looked at the difference between the two.   Wampold and Imel give us a body of information in their article The great psychotherapy debate: The research evidence for what works in psychotherapy.

What Doesn’t Matter:

Theoretical Orientation – They all work

Experience – Therapists earlier in their career are actually better than those with more experience

Therapist characteristics of age and gender

Therapists rating

How many of us spend time trying to get more experience, or working hard to find the best theoretical model?  We spend a lot of time and money here.  Research tells us, at the end of the day, these things don’t matter when it comes to being a good therapist. 

What Does Matter:

Alliance - Learn to form a collaborative working alliance with a range of clients (even challenging clients)

Make it Simple – Can explain aspects of therapy effectively and succinctly

Attuned – Can recognize metacommunication happening as it happens (example picking up on body language, seeing facial expressions that are in discord with words)

Grounded- warm, accepting, empathetic, modulate own emotional response while staying focused on client and his/her problems

Humble- questioning our own effectiveness and work to improve

Understanding- offering an explanation for client distress and a means to overcome it. (why do they do what they do and how do they minimize what is limiting them?)

So if you are like me, and you want to be the best therapist you can be, spend less time doing what doesn’t matter and more time doing what does.  If you are not sure about your ability to build an alliance with all clients, get training in that.  If you struggle taking hard concepts and making them simple, get coaching on this.  If you are not very good at being attuned to clients, consider extra learning in that area. 

To summarize, to be a good therapist, evaluate how you do on what matters. Spend less time and money on what doesn’t matter, and more time and money on the things that do. 

Wampold, B.E. & Imel, Z.E. (2015). The great psychotherapy debate:  The research evidence for what works in psychotherapy (2nd ed.). New York: Routledge.

Wampold, B.E. (2016 September/October)  Can we become better therapists? Yes, we can!. Family Therapy Magazine, 15(5), 16-19.

Taking it Home

“This client is really driving me crazy.  I don’t know what to do with them anymore.  No matter what I say they have a reason or an argument for why it wont work.  I find myself dreading the session”.

Anyone else been here?  At some point in our careers we all find ourselves in this place.  Sometimes it’s with the ‘resistant’ client.  Sometimes it is with the client who is really good at asking for help….over and over and over….and only from you.  Sometimes it’s with the client who is in so much pain and hurting that it’s hard for either of you to see any light at the end of the tunnel.  What do all of these have in common?  No matter how hard we try, these are the clients that follow us home (figuratively…I hope). 

So what do we do with them? Respond vs. React.  More often than not, when these clients are in our room, one of them triggers us into our own stuff, which causes us to react out of our old patterns.  This reaction sets off a chain of events and before we know it we are in really deep, feeling what they feel, imagining what they imagine, carrying what they carry.  All of these are reactions.  For us to do our best work, we are called to empathize without taking it on.  The best way I have found to do this is with the notion of response vs. reaction.  So here are some tips on how to respond…

11)      Setting up the internal awareness- Take a moment to close your eyes, center yourself, and then imagine an object out in front of you that represents what it is with this particular client that seems to stay with you.  As you get an image of this object, keep it out in front of you and notice it’s shape, size, texture.  As you take time with this, notice if there is a color.  Then take a moment to position your arms around the object as you currently feel like it is positioned in relation to your body.  Notice how uncomfortable that feels.  When you are ready, push the object out away from you so that it is just the right distance out. Where ever you place it in the room is just right.  Now hold your hands up like a boundary and position them just how you need them to be so that the object stays out from you vs. on you.  Anchor in that position to where it feels ‘known’.

22)      Get perspective – Consult with a colleague, see if they can offer any insight on counter-transference that you may be experiencing that pulls you in.

33)      Prepare before the session – Prepare in a way that allows you some time before the client comes to ground/center yourself into the most professional and wise self you have to offer.  Do your internal awareness exercise to put the object in it’s place. Remind yourself of your clinical goals for the session.

44)      Consider your own therapy – If the issue continues, consider exploring what it is about this particular client dynamic pulls you in.  Having the perspective of a therapist to help you work through this pull can benefit you and your current and future clients.

We are all human, and with that humanity brings the pull to connect with others.  Sometimes that connection is a reaction which is unhealthy for us and the client.  Choosing response vs. reaction is a hard choice and sometimes not one that comes easy.  However, this choice lessens the consequence of ‘taking it home’ which is something I know many of us strive for. 

The Power of Why

The Power of Why?

One of the things I have realized I do in my practice is ask myself “why?” This is really a powerful question.  I remember in school they always said avoid the question why.  So my starting off with this simple but complex word my trigger some of you or completely put off others.  If you can stay for just a few more seconds maybe an opportunity will open up for you. 

When a client comes in my office I immediately start an internal question of “why are they here?”  Really this word is motivated by curiosity, and curiosity keeps me grounded and objective.  Then as they share in the initial session of why they are here I’m asking myself “why is their problem a problem?”  Then as I form a hypothesis about this I ask myself “why are they sharing what they are sharing?”

All of these ways of asking why begin forming a hypothesis in my mind to help inform my exploration and treatment with clients. As treatment begins, I continue with the “whys”. The “why” helps me with evaluating countertransference, transference, resistance, success.   Consider curiosity to help ground you in the following treatment steps.

·       Setting client goals: “why are they here?”, “Why is the problem the problem?”, “why does the problem continue to be a problem?”

·       Client Stuck Place: “Why is the client stuck in this specific way?”, “How could this problem be helpful?”, “Why would this problem have been helpful to them at some time in their life?”

·       Countertransference: “why does this client bother me so much?”, “why do I dread this client?”, “why do I look forward to this client?”, “Why am I bothered when the client doesn’t meet treatment goals quickly?”, “why do I feel relief when the client does this?”

·       Transference: “Why am I the one the client keeps calling?”, “why is the client yelling at me?”, “why did they choose me as their therapist?”, “How is what they are doing right now normal for them?”,  “What purpose doe s this serve for them?”

·       Success: “Why did they get better?”, “Why did this work for them?”

Asking the question of why and staying in a curious place can help inform every phase of treatment.  If you ask the question why and are struggling with the answer maybe be curious about that, or call a colleague and see if they can help with exploring why.  If “why” is just too difficult for you,  try “How” or “what” inserted in the same type questions and just see what happens in your treatment process.