I’m looking at grad school [gasps, slams laptop closed], and thinking about careers and plans and futures. (Adulting! It’s scary shit.) Which means lots of reflecting on what I’ve learned and heard about the good and awful things therapists can do. So, some notes, some things I want the future Therapist Kate to remember:
1. I will talk process.
Get an email from a potential client? Those are scary to send. Like, preventatively terrifying. And years from now, I will remember how hard it was to press ‘send’ this year. And then I will respond, right away. Even if it’s that I can’t help, that I’m not taking new clients, I will respond. Because it’s even scarier to have pressed send and never hear back.
2. I will continue to update and talk process in every step of the way.
Going to need a week to figure out my schedule? I’ll make sure to check in and update.
3. I will ask everyone pronouns and then use preferred ones in all notes and files.
Because really. This is just a habit worth developing.
4. I will have multiple avenues of contact.
Making my first therapy appointment involved no less than two websites for health services, three google searches, and one very very scary phone call. (Apologies to everyone who thought Moaning Myrtle briefly occupied the third floor bathroom that day. I didn’t have anywhere else to call from.) Then, to do intake? Another phone call. This time, a long one, conducted from my room. I had a roommate. Not to mention, this just about sums up my feelings about phones.
Email is easy! Email means clients can revise and edit and make sure they’re clearly stating what I need. They can write down lists and then give accurate pictures of their symptoms. I will have multiple ways to be contacted, because the barrier to entry shouldn’t be calling me. (Happy ending: my new counseling center takes–nay, encourages–scheduling via email.)
5. I will remember that I can’t help everyone.
This is the stray cat principle. As nice as it would be to rescue every feline with big eyes and soft fur, you have a house, apartment, or commune of finite and inchangeable size. You know this. So which cats do you adopt? The ones who get along with your life. The ones who you think won’t tear all the drapes up every night and leave you stressed and angry and neglectful of other cats.
In the same way, I will remember that it’s both unethical and downright harmful to take on clients who have issues you’ve no experience in. It’s not acceptable to take on so many clients that I let them slip through the cracks. That I owe it to my clients to take care of myself, to make recommendations and decline and refer when I think I’m not the best practitioner.
Ideas? Put them in the comments!
OK.
And the best of luck to you.
Hey!
So I was asking for specific suggests for future therapists. Given that 1) you posted a link to your own work, and not suggestions and 2) you don’t seem to be actually responding to the prompt since hey, I won’t be working in psychiatry, consider this a friendly reminder to please actually comment on the piece at hand.
You seem rather confused. You asked for “ideas.” I linked to a long post describing what I believe to be the best tradition of humanistic practice (if you’d read it you’d have seen that it deals with all of the “mental health” professions and not just psychiatry). It’s intended to be more general, but it explains – see especially the bullet points at the end – the key features of a political-humanist-liberation approach to mental health. If you find some or all aspects of that approach not to be of interest, then you don’t have to take them on board (though I would recommend having a reasoned basis for whatever general approach you decide to take, including examining its assumptions and probable political effects). So it was very much a comment on the piece at hand. My specific suggestion for future therapists is that they continue to be open to new and different ideas.
I suspect I will find myself referring back to this, or at least making my own version. Though pronouning people correctly in all files is problematic with a lot of insurance carriers, so 3.5 involves a lot of note-taking and cross-referencing, I suppose.
I’d add something like: 6. Check back in after musing or note-taking. Because nothing puts the halt on productive conversation and understanding like working from faulty assumptions or memories. (and will be thinking about more for the foreseeable future, so I might come back).
i would add to 5 that it’s not just something you do when you take on a client, but it’s something you need to reexamine as your knowledge of the client changes.
my first psychologist was good as far as the depression side of things went, but she had no real experience with the trans side of things (didn’t know what cis meant, called some one a tranny). so number 5 is right, but it’s a continuous thing, you need to recognise when the situation has changed.
I don’t know how psych handles scheduling, but I’ve been burned by it elsewhere: Always book at least two appointments at every …booking phase. Otherwise an anxiety attack, depressive episode, or other flareup can completely obliterate the go-to-appointment-book-next-one-go-to-that-etc daisy chain, and then it’s back to contact anxiety–now with added guilt! It doesn’t even have to be an appointment, just minimize the cost of getting back into the cycle.
PS: Web-based scheduling apps exist, why do we ever need to talk to secretaries over phones? They’re just doing it with software anyway…
Ooooooh. I hadn’t thought about that because yeah, I’ve always had several appointments booked at once.
Wow, multiple-appointment bookings are unusual in my experience, which has involved at least a dozen providers over the course of twenty years. I would add to this that coercive scheduling practices are really bad. Short-term prescriptions won’t apply to you (nearly every psychiatrist I’ve ever had would only prescribe me medication until the next appointment, even for stuff I’ve been taking for years), but things like missed appointment fees can also be an issue, though I can also understand why blocking out time and then having someone not show up is a problem; we need publicly-funded health care – not just insurance – I think, so that providers get paid not matter what and clients aren’t mistreated by the market concerns. I’m not sure if this one can actually be addressed in a way that’s fair to both clients and providers.
Are you familiar with the ideas of Rosenberg? He was originally a therapist, and has a lot to say about therapist-client interaction.
And maybe: 6. I will take care of myself too.
Very weirdly, I was actually flipping through this book this weekend in someone else’s library. I’m only a little familiar with Rosenberg’s work–it’s been covered as a footnote in a few classes.
I do wonder about #1.
After stressing over an email, and having finally sent it off, and then double checking what you just sent, it can be quite alarming to get an instant response (unless it’s just an automated acknowledgement). It’s a bit like puting a letter through someone’s letterbox and having it snatched away as if they were waitng behind the door.
Rather than feeling exhilarated you’ve achieved something and tense that you’ve just started something, it can feel like you’re under pressure to respond with the same speed, and now you have to agonise over another email but this time with a time limit.
I should have been a bit more clear–I didn’t meant writing an instant response. However, within 24 hours? I want that to be a habit. I’ve had too many friends (and one experience myself) who’ve nerved themselves up…only to wait a week or more to even be acknowledged.
++ to web-based scheduling systems.
Also. I’m not sure how techie the community you’ll be practicing for will be, but where I come from, emails are generally considered to be very insecure. I still can’t bring myself to send some info over email unless it’s encrypted. I personally use PGP but can adapt to other systems, but having a system for encrypted emails can be useful.
Yeah, e-mail is (sometimes: the precedent is contested and may depend on the particular local jurisdiction) legally considered public information here in USA (for example, see FindLaw’s analysis and also the ruling in Smith v. Maryland, 442 U.S. 735, 743-44 (1979) which has been used as precedent in cases involving other communications processed by third parties, like e-mail, most recently by Google to argue that it is not liable for civil damages sought in response to Snowden’s disclosures about the NSA spying apparatus), so its use might actually violate confidentiality statutes in some cases unless it’s encrypted.
I would add that perhaps finding some way to encourage clients to interview you for the first session or two (or volunteering information that’s likely to be relevant – some training programs may actively discourage this based on the flawed notion that ‘objectivity’ is actually possible for human beings, but I very much think that self-awareness and transparency of biases is the best path) might be a good idea. After years of jumping from one unhelpful therapist to the next, it finally occurred to me that I should really spend the first session asking them questions about their worldviews, training/background, and psychological paradigms (hardcore Freudians and credulous evo-psych fans are right out for me) instead of having them ask me about my issues (or doing both) so I didn’t have to waste multiple sessions figuring out that the therapist couldn’t help me. For example, someone who pathologizes (or doesn’t consider in terms of how it impacts my experiences) my anti-capitalist, existentialist/nihilist, anarchist, communitarian/socialist, constructivist, or other views that impact how I view and experience the world isn’t going to be able to help me. Ideological and/or philosophical compatibility is important (therapist and client don’t need identical views, of course, but strong opposition can be problematic).
I whole-heartedly agree with John about being open about your worldview (and open-minded about your clients’ worldviews). I would go so far as to say that it’s pretty dodgy to offer grief counselling in particular to someone who comes from a different belief system – I was actually hurt pretty badly when I was experiencing complicated grief and had my atheism implicitly criticized by a Buddhist therapist. I told him off (rather harshly) and he apologized, but I still never got the help I needed.
I’d also add that you should ask someone you trust to look at your waiting room with an outside eye; I know a therapist doesn’t always have full control over the physical environment of the office, but anything that can be done to make it less anxiety making is important. I don’t mean plants or nice paint – I mean it should be super-obvious where to sit and wait etc. Any ambiguity about how to behave while in the midst of an episode is paralyzing, in my experience.
I hate to bring money into it, but:
I will be both up front and understanding about costs.
Because, from experience? It’s really bad to finally get over your nerves and seek help for something… only to find out that help is beyond your ability to afford it, and then have the psychologist snark at you about how it would have been nice for you to let her know more than a week in advance of your appointment, when you had no way of knowing it was going to be that expensive after insurance because you’ve never gone for psychology services not covered by the province before.
Really, really bad.
And not many people can drop $1800 drop of a hat (seriously, that’s three months of school-year living expenses for me), and not many psychologists are open about how much they charge so you don’t know that they charge that much unless you overcome your “don’t talk money” social rule and ask. And then you get an unpleasant surprise.
Just sayin’. If I’d known ahead of time how much I was looking at, I could have saved up the money or taken out a loan or something while I was on the six month waitlist for an appointment. But I didn’t know ahead of time, and now I’m worried that I’m blacklisted from the only psychologist that does the kind of evaluation I need in my city.
I also agree wholeheartedly with John about encouraging clients to treat the first session or two as a mutual interview process to judge compatibility.
I like using email, but it is definitely not secure enough, so that’s something people need to be made aware of if they use it.
In general, I really appreciate your list of stuff to remember and if you keep true to it, I bet you’ll be an awesome therapist. :)