Friday, April 17, 2009

Common Mistakes Made by Therapists


1. Too Much Advice Giving/Not Enough Listening: This is a common mistake made by many therapists, regardless of how long they have worked in the field. We know that people need to gather feelings from the limbic system and send them to the frontal cortex for processing. Essentially, they need to feel their feelings, talk about it. Feel a little, talk about it, feel it, talk about it. This process of feel then talk is what we call processing and, ultimately, healing. When we jump in too quickly and interrupt that process with advice, the client is not given the opportunity to engage in the processing, and a giant piece of work is left undone.

2. Impatience: This is usually the mistake that leads to mistake #1. Good therapists can quickly assess a client and often have a fairly accurate reading as to why a client is in therapy, what is contributing to their problems, and what they need to do to change-- all within the first 2-3 sessions. The impatient therapist recognizes all of this and wants to jump straight to the healing! As therapists, we have to relax and allow clients to walk through their own process of change at their own pace. We have to accept that this process can sometimes takes months or even years. We may not even be around to see the entire process, and we need to accept that we are here for a time to assist this person in this phase of their growth. It is our role to guide, challenge, listen, and support along the way. This is often one of my own biggest mistakes, and what has helped me the most is learning to find the wonder in the client's process. I may have their ultimate goal in mind, but I have learned to find peace and gratitude in every little step they take to get there. It is much like parenting. We want our babies to grow up to be healthy adults, but this doesn't happen overnight! We celebrate every small accomplishment along the way.

3. Taking Clients out of Their Feelings: Because most therapists are naturally and intensely compassionate people, it is often difficult for them to sit with a client who is experiencing pain. We know we want clients to discuss their hurts, and when they do they will cry or rage. This is difficult to watch and be with, particularly when you are connected with the client. We do not enjoy seeing people hurt and we want to rescue them from this. This is especially hard with child clients, so children's therapists need to be particularly mindful of this trap. As therapists, we should remind ourselves-- it is good for clients to feel; it is good for all people to feel; this client needs to experience this deferred grief or anger; these stored feelings have become toxic and are poisoning this person, we have to clean it out.

The field of psychotherapy naturally draws to it hurting people with deep wounds of their own. This is true for many "caretaking" fields such as social work and nursing. This is not to say that every therapist and nurse is a hopeless codependent. It is just very important for those of us in this field to know why we came to it, be aware of it, and how it affects us when we step into the room with clients. Many therapists have deep wounds or "original pain" as John Bradshaw described it. If a therapist has not worked through their own "original pain," he/she will be unable to allow a client to go there. This leads to mistake #4.

4. Denial of Personal Make-up/Triggers: I have seen countless therapists who present with giant steel barriers around their own pasts and hurts. A good therapist has to acknowledge their own humanness. That is, they have to admit, I am a person capable of the same hurts and behaviors that my clients come to treatment with. I am capable because I am human too and I have my own weaknesses and issues that I work through daily. If you are a human being, then you are imperfect and have flaws. Therapists have to be comfortable with their flaws, which may be a tendency to control others, defensive, overly sensitive, or procrastinating, etc. It's ok to admit weaknesses to yourself! Therapists who are in denial that they have any personal issues of their own often come across as judgemental with clients. Their attitude is "Why can't you just do the right thing, get better, and be a great person like me?" If you believe for one second that this attitude does not come across with your clients, allow me to correct you-- IT DOES. A good therapist should believe from their very core, "But for the grace of God, there go I."

5. Poor Self-Care: Every day when we, as therapists, step into sessions with clients we bring our tools into treatment. Carpenters use hammers, nails, saws, etc. Doctors use their scalpels, x-ray machines, and whatnot. Therapists, well, we bring ourselves. We bring our minds, our bodies, and our emotions. When I come into the therapy room I want to bring healthy, sharpened, up-to-date tools. Would you want your doctor doing surgery on you with an outdated rusty tool? Would you want someone building your home with half the tools missing or without any blueprint? In the same vein, we should bring a healthy self into treatment. We should take good care of our feelings. This means we ACKNOWLEDGE that we have them, especially feelings brought up in therapy with this client. We get our own good therapy to keep our emotions and mind sharp and healthy. We stay connected with peers and supervisors to remain cleaned out. We get good sleep, exercise, eat well. We manage our time, delegate, speak up for ourselves, and know when to remain quiet. We nurture ourselves spiritually, physically, and mentally. We TAKE VACATIONS AS NEEDED without guilt. If you care about your field and your clients, then start with caring about you!!

6. Stagnation: Ok, therapists, here is a real shocker for you. Did you know that when you graduate from school that you really know very little in the way of providing good therapy?! Did you know that you will hone your skills in the moment with clients and in your supervisions and consultations? Good therapists are not born from textbooks alone and the textbook you learned from in 2006 may already be made obsolete by new research? Many well-intentioned therapists graduate and believe they are now finished with learning. They may feel "I know all about Psychology, I have a degree, " and never care to crack another book on the subject or seek out good guidance. Getting a degree in Psychology does not make you a therapist, it's just a good start. After that you have to stay updated in what is going on in your field. There are so many wonderful new treatments available. Every day we are learning about the brain's involvement and impact on behavior. Again, would you want a doctor operating on you who is operating using techniques from a 1920's textbook? This is not to say that some of our great foundational teachings in psychology are to be forgotten... they are not. Just stay current and open-minded.

The cartoon above is originally found at:
http://emperornortonii.deviantart.com/art/The-World-s-Worst-Psychiatrist-19694748

3 comments:

  1. "I may have their ultimate goal in mind, but I have learned to find peace and gratitude in every little step they take to get there. It is much like parenting. We want our babies to grow up to be healthy adults, but this doesn't happen overnight! We celebrate every small accomplishment along the way." This passage was written in very condescending language. Maybe therapists should consider condescension another pitfall to avoid.

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    1. I can see how the passage you reference can appear condescending, but it is not meant to be, of course. A good counselor will not think of their clients as lesser beings or as their children. I think the writer is just trying to say that clients are usually coming to therapy to grow in some way or another, not necessarily mature or 'grow up'. Yet condescension is a pitfall therapists must avoid and be mindful of, I agree. Humility and respect for your clients are therapist traits that must be inherent to the practitioner, as are the skills to be self-evaluative.

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  2. Good therapy is very rare and more so good therapists that have good instincts. Therapy should be like talking to a GOOD close friend that is there in a time of need.

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